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Pathology III > Final - new material > Flashcards

Final - new material Flashcards

1
Q

Anytime a male or non-gravid female is producing breast discharge:

A

galactorrhea

MC from hormonal dysregulation or side-effect from several meds (OCPs)
excess prolactin expressed, mb from prolactinoma

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2
Q

The breasts are modified ___________:

A

sweat glands

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3
Q

The lactiferous duct system contains _________ ducts, which correspond to ____ openings at the nipple.

A

4-18

each duct opens to the nipple (equal #)

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4
Q

% of breast cancer found in each quadrant:

A

Upper Outer - 58%***

Upper Inner - 17%
Lower Outer - 12%
Lower Inner - 13%

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5
Q

The lactiferous ducts and lobules are lined by 2 cell types:

A

luminal epithelium cells - milk production

myoepithelial cells - assist lactation (ejection); normal structure/function

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6
Q

___% of lymph flow from breast travels to _____ node system:

A

75%

axillary [includes pectoral, sub-scap, humeral]

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7
Q

How are stroma & parenchyma different?

A

Stroma - non-functional, connective tissue, supportive framework.

Parenchyma - functional parts of an organ; in cancer, the mutant cells.

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8
Q

Amastia:

A

absent breast tissue/nipple/areola

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9
Q

Amazia:

A

absent mammary gland tissue

nipple/areola present

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10
Q

Athelia:

A

absent nipple or areola

glandular tissue present

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11
Q

In the ___ decade breast stromal tissues begin to involute, and at ________ diminish/disappear, replaced by adipose.

A

3rd decade

menopause

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12
Q

Estrogen stimulates what:

A

epithelial cell proliferation
ductal elongation/branching
increased volume & elasticity of CT/ducts
increased adipose tissue

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13
Q

Progesterone stimulates what:

A

increased lobule formation

increased size of acini/lumen/ducts

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14
Q

The glands on the areola are called _________ and function to:

A 
Montgomery tubercles (sebaceous glands)
lubricate nipple
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15
Q

Breast histology - 1st trimester:

3rd trimester:

A

1st - acinar proliferation
stromal involution
minimal secretory changes

3rd - lobular proliferation
cells enlarged, increased cytoplasm, lg nuclei
dramatic stromal involution

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16
Q

Inverted nipples are familial in ___% of cases,
bilateral in ____% of cases,
and present in ___% of the population.

A

familial - 50%
bilateral - 90%
incidence - 3%

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17
Q

When is an inverted nipple a red flag sign?

A

When it is a new onset in absence of a known cause

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18
Q

Galactorrhea is disconcerting when:

A

unilateral
bloody
assoc w/mass

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19
Q

Inflammation of the parenchyma of the mammary gland:

A

Mastitis

usu. when lactating -> puerperal

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20
Q

When found to be infectious in cause, mastitis is usu d/t:

A

staph aureus OR strep epidermitis

generally enters via cracks/fissures in nipple

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21
Q

Peri-ductal mastitis usu presents as:

A

painful mass in the sub-areolar area
overlying skin erythema
>90% are smokers
nipple inversion may occur

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22
Q

Peri-ductal mastitis - histology:

A

keratinizing squamous epithelium in the duct system
extends to abn depth
chronic granulomatous inflammatory response
dilation/rupture of ducts

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23
Q

Mammary duct ectasia is:

commonly seen in:

A

dilatation of the sub-areolar ducts
often unilateral, but mb bilateral

5th or 6th decade
multiparous women

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24
Q

Mammary duct ectasia - clinical presentation:

