Breast Pathology (Dobson) Flashcards
A 28-year-old G0 woman comes to her physician because she noticed a lump in her left breast. She was recently started on a combined OCP. She is otherwise healthy. On physical exam, there is a painless, well-defined, 3cm, mobile, rubbery mass in the upper outer quadrant of the right breast. The mass is biopsied, and histology reveals the proliferation of benign-appearing myxoid stroma encircling and compressing epithelium-lined glandular spaces. What should you advise your patient with regard to her new diagnosis?
Fibroadenomas are benign breast tumors most commonly found in women ages 15-35. They present as painless, well-defined, mobile, rubbery masses. Histology shows benign-appearing myxoid (fibrous) stroma that encircles (adenomatous) epithelium-lined glandular spaces. Proliferation of the stroma can compress the glandular ducts, causing them to appear as slits on histology. Importantly, fibroadenomas are estrogen responsive, meaning that they increase in size with increasing estrogen levels. Pregnancy, lactation, and just prior to ovulation are high estrogen states and can cause the tumor to transiently grow. As a result, these tumors will also shrink with menopause, due to the decrease in estrogen.
When is nipple discharge considered pathological?
Nipple discharge is considered pathologic if it is unilateral, persistent, and/or bloody.
What is the most common cause of bloody nipple discharge?
Intraductal papillomas
A 49-year-old woman with a past medical history of hypertension, hyperlipidemia, and fibrocystic change of the breast, comes to the clinic because of a large mass in her left breast. She has not seen a physician in 5 years, but she was prompted to come to the clinic due to the growing mass. She denies any abnormal nipple discharge or family history of breast cancer. On physical exam, there is a well-defined, 8cm, painless, mobile, rubbery mass in the upper outer quadrant of the left breast. The patient is so bothered by the large mass that she requests resection. Pathology reveals leaf-like papillary projections. What is the most likely diagnosis?
Phyllodes tumors are benign fibroepithelial tumors most commonly found in older women – patients are usually in their 40s. On physical exam, they present as a well-defined, painless, mobile, rubbery mass, making them difficult to differentiate from fibroadenomas. They are often quite large and, rarely, malignant. On histology, they have leaf-like papillary projections.
Nonproliferative lesions of fibrocystic change?
breast cysts, fibrous stromal proliferation, and papillary apocrine change
Proliferative lesions of fibrocystic change?
epithelial hyperplasia and sclerosing adenosis
A 57-year-old woman comes to her physician because of bloody nipple discharge from her right breast. Several months ago, she noted scant red discharge on the inside of her bra at the end of the day. Since then, she has occasionally noted blood stains on the right side of her shirt upon waking up in the morning and increasing volumes of blood in her bra at the end of the day. She is otherwise healthy. Her grandmother was diagnosed with breast cancer at age 55, but the remainder of her family history is unremarkable. On physical exam, the physician is unable to appreciate a breast mass; there are no skin changes. A small soft tissue mass is identified on imaging. What is likely to be seen on pathology if this area is biopsied?
Histology will show papillary cell projections with a fibrovascular core. These lesions are benign, but can hide underlying malignancies, so they are usually surgically removed.
A 40-year-old woman comes to her physician because she noticed a small, slightly tender mass in her right breast. Physical examination demonstrates a well-defined, 1.5 cm, mobile mass in the upper outer quadrant of the right breast; there is no nipple inversion or skin changes. Mammography reveals punctate calcifications in the region of the mass. The mass is biopsied, and histology reveals necrotic adipose tissue surrounded by neutrophils and lipid-laden macrophages. Which of the following is most likely to be found in the patient’s history?
Fat necrosis is the benign necrosis of adipose tissue in the breast stroma. It is most often due to breast trauma, such as a car accident, or surgery. It can present with breast pain and an irregular mass, as described in the question stem. Mammography can show radio-opacities due to calcifications within the necrotic fat, and histology will show necrotic adipose tissue surrounded by neutrophils and lipid-laden macrophages. Importantly, fat necrosis is not a risk factor for breast cancer.
The two main blood supplies to the breast?
Lateral thoracic artery (lateral side) and Internal thoracic artery (medial side)
Most common lymph node involved in malignancy?
Axillary lymph node
Where is the primary site where breast cancer arise?
Terminal duct lobular unit (TDLU)
Mastodynia
pain in the breast; cyclic (diffuse) = menstrual or noncyclic (localized) = ruptured cyst, trauma, infection
What are the most common palpable benign lesions?
cysts and fibroadenomas; round or oval, rubbery, mobile and circumscribed borders
What are the most palpable malignant lesion?
Invasive ductal carcinomas; invade across tissue planes, often hard (scirrhous), have irregular borders
The most commonly used screening test for breast cancer
Mammographic screening; detects nonpalpable asymptomatic breast carcinomas before metastasis
