Non-Neoplastic Breast Pathology

Question 1

Normal breast histolgy

Answer 1

see adipose, extralobular ducts, terminal ducts, and lobules,

Question 2

normal anatomy of breast

Answer 2

Question 3

What is this an image of?

Answer 3

Terminal Ductal Lobular Unit :

Question 4

ducts in breast tissue if normal should awys have

Answer 4

2 cell layers:

Myoepithelium on outside

Epithelial cell on inside

Question 6

Clinical presentation of breast disease that is cancer is usually:

Answer 6

Palpable mass

Question 7

Concerns of breast that are likely Benign

Answer 7

Pain is IG bening

lumpiness is IG benign

discharge liekly benig

Question 8

Gold standard for diagnosis and eval of breast lesion

Answer 8

core biopsy

Question 9

Screening guidelines for women to get mammogram

Answer 9

40-50 yrs; get one every year or every other

>50 get one every year

1st degree relative w/ breast cancer start 10 years early for screening

Question 10

Interesting findings in mammograms

Answer 10

Density: carcinomas are 1⁄2 the size of palpable ones

Microcalcifications Picks up even smaller lesions May herald an in situ carcinoma

Magnification or compression views may aid in the evaluation of mammographic abnormalities

Question 11

used in women younger than 35 years especially if the lesion is clinically benign

Can differentiate solid from cystic masses

Answer 11

ultrasound

***oval masses often benign

Question 12

Indications for Breast MRI

Answer 12

Pre operative evaluation of extent of malignant disease/ contralateral process adjuvant

Axillary lymph node positive for metastatic carcinoma with unknown primary

Evaluate integrity silicone breast implant High risk screening

Evaluate tumor response to neo chemotherapy

Question 13

Cannot distinguish between in situ and invasive lesions

Safe, accurate and well tolerated , Higher rate of false negative results

Answer 13

Fine needle aspiration

Question 14

Can be obtained using radiologic guidance if the mass is small, deep, mobile, vaguely palpable or multiple

False negatives are usually due to sampling error

Answer 14

Core needle biopsy; get several samples

Question 15

Combination of physical examination, imaging studies and biopsy :if all three tests point to a benign diagnosis, it is likely that the process is benign and can be followed without requiring surgical removal (95% sensitive)

Answer 15

Triple test

Question