A 
breast pain
overlying erythema
palpable areolar or peri-areolar mass
poorly defined mass 
mb thick secretions from nipple
mb nipple inversion (30-40%)
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25
Mammary duct ectasia - histology:
dilated lactiferous ducts granular debris -> inc foamy (lipid) macrophages infiltration of lymphs & macrophages inc plasma cells
26
Condition characterized by fibrous lumps & cords in breast tissue that are non-cancerous:
Fibrocystic breast dz 30-60% of women frequently dx'd at 20-40 yo uncommon before adolescence/after menopause
27
Fibrocystic breast changes are most often found: | Dx:
in the upper outer quadrant mammography - limited value, mb too dense to visualize bx or aspiration - definitive
28
Fibrocystic breast - histology:
fibrosis - dense collagen sclerosing ductal epithelial proliferation - round ducts inc in size adenosis - full of glands apocrine metaplasia - lg cystic spaces, fluid-filled
29
MC occurs as result of prior breast trauma or 2° to breast surgery:
fat necrosis adipocyte rupture -> lipolysis, converted to fatty acid + glycerol -> fibroblastic proliferation, inc vascularization -> calcification, hemosiderin deposition presents as painless breast mass, skin thickening, mb tissue retraction -> looks like malignant neoplasm
30
Fat necrosis - on mammogram:
central radiolucent area of fat w/inc density calcifications at fat periphery bx follows if mammo fails to r/o cancer
31
Fat necrosis - histology:
irregular fatty spaces foamy histiocytes surrounding multinucleate giant cells
32
Condition characterized by a single hard mass or multiple hard masses that are made up of collagenized stroma surrounding atrophic ducts and lobules:
lymphocytic mastopathy
33
Lymphocytic mastopathy - histology:
thickening & fibrosis of stromal tissue | lymphocytic infiltrates surround epithelium & vessels
34
Lymphocytic mastopathy MC found in:
women w/ DM 1 women w/ AI thyroiditis -> mb LM is also AI dz...? (theory)
35
Uncommon form of mastitis characterized by the presence of granulomas, formed by epithelioid cells & giant cells:
Granulomatous mastopathy etio - idiopathic mb d/t TB, sarcoidosis, Wegener's granulomatosis mb seen w/ breast carcinoma, mb draining lymph nodes
36
What confirms the granulomatous mastopathy dx?
positive cultures for/demonstration of acid-fast bacilli
37
Adenosis refers to:
increased number of glandular components | grows/organizes -> adenoma (benign)
38
MC benign tumor of the breast:
``` fibroadenoma well-circumscribed mass w/fibrotic capsule firm freely movable NTTP MC ```
39
Fibroadenoma - histology:
low mag - well-encapsulated | high mag - notable hyperplasia of intraductal epithelial cells, normal nuclei, normal nucleus/cytoplasm ratio
40
T/F - fibroadenomas commonly increase in size during pregnancy.
True they are hormonally responsive also inc during luteal phase of menses regress after menopause
41
A localized focus of hyperplastic cells seen in breast tissue during pregnancy:
Lactating adenoma solitary or multiple histo - hyperplastic lobules, cytoplasmic vacuolization
42
Intraductal papillomas are identified in ___% of all breast biopsies.
1-3% benign, but definite potential for malignant transformation (very small liklihood): solitary ductal papilloma / multiple
43
Intraductal papilloma - histology:
``` myoepithelial cells multilayered ductal cells * flattened * nuclei near lumenal surface * long axes align in same direction ```
44
Vast majority of breast cancers arise in _______ tissue and are classified as _______________.
Glandular (lobular & ductal) | adenocarcinoma
45
Risk factors for breast cancer - HIGH:
female advancing age PMHx of cancer in one breast FHx of both mother & sister w/breast cancer >2 alcoholic bevs/day high premenopause IGF-1 levels high post-menopause blood estrogen levels
46
Risk factors for breast cancer - MOD:
``` >30 yrs at first pregnancy nulliparity early menarche late menopause post-menopause obesity caucasian, >45yo African-American, <45yo any 1st deg relative w/Hx of breast cancer Hx of endometrial / ovarian cancer tobacco use high fat/sat fat rich diet Hx of benign proliferative lesion, dysplastic mammography changes, & high dose of ionizing radiation to chest ```
47
Protective factors against breast cancer:
``` >15 at menarche (anovulation, early menopause) >1 yr breast feeding physical activity minimal EtOH consumption no tobacco use monounsat fat rich diet ```
48
Hereditary breast cancers represent ____% of total:
27% of inherited -> mutated BRCA 1 & 2 account for 30-40%
49
BRCA in gen population: ____% | in Ashkenazi Jew population: ____%
0.1% | 20%
50
By their cell proliferating effects on breast epithelium, _________ increase the chance of DNA replication errors leading to greater chance for mutations.
Estrogens
51
Women in what country have the highest incidence rate of breast cancer?
USA MC cancer, 2nd MC cause of death - women in USA
52
What does "ER positive" suggest:
Over-expression of estrogen receptors found in 70% of breast cancer cases two kinds - alpha & beta, encoded by ESR1 & ESR2 genes
53
______ preferentially binds to the alpha ER. ______ preferentially bind to the beta ER. ______ binds to both ERs equally well.
Estrone Estriol, Raloxifene, Genistein 17-beta-estradiol
54
BRCA1 & BRCA2 are both _________ genes.
Tumor suppressor genes, involved in DNA repair of double-strand breaks. BRCA2 also binds/regulates RAD51 to fix DNA breaks. Heterozygous germ-line mutations in either BRCA1 or BRCA2 gene show inc rates of breast & ovarian cancer.
55
_____% of women with mutated BRCA1 gene will develop breast cancer during their lifetime.
50-85% reduced risk with: prophylactic mastectomy salpingo-oophrectomy (age 40) For BRCA2 -> advantage shown only w/concurrent procedures
56
A genetic risk factor for breast cancer is presence of the proto-oncogene _________, present in _____% of breast cancers. Also seen in:
HER2/neu (human epidermal growth factor receptor 2) 30% ovarian cancer stomach cancer uterine cancer assoc w/ worse prognosis, inc recurrence (in all types)
57
PE findings assoc w/breast cancer:
``` firm/hard breast mass painless mass (TTP only 10-15%) irregular borders to mass mb fixed to chest wall or skin skin dimpling nipple retraction bloody dc from nipple ```
58
PE findings assoc w/benign mass:
``` firm, rubbery frequently TTP regular margins mobile no dimpling/skin retraction/bloody dc ```
59
The 3 main types of breast cancer are:
Ductal Lobular Nipple (Paget's dz of breast/nipple)
60
MC type of breast cancer:
infiltrating ductal carcinoma [80%] usu. single hard mass irreg borders not easily movable
61
Infiltrating ductal carcinoma - histology:
cords & nests of neoplastic cells intervening collagen dystrophic calcifications pleomorphic cells strewn through stroma
62
2nd MC type of breast cancer:
Lobular [5-10%] high risk for multiple loci inc risk for BL involvement
63
Lobular carcinoma is characterized by presence of small homogenous cells that invade the stroma, often seen in a ___________ pattern. Worse prognosis is assoc w/ presence of ______ appearance.
Single-file pattern Signet ring appearance
64
Relatively uncommon dz of the breast involving the nipple & areolar area, presenting w/persistent change in sensation of that area (itching, burning):
Paget's dz of the breast classic finding: eczematous changes over nipple/areola later stage: ulceration/destruction of nipple/areolar complex
65
Paget's dz of the breast - histology:
large round cells pale cytoplasm pleomorphic nuclei derived from glandular epithelium
66
Form of ductal carcinoma distinguished by the markedly inflammed appearance of the affected breast:
Inflammatory breast cancer (IBC) especially aggressive presents w/o palpable lump

Pathology III (5 decks)

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