Chapter 23 Female Genital Tract- The Breast

Question 1

True or false Each element is a source of benign and malignant lesions.

Answer 1

True

Question 2

The superficial lining of breast is Keratin squamous cell. What are the 2 types of epithelial cells?

Answer 2

a. Luminal

b. Myoepithelial

Question 3

2 major structures remain after the double-layered epithelium (luminal and emyoepithlial cells)

Answer 3

a. Ducts: 6-10 open on skin surface at nipple

b. Lobules

Question 4

What 3 features distinguish the breast from other organs?

Answer 4

a. Function: Nutritional support another individual/infant
b. Structure: periodic change in adulthood (pregnancy), before b4 involving age
c. Visible: has a social, cultural, personal significance

Question 5

What is the origin of common breast lesions such as 
Cyst
sclerosing adenosis
small duct papilloma
hyperplasia
atypical hyperplasia
Carcinoma

Answer 5

lobules and terminal ducts

Question 6

What common breast lesions are found in large ducts?

Answer 6

Duct ectasia
Squamous metaplasia of Lactiferous ducts
Large duct papilloma
Paget disease

Question 7

Fibroadenoma and Phyllodes tumor are lesions found where in the breast tissue?

Answer 7

Intralobular Stroma

Question 8

Fat necrosis, lipoma, Fibromatosis and Sarcoma are breast lesions associated with what part of the breat?

Answer 8

Inter-lobular stroma

Question 9

The breast become completely mature and functional in the onset of what

Answer 9

Pregnancy

Question 10

what produces colostrum (high in protein)? What does colostrum change into?

Answer 10

a. after parturition lobules

b. milk (higher in Fat and Calories)

Question 11

Interlobular stroma converts from radio-dense fibrous stroma to what?

Answer 11

radiolucent adipose tissue

Question 12

Supernumerary nipples or breasts result from persistence of epidermal thickenings along what?

Answer 12

Milk line (extends from Axilla to perineum)

Question 13

The Milk line extends from the axilla to what?

Answer 13

Perineum

Question 14

Disorders affecting normally situated breast rearly arise in

Answer 14

Heterotropic hormone-responsive foci

Question 15

What is the aka for Milk Line Remnants?

Answer 15

Polythelia

Question 16

Aquired nipple retraction indcates the presence of what disorders?

Answer 16

invasive cancer or

inflammatory nipple disease

Question 17

What are the MC symptoms reported women with breast disorders?

Answer 17

Pain
Palpable mass, lumpiness (w/o discrete mass)
nipple discharge

Question 18

These nonspecific signs/symptoms Must be evaluated for possibility of malignancy?

Answer 18

pain
palpable mass, lumpiness w/o discrete mass
nipple discharge

Question 19

Diffuse cyclic Pain (mastalgia or mastodynia) may be d/t what?

Answer 19

premenstrual edema

Question 20

Non-cyclic Pain (mastalgia or mastodynia) localized in one area may be caused by ruptured cysts, physical injury and what?

Answer 20

infections

Question 21

True or False: Almost all painful masses are malignant, about 90% of breast cancers present with pain.

Answer 21

False: Almost all painful masses are BENIGN about 10% of breast cancers present with pain.

Question 22

The most common palpable lesions are what?

Answer 22

• Cysts,
• Fibroadenomas,
• Invasive carcinomas.

Question 23

Breast mass are malignant in women younger than age 40 is ___ %, and masses in women over age 50 is ____%.

Answer 23

a. 10

b. 60

Question 23

Breast mass are malignant in women younger than age 40 is ___ %, and masses in women over age 50 is ____%.

Answer 23

a. 10

b. 60

Question 24

Carcinomas are mostly located where in the breast? | Majority of cancers are generalliy what size before they metastasize ?

Answer 24

upper outer quadrant | 2 to 3 m.

Question 25

Milky discharges (galactorrhea) are associated with what?

Answer 25

Elevated prolactin levels (e.g., by a pituitary adenoma), hypothyroidism, or endocrine anovulatory syndromes,

Question 26

Milky discharges (galactorrhea) occurs in pt's taking what?

Answer 26

oral contraceptives, Tricyclic antidepressants, methyldopa, or Phenothiazines

Question 27

True or False: Galactorrhea is NOT associated with malignancy

Answer 27

True

Question 28

MC cause of a Bloody or serous nipple discharges is what?

Answer 28

large duct papillomas and cysts

Question 29

What are the Different types of nipple discharges?

Answer 29

A: milky discharge; B: yellowish ± greenish multiple pore discharge in a context of fibrocystic breast disease; C: straw-colored single pore discharge; D: bloody single pore discharge.

