Flashcards in Breast Pathology (Non cancerous) Deck (38)
What is the composition of the terminal duct lobular unit (TDLU)?
Made of the lobule and the extralobular terminal duct.
In a normal breast histology, what are 2 things that you should be able to see?
The "Ductal" and "Myoepithelial" layers.
Where is the breast embryonogically derived from?
It is a modified sweat gland, ergo derived from skin.
What is the "Milk line?"
Anywhere from the axilla and the vulva, this is an area where breast tissue can develop.
In the terminal duct-lobular unit, what makes the milk?
The lobules make the milk and that milk is drained via the ducts to the nipple.
What are the "Luminal cell layers?" What do they do?
The epithelial cells of the ducts, and in the ducts they protect the ducts. However in the lobules they would be the cells producing the milk.
What is the function of the myoepithelial cells?
They have contractile functions so their job is to squeeze and propel the milk across the duct.
Where is the highest concentration of breast tissue in a female?
The upper outer quadrant of the breast.
What is "Galactorrhea?"
Production of milk however it is outside of lactation, meaning she is not nursing a baby but producing milk anyway.
What are some causes of galactorrhea?
Excessive nipple stimulation, prolactinoma in the anterior pituitary, and drugs.
What is "Acute mastitis?" Major cause of this is?
Bacterial infection of the breast usually due to Staph Aureous, usually due to fissures induced during breast feeding.
What is the classic drug administered to tx Acute Mastitis?
Dicloxacillin, as well as continued drainage.
How would a patient with acute mastatis present?
Warm, red breast with a purulent nipple discharge.
Can patients with acute mastitis present with a mass?
It can form an abscess and in that case there will be a mass that is formed.
What is "Periductal Mastitis?" Where is this seen?
Inflammation of the subaerolar ducts, seen in smokers.
How do periductal mastitis present?
Subareolar mass with nipple retraction.
What is a general requirement of any specialized epithelium cells, including those that are found in the lactiferous ducts?
They require Vitamin A to maintain their integrity.
Why are smokers the people mostly seen with periductal mastitis? What is the principal behind this pathology?
Smokers have a relative deficiency of Vitamin A, and as a result the specialized epithelium of the lactiferous ducts esp closer to the nipple lose their integrity, undergo squamous metaplasia. There begins to be some degree of keratin formation --> blocking of the lactiferous duct. As a result, everything behind the block clogs up and we have inflammation --> Periductal mastitis.
Why is there nipple retraction in periductal mastitis? What about the mass?
Because of the inflammation behind the block, there will be granulation tissue which includes myofibroblasts, which contract. As a result the nipples will be pulled inwards resulting in nipple retraction. The granulation tissue can also feel like a mass.
What is Mammary duct ectasia?
Ectasia means "dilation" and therefore in this disease there is inflammation of the walls of the subaerolar duct which leads to dilation of the sub areolar ducts . The inflammatory debris can slip out of the nipple as a "green brown nipple discharge." Can present as a mass with the inflammation.
What is the buzzword for mammary duct ectasia?
"Green Brown Nipple Discharge."
Who is more prone to have Mammary duct ectasia?
Multiparous (multiple births) postmenopausal woman.
If a biopsy reveals chronic inflammation with plasma cells in addition to the clinical presentation being a green brown nipple discharge, what is the diagnosis?
Mammary Gland ectasia.
What causes fat necrosis of the breast? Why would this alarm the physician?
Usually trauma, this will alarm the physician because it can either present as a mass (due to fat necrosis leading to fibrosis), or on a mammogram it will present as calcification (because fat necrosis will lead to soapanofication, which occurs via the addition of calcium). This is alarming because calcification is an early sign of breast cancer.
Biopsy shows necrotic fat w/ associated fat and giant cells. What is the diagnosis?
Fat necrosis of breast tissue.
Why is the disease called "Fibrocystic change?" What causes this?
Due to the fluctuating levels of estrogen and progesterone in a pre menopausal woman, eventually this can lead to cysts forming in the lobules or the terminal duct, and this will stretch the connective tissues to form fibrosis, hence "fibrocystic changes."
What does the fibrocystic changes present as?
Presents as "lumpy breasts" where parts of the breasts feel weirder than other parts, cysts have a "blue domed" appearance on gross examination. Seen usually in the upper outer quadrant.
Is fibrocystic change benign or malignant?
Benign in itself but can have other things present in the biopsy that might be a predictor of cancer.
A woman with fibrocystic changes presents with fibrosis cysts and aprocrine metaplasia on biopsy. Should you be worried?
No, this has no risk of cancer.
What kind of cancers are associated with apocrine metaplasia?
Unlike most other metaplasia, apocrine metaplasia has no associated cancers.
If a breast biopsy show ductal hyperplasia or sclerosing adenosis, what does that mean?
Ductal hyperplasia means that there is increased ductal epithelium, sclerosing adenosis means that there are more glands in the lobules which leads to fibrosis (and can also lead to calcification). Both of these findings means there is x2 increase of invasive carcinoma in the future than normal.
If a biopsy reveals atypical ductal or lobular hyperplasia what does that mean?
This means that there is in increased number of atypical cells in the lobules or ducts and is associated with x5 increase in risk of invasive carcinoma.
What is "Intraductal Papilloma?"
Benign tumor in which there is a papillary growth in the duct, and since it is a papilloma this means its a finger like projection with fibrovascular blood supply and epithelium cells around the finger (the epithelial cells has the normal 2 layer of epithelial and myoepithelial cells as found in normal breast tissue).
Young woman (pre menopausal) with bloody nipple discharge is indicative of?
How do papillary carcinoma and intraductal papilloma compare?
Intraductal papilloma occurs in younger pre menopausal woman, papillary carcinoma occurs in older women. Both these processes involve a papillary growth in the duct however in papillary carcinoma the epithelial cells WILL NOT HAVE MYOEPITHELIAL CELLS, intraductal papilloma will.
What if fibroadenoma?
Most common benign tumor of the breast in pre menopausal females, this tumor involves both the fibrous tissue and glands.
A benign, estrogen sensitive, well circumscribed mobile marble like mass is diagnostic of?