midterms L5 Flashcards
(19 cards)
what is acute mastitis
occurs during the first month of breast feeding, staphylococcus aureus us the causative agent
breast is painful and we can have presentation of fever
what is preiductal mastitis
not associated with lactation strong association with cigarette smoking
what is the inflammatory process of the breast
fat necrosis: benign, painless lump due to the injury of breast tissue, calcified oil cyst.
lactational mastitis: occurs during breast feeding, increased risk of bacterial infection through cracks in the nipple. S areus is the causative agent. we treat w antibiotics
mammary duct ectasia: dilation of subareolar ducts with inflammation and fibrosis, associated with smoking
gynecomastia
breast enlargement in males due to high oestrogen levels
3 types of benign epithelial lesions of breast
non proliferative breast changes ( fibrocystic changes) thought to be caused by hormonal imbalance, produces palpable breast and we could see fibrosis, adenosine and cyst formation with aprocine metaplasia, fibrosis and adenosine)
proliferative (without atyoia) - risk for cancer is present
proliferative ( with atypia) -
proliferative disease without aplasia
risk for cancer is present, rare to find palpable mass,
- epithelial hyperplasia ( presence of more then 2 layer of cells in breast tissue.) it can be seen in ducts and lobules
- sclerosing adenosis ( calcification is seen in the lesion, associated with other forms of fibrocystic change.)
- complex sclerosing lesions (
- papillomas ( papillary tumor that arises from. the ductal epithelium)
- proliferative varient of fibrocystic disease ( the 2 are atypical ductal hyperplasia and atypical lobular hyperplasia)
risk factors of breast cancer
combination of genetic, hormonal and environmental risk factors.
The major risk factors being hormonal and genetic (family history).
hereditary is due to: autosomal-dominant genes: BRCA1 and BRCA2
sporadic causes: major risk factors for sporadic breast cancer are related to hormone exposure, gender, age at menarche and menopause, reproductive history, breast-feeding, and exogenous estrogens. The majority of these cancers occur in postmenopausal women and in overexpression of estrogen.
two types of carcinoma
Ductal (in-situ and invasive)
Lobular (in-situ and invasive)
carcinoma in situ
This is epithelial proliferation that is still confined to the TDLU, has not invaded beyond the basement membrane and is therefore incapable of metastasis.
There are two subtypes:
Ductal carcinoma in situ (DCIS) or intraductal carcinoma (80%).
Lobular carcinoma in situ (20%)
ductal carcinoma insitu
DCIS is the non-invasive proliferation of malignant cells within the duct system without breaching the underlying basement membrane
he tumor distends and distorts the ducts.
Often multifocal—malignant cells can spread widely through the ductal system without breaching the basement membrane
CIS frequently shows
micro-calcifications. Mammography is a very sensitive diagnostic procedure for detecting DCIS since majority of DCIS are not palpable
what is pagets disease
Paget’s disease of the breast is a rare type of breast cancer that is characterized by a red, scaly eczematous lesion on the nipple and surrounding areola.
ruritus is common and it might be mistaken for eczema.
Malignant cells are called Paget cells and are found scattered in the epidermis.
infiltration of the epidermis by large neoplastic ductal cells with abundant cytoplasm,
lobular carcinoma insitu
always an incidental finding in breast biopsy performed for another reason.
does not form a palpable mass and cannot be detected clinically on palpation or on gross pathological examination.
Microcalcifications in LCIS are infrequent and so mammography is not useful for detection.
clinical features of invasive breast cancer
Palpable mass.
About half of the patients will have axillary lymph node metastases.
Larger carcinomas may be fixed to the chest wall or cause dimpling of the skin.
Lymphatics may become involved and the lymphatic drainage of that area and the overlying skin gets blocked causing lymphedema and thickening of the skin, a change referred to as peau d’orange.
When the tumor involves the central portion of the breast, retraction of the nipple may develop.
invasive ductal carcinoma
Most of these tumors induce a marked fibroblastic (desmoplastic) stromal reaction to the invading tumor cells producing a palpable mass with hard consistency (scirrhous carcinoma). And therefore a palpable mass is the most common presentation.
The tumor shows an infiltrative attachment to the surrounding structures and may cause dimpling of the skin (due to traction on suspensory ligaments) or nipple retraction.
medullary carcinoma
Special type of triple-negative cancer
This subtype of breast cancer presents as a well circumscribed mass.
May be mistaken clinically and radiologically for fibroadenoma
It does not produce any fibroblastic (desmoplastic) reaction and therefore is soft and fleshy.
tubular carcinoma
ER-positive/HER2-negative
detected on mammography as a small irregular mass
Well-formed tubules and have low-grade nuclei
Lymph node metastases are rare, and the
prognosis is excellent.
Two basic stromal tumors are:
Fibroadenoma
Phyllodes tumor
fibroadenoma
The most common benign tumor of the female breast.
It is composed of benign proliferation of both epithelial and stromal elements (biphasic).
Any age, most common before age 30
It may increase in size during pregnancy. It may stop growing and regress after menopause.
The tumor is usually solitary but may be multiple and involve both breasts.
The tumor is completely benign. FA are almost never malignant.
MOST FREQUENT LOCATION-Upper outer quadrant
Phyllodes tumors
Phyllodes tumors can occur at any age, but most present in the 40s and 50s, that is 10 to 20 years later than the average presentation of a fibroadenoma
These tumors are much less common than fibroadenomas
Most present as large palpable masses (usually 3 to 4 cm in diameter)
They are fibro-epithelial tumors, have a leaf like pattern and a cellular stroma.
Phyllodes tumors are classified as:
Benign phyllodes tumors: most (75%) phyllodes tumors are benign.
Low-grade phyllodes tumors: they tend to recur locally and a rarely metastasize.
High-grade phyllodes tumors: are uncommon and they behave aggressively with frequent local recurrences and can have distant metastases to lung, bone, CNS. They have better prognosis than invasive ductal carcinoma.
