Ch 16 Pathoma - Breast Pathology

Question 1

_____ is a modified sweat gland embryologically derived from skin

Answer 1

Breast

Question 2

Breast tissue can develop anywhere along the ____, which runs from the axilla to the vulva (supernumerary nipples)

Answer 2

milk line

Question 3

_____ is the functional unit of the breast. ___ make milk that drains via ___ to the nipple.

Answer 3

Terminal duct lobular unit; lobules; ducts

Question 4

Lobules and ducts are lined by these two layers of epithelium

Answer 4

Luminal cell layer - inner layer, responsible for milk production in lobules

Myoepithelial layer - outer cell layer, contractile function propels milk to nipple

Question 5

Breast tissue is _____. Before puberty, it consists primarily of ____. After menarche, development is driven by ___ and ___. During pregnancy, breast ____ undergo hyperplasia. After menopause, breast tissue undergoes ____.

Answer 5

hormone sensitive; large ducts under nipple; estrogen and progesterone; lobules; atrophy

Question 6

Where are lobules and ducts found in the highest density of the breast?

Answer 6

upper outer quadrant

Question 7

_____ refers to milk production outside of lactation. True/False: it is a symptom of breast cancer. Causes include _____, _____, and ____.

Answer 7

Galactorrhea; false; nipple stimulation, prolactinoma, and drugs

Question 8

_____ is a bacterial infection of the breast, usually due to staph aureus. It is associated with ____ and presents as an ____ breast with ____. It may progress to abscess formation. Treatment involves continued drainage and ____

Answer 8

Acute mastitis; breast-feeding; erythematous; purulent nipple discharge; antibiotics (dicloxacillin)

Question 9

_____ is inflammation of the subareolar ducts. Usually seen in ____. It is due to a ____ deficiency, that causes a squamous metaplasia of _____, producing blockage and inflammation. It presents as a ____ with _____.

Answer 9

Periductal mastitis; smokers; vitamin A; lactiferous ducts; subareolar mass; nipple retraction (w/inflammation –> fibrosis –> granulation tissue –> myofibroblasts –> contraction –> nipple retraction)

Question 10

_____ is inflammation with dilation of the subareolar ducts. It classically arises in ____ ____ women. Presents as a perioareolar mass with _______. On bx, ____ are seen.

Answer 10

Mammary duct ectasia; multiparous postmenopausal; green-brown nipple discharge; plasma cells

Question 11

Fat necrosis of the breast is usually related to _____. It presents as a ____ on physical exam or as _____ on mammography. Bx shows necrotic fat with associated ____ and ____.

Answer 11

trauma (may not always be evident); mass; abnormal calcifications (due to saponification); calcifications; giant cells

Question 12

Fibrocystic change involves development of ____ and ____ in the breast. It is the most common change in the premenopausal/postmenopausal breast?

Answer 12

fibrosis and cysts; premenopausal

Question 13

Fibrocystic change presents as _____ of the breast tissue, usually located in the ____. Cysts have a ____ appearance on gross exam. It is benign/malignant.

Answer 13

vague irregularity (lumpy breast); upper outer quadrant; blue-dome; benign

Question 14

What level of increased risk of invasive carcinoma does this carry: apocrine metaplasia

Answer 14

No increased risk

Question 15

What level of increased risk of invasive carcinoma does this carry: sclerosing adenosine and ductal hyperplasia

Answer 15

2x increased risk

Question 16

What level of increased risk of invasive carcinoma does this carry: atypical hyperplasia

Answer 16

5x increased risk

Question 17

What level of increased risk of invasive carcinoma does this carry: fibrosis, cysts

Answer 17

no increased risk

Question 18

Intraductal papilloma involves papillary growth into a _____. Characterized by _____ lined by epithelial and myopethelial cells. It classically presents as _____ in ____ women and it must be distinguished from _____ (and how)

Answer 18

large duct; fibrovascular projections; bloody nipple discharge; premenopausal; papillary carcinoma; papillary carcinoma does not have underlying myoepithelial cells and is more commonly seen in post menopausal

Question 19

_____ is a benign tumor of fibrous tissue and glands. It is the most common benign neoplasm of the breast (/seen in premenopausal women). It presents as ____, ____, ____-like mass, and is sensitive to ____.

Answer 19

Fibroadenoma; well-circumscribed, mobile, marble; estrogen

Question 20

_____ is a fibroadenoma-like tumor with overgrowth of the fibrous component. It has characteristic ____ projections seen on bx. Most commonly seen in premenopausal/postmenopausal women. Is it benign or malignant?