Question 30

What is the principal mammographic signs of breast carcinoma?

Answer 30

densities and calcifications

Question 31

Rounded densities are most commonly benign, whereas invasive carcinomas generally form what?

Answer 31

irregular masses

Question 32

Calcifications form on secretions, ncerotic debris and what? | Calcifications associated with benign lesions are what? Give an example.

Answer 32

a. hyalinized stroma | b. clusters of apocrine cysts

Question 33

Malignant calcifications are usually what?

Answer 33

small, irregular, numerous and clustered

Question 34

What percentage of invasive carcinomas are NOT detected by mammography?

Answer 34

10%

Question 35

Inflammatory diseases of the breast are rare (less than 1%) and caused by?

Answer 35

infections Autoimmune disease Foreign body type reactions to extravasated keratin or secretions

Question 36

Inflammatory breast cancer” mimics what?

Answer 36

inflammation and always considered in women with Erythematous swollen breast

Question 37

Acute mastitis usually occurs when? What is it most commonly due to?

Answer 37

``` first month of breast feeding Staphylococcus aureus (Less commonly, Streptococcus) ```

Question 38

Streptococci is less common in acute mastitis, but spreads infection in the form of what?

Answer 38

cellulitis

Question 39

Warm, erythematous breast,Painful,Fever,Purulent nipple discharge are all clinical features of what?

Answer 39

Acute Mastitis

Question 40

What is the treatment for Acute Mastitis?

Answer 40

drainage via breast feeding and | Antibiotics

Question 41

Squamous Metaplasia of Lactiferous Ducts is assocated with what?

Answer 41

smoking

Question 42

Inflammation of the subareolar ducts with blockage is associated with squamous metaplasia of lactiferous ducts and what condition?

Answer 42

Periductal mastitis

Question 43

A key feature of Periductal Mastitis is

Answer 43

keratinizing squamous metaplasia of the nipple ducts.

Question 44

True or False: Many women have an inverted nipple, most likely as a secondary effect of the underlying inflammation

Answer 44

True

Question 45

What is the clinical feature of squamous metaplasia of lactiferous ducts (aka Periductal mastitis)

Answer 45

Subareolar mass with nipple retraction

Question 46

Subareolar mass with nipple retraction and offending keratinizing epithelium deep into ducts are features of what condition?

Answer 46

Squamous Metaplasia of Lactiferous Ducts AKA Periductal Mastitis

Question 47

Rupture of an abscess with inflammation is a response to what

Answer 47

Keratin debris

Question 48

What is Inflammation of the wall of the subareolar duct with dilation (ectasia) of the ducts but NOT associated with smoking

Answer 48

Mammary Duct Ectasia

Question 49

a. Histologically, mammary duct ectasia is chronic inflammation with what type of cells? b. It is also known as what?

Answer 49

a. Plasma cells | b. Plasma cell mastitis

Question 50

What are the clinical features features of mammary duct ectasia?

Answer 50

``` Palpable periareolar mass Thick, white nipple discharge Skin & nipple retraction Occurs in 5th or 6th decade of life usually in multiparous women No increased risk for breast cancer ```

Question 51

What presentation closely mimics cancer?

Answer 51

Fat Necrosis

Question 52

What specific Fat Necrosis presentation closely mimic cancer?

Answer 52

Mammographic densities or calcifications & a PainLESS palpable mass

Question 53

1/2 of the women with Fat necrosis have a HISTORY of what?

Answer 53

Breast trauma or Piror surgery

Question 54

Fat necrosis acute lesions may be what?

Answer 54

hemorrhagic

Question 55

What is the AKA for Lymphocytic Mastopathy?

Answer 55

Sclerosing Lymphocytic Lobulitis

Question 56

Lymphocytic Mastopathy (aka sclerosing lymphocytic lobulitis) is the mc condition in women with what?

Answer 56

Type 1 (IDDM), or autoimmune thyroid disease,

Question 57

Sclerosing Lymphocytic Lobulitis AKA Lymphocytic Mastopathy is hypothesized to have what kind of basis?

Answer 57

autoimmune

Question 58

Its only clinical significance is that it must be distinguished from breast cancer. What is it?

Answer 58

Lymphocytic Mastopathy AKA Sclerosing Lymphocytic Lobulitis

Question 59

Granulomatous inflammation of the breast can be a manifestation of what?

Answer 59

Systemic granulomatous diseases (e.g., granulomatosis with polyangiitis, sarcoidosis, tuberculosis).

Question 60

Local granulomatous diseases is known as

Answer 60

Granulomatous lobular mastitis

Question 61

What is rare and only occurs in Parous women and has effective steroid treatments?

Answer 61

Granulomatous Mastitis