Breast Pathology I

Question 1

TDLU

Answer 1

terminal ductal lobular unit
end of collecting duct in breast

function unit of breast

Question 2

cell layers of breast

Answer 2

inner luminal cells
outer layer of myoepithelial basal cells
surrounding basal lamina layer

all surrounded by fat with arteries, veins, and lymph vessels

Question 3

tanner scale

Answer 3

classification of pubertal breast

Question 4

coopers ligaments

Answer 4

help breast stay elevated

constriction - dimpling

Question 5

pectoralis fascia

Answer 5

forms deep margin of breast for surgery

Question 6

expanding duct

Answer 6

bad sign

can form abscess and fissures to outside

Question 7

lactiferous duct

Answer 7

enlarged and dilated near base of nipple - at lactiferous sinus

sinus - holds milk and discharges with smooth m contraction

cross section - scalloped - to allow expansion

Question 8

most breast cancer

Answer 8

arise from TDLU

Question 9

TDLU stroma

Answer 9

less dense

collagenous

Question 10

S100

Answer 10

stains the myoepithelial cell protein

IPX stain

Question 11

mammaglobin

Answer 11

breast secretion protein

Question 12

luminal cells

Answer 12

secretory

Question 13

myoepithelial cells

Answer 13

BM equivalent for invasion of cancer

S100 marker

Question 14

young breast

Answer 14

harder to see on mammogram

Question 15

ductal carcinoma

Answer 15

typically estrogen positive

Question 16

basal carcinoma

Answer 16

typically estrogen negative

Question 17

oxytocin

Answer 17

myoepithelial contraction - milk letdown

Question 18

colostrum

Answer 18

earliest milk

-higher in protein and lower in lipids

Question 19

supernumerary nipples

Answer 19

milk line remnants

Question 20

older breasts

Answer 20

lobules decrease in size and number

interlobular stroma replaced by adipose

Question 21

higher risk of lactiferous sinus obstruction

Answer 21

with inverted nipple

also difficulty breastfeeding

if congenital

Question 22

acquired inverted nipple

Answer 22

must rule out underlying pathology - malignancy

Question 23

painful breast cancer

Answer 23

only 10%

Question 24

mastodynia

Answer 24

painful breast

aka mastalgia

Question 25

bloody nipple discharge

Answer 25

must be investigated

Question 26

galactorrhea

Answer 26

milky discharged associated with prolactin and meds

Question 27

most presentation of breast cancer

Answer 27

abnormal mammogram then palpable mass some pain and nipple discharge

Question 28

patient symptoms of breast cancer

Answer 28

most often - lumpiness or palpable mass

Question 29

mammogram

Answer 29

sensitivity and specificity improve with age -due to decreased density see densities - to 1cm microcalcifications

Question 30

ultrasound of breast

Answer 30

differentiate cystic vs. solid

Question 31

posterior shadow

Answer 31

on U/S of breast with solid lesion

Question 32

malignant calcifications

Answer 32

small, irregular, clustered and numerous commonest way to diagnose DCIS

Question 33

diagnosis of palpable breast pass

Answer 33

cytology biopsy - needle core, incisional, excisional simultaneous staging (if malignant)

Question 34

negative FNA rule out cancer

Answer 34

no 10% false negative rate

Question 35

needle core biopsy

Answer 35

can determine if invasion has occured can also do cytohisto marker studies

Question 36

needle localization

Answer 36

to determine location of breast palpable mass

Question 37

modified radical mastectomy

Answer 37

also removes axillary nodes NOT pectoralis muscle

Question 38

radical mastectomy

Answer 38

removes pectoralis muscle

Question 39

lactational mastitis

Answer 39

acute mastitis - first month post partum (puerperal) segmental with acute inflammation - 10% to abscess start - nipple fissure and stasis - skin bacteria infection -staph aureus and strep

Question 40

non-lactational mastitis

Answer 40

periareolar - mammary duct ectasia | peripheral

Question 41

mammary duct ectasia

Answer 41

obstructed lactiferous sinus at level of nipple | -with inverted nipple - and cigarette smoking

Question 42

cigarette smoking

Answer 42

squamous metaplasia of lactiferous sinus - with keratin plugging leads to non-lactational mastitis

Question 43

periductal mastitis

Answer 43

with rupture

Question 44

painful nursing

Answer 44

obstruction of breast duct

Question 45

ectasis

Answer 45

dilation

Question 46

ductogram

Answer 46

radio-opaque dye injected to sub-areolar sinus through openings of nipple dye outlines duct architecture

Question 47

trauma to breast

Answer 47

can lead to fat necrosis

Question 48

fat necrosis

Answer 48

trauma to breast -liquefactive necrosis of fat cells release cytoplasmic fat acute foreign body granulomatous response - fibrosis repair requires biopsy**

Question 49

hard breast mass, dimpling of skin, following trauma

Answer 49

fat necrosis

Question 50

breast implants

Answer 50

can induce fibrosis - form constricting capsule - causes implant to rupture - hard to determine cancer with implants

Question 51

implants

Answer 51

no link to disease

Question 52

atypical ductal hyperplasia

Answer 52

bridges form in ducts