Answer 20

Phyllodes tumor; leaf-like; postmenopausal; can be malignant sometimes

Question 21

Risk factors for breast cancer are mostly related to ____.

Answer 21

Estrogen exposure (female, age (postmenopausal), obesity, early menarche/late menopause, atypical hyperplasia, first-degree relative)

Question 22

DCIS is malignant proliferation of cells in ducts with/without invasion of basement membrane. Often detected as ____ on mammography.

Answer 22

Without; calcification

Question 23

Mammographic calcifications can be associated with these 2 benign conditions and this malignant condition

Answer 23

fibrocystic change (sclerosing adenosis) and fat necrosis; DCIS
(bx needed to distinguish)

Question 24

_______ of the breast is DCIS that extends up the ducts to involve the skin of the nipple. Presents as _____ and ____. It is/never is associated with an underlying carcinoma

Answer 24

Paget disease; nipple discharge; erythema; is (almost always - different then extramammary which is usually not)

Question 25

_____ type of DCIS is histologically characterized by high grade cells with necrosis and dystrophic calcification in the center of ducts

Answer 25

comedo

Question 26

What is the most common type of invasive carcinoma of the breast?

Answer 26

invasive ductal carcinoma

Question 27

Invasive ductal carcinoma presents as a ____ detected by PE or mammography. Clinically detected usually __ cm or greater on PE or __ cm or greater on mammography.

Answer 27

mass; 2; 1

advanced tumors may result in dimpling of the skin or retraction of the nipple

Question 28

Name the four subtypes of invasive ductal carcinoma (and their prognosis)

Answer 28

Tubular carcinoma (good prognosis); Mucinous carcinoma (good); Medullary carcinoma (good); Inflammatory carcinoma (poor)

Question 29

Tubular carcinoma is characterized by well-differentiated tubules that lack _____. Mucinous carcinoma tends to occur in ____ women.

Answer 29

myoepithelial; older (~70yrs)

Question 30

_____ is a type of invasive ductal carcinoma that is characterized by large, high grade cells growing in sheets with associated lymphocytes and plasma cells. It has increased incidence in ____. It grows as a well circumscribed mass that can mimic ____ on mammography.

Answer 30

Medullary carcinoma; BRCA1 cariers; fibroadenoma

Question 31

Inflammatory carcinoma (a type of invasive ductal) is characterized by carcinoma in _____. Presents as an ___, ___ breast with no discrete mass. Easily mistaken for ____.

Answer 31

dermal lymphatics (hence a poor prognosis); inflamed, swollen; acute mastitis

Question 32

_____ is a malignant proliferation of cells in lobules with no invasion of the basement membrane.

Answer 32

Lobular carcinoma in situ (LCIS)

Question 33

LCIS does not produce a ___ or ____, and is usually discovered incidentally. It is characterized by dyscohesive cells lacking ____. It is often focal/multifocal and unilatera/bilateral. Treatment is ____.

Answer 33

mass; calcifications; E-cadherin adhesion protein; multifocal; bilateral; tamoxifen

Question 34

LCIS has a low/high risk of progression to invasive carcinoma

Answer 34

low

Question 35

Invasive lobular carcinoma grows in a ____ pattern, and cells may exhibit signet ring morphology. There is no duct formation due to lack of _____.

Answer 35

single-file; E-cadherin

Question 36

_____ is the most important factor in prognosis of breast cancer and ____ is the most useful.

Answer 36

Metastasis; spread to axillary lymph nodes

Question 37

Presence of ER and PR receptors (both located ____) are associated with response to _____. Presence of HER2/neu (growth factor receptor located ____) amplification is associated with response to _____.

Answer 37

in the nucleus; anti-estrogenic agents (tamoxifen); on the cell surface; trastuzumab (Herceptin - an antibody against the HER2 receptor)

Question 38

_____ women have an increased propensity to develop triple negative carcinoma.

Answer 38

African american

Question 39

BRCA1 mutation is associated with ____ and ____ carcinoma; BRCA 2 is associated with _____.

Answer 39

breast and ovarian carcinoma; breast carcinoma in males

Question 40

Male breast cancer represents __% of all breast cancers. It usually presents as a ___ mass in older males and may produce ____. Most common histological type is ____, and it is associated with _____ mutations and ____ syndrome.

Answer 40

1; subareolar (where the highest density of breast tissue is in males); nipple discharge; invasive ductal carcinoma (lobular is rare - lobules produce milk so not as prominent in men); BRCA2; Klinefelter