breast pathology - non cancer

Question 1

breast histology

Answer 1

stroma –> termnal duct lobular unit –> Major duct –> lactiferous sinus –> Nipple

Question 2

Fibroadenoma - epidemology/presentationsituations

Answer 2

MC under 35. Small, well-defined marble-like, mobile mass

increased size with estrogen (pregn, prior to menstr)

Question 3

Fibroadenoma - cancer

Answer 3

not increased risk

Question 4

Fibroadenoma - histology/location in breast

Answer 4

stroma –> fibrous tissue and glands

Question 5

Fibrocystic changes - epidemiology/cancer

Answer 5

MC in premenopausal over 35

no risk for cancer

Question 6

Fibrocystic changes - presentation

Answer 6

premenstrural breast pain or lumps, often bilateral or multifocal

Question 7

Fibrocystic changes - histology

Answer 7

terminal duct lobular unit –> nonproliferative lesions include simple cysts (fluid-filled duct dilation, blue done) papillary apocrine change/metaplasia, stromal fibrosis

Question 8

Sclerosing adenosis?

Answer 8

increased number of the acini and their glandsi and stromal fibrosis –> associated with calcification

Question 9

Sclerosing adenosis - cancer

Answer 9

1.5-2x increased risk

Question 10

MCC of nipple discharge (serous or body)

Answer 10

Intraductal papilloma

Question 11

Intraductal papilloma - definition/histology

Answer 11

small papillary tumor (fibrovascular projection) within lactiferous ducts (lactoferous sinus or major duct), typically beneath areola
–> 2 LAYERS (luminal epith + myoepithelial) (vs CA)

Question 12

Intraductal papilloma - cancer

Answer 12

1.5-2x increased risk

Question 13

breast - epithelial hyperplasia?

Answer 13

increased cell in terminal ductal or lobular epithelium

Question 14

breast - epithelial hyperplasia - cancer

Answer 14

increased risk of carcinoma with atypical cells (x5)

if not atypical –> x2

Question 15

Phyllodes tumor - definiton/appearance

Answer 15

large mass of connective tissue and cysts with leaf-like lobulations (AT STROMA)

Question 16

Phyllodes tumor - cancer

Answer 16

some may becoma malignant

Question 17

Phyllodes tumor - age

Answer 17

MC in 5th decade (postmenopausal)

Question 18

Fat necrosis - definition/presentation

Answer 18

Benign, usually painless, lump due to injury to breast tissue
Up to 50% patients may not report trauma

Question 19

Fat necrosis - appearance

Answer 19

1. calcified oil cyst on mammography

2. necrotic fat and giant cells on biopsy

Question 20

Intraductal papilloma - epidemiology

Answer 20

premenopausal women

Question 21

indraductal papilloma vs cancer

Answer 21

1. papiloma has also the myeoepithelial layer

2. papilloma is premenopausal

Question 22

Lactational mastitis?

Answer 22

during breastfeeding –> high risk of bacterial infection through cracks in nipple

Question 23

Lactational mastitis - MC pathogen/presentation

Answer 23

S. aureus / presentation: warm, red breast with purulent nipple discharge

Question 24

Lactational mastitis - treatment

Answer 24

1. antibiotics (dicloxacilin)

2. continue breastfeeding

Question 25

Gynecomastia?

Answer 25

breast enlargement in males due to high estrogen levels compared with androgen activity

Question 26

Gynecomastia is physiologic in

Answer 26

1. newborn 2. pubertal (but may perists after puberty 3. elderly males

Question 27

causes of pathologic gynecomastia

Answer 27

1. cirrhosis 2. hypogonadism (eg. Klinefelter) 3. testicular tumors 4. drugs

Question 28

drugs that causes gynecomastia

Answer 28

1. spironolactone 2. Hormones 3. cimetidine 4. Ketoconazole

Question 29

Periductal mastitis - definition/epidemiology

Answer 29

- inflammation of subareolar ducts - in smokers (low vit A --> epithelial become squamous - -> keratin --> plag --> inflammation behind --> granoulation tissue --> retraction

Question 30

Periductal mastitis - presentation

Answer 30

subareolar mass with nipple retraction

Question 31

Mammary duct ectasia - definition/epidemiolgy/presentation

Answer 31

- inflammation with dilation (ectasia) of subareola ducts - multiparous postmenopauseal - -> green brown nipple discharge

Question 32

Mammary duct ectasia - biopsy

Answer 32

chronic inflammation with plasma cells

Question 33

benign breast conditions - cancer?

Answer 33

1. Fibroadenoma - no 2. fibrocystic changes - no 3. sclerosing adenonis - 1.5-2 x cancer 4. Intraductal papilloma --> 1.5-2 x cancer 5. epithelial hyperplasia --> x5 if atypical, x2 if not atypical 6. Phylloid tumor --> some may become malignant 7. Fat necoris 8. Lacational mastitis 9. Gynecomastia 10. Periductal mastitis 11. Mammary duct ectasia

Question 34

Breast pathology - disease on stroma

Answer 34

fibroadenoma | phyllodes tumor

Question 35

Breast pathology - disease on termina duct lobular unit

Answer 35

1. Fibrocystc change 2. DCIS and invasive 3. LCIS and invasive

Question 36

Breast pathology - disease on lactiferous sinus / Major duct

Answer 36

1. intraductal papilloma 2. abscess/mastitis 3. paget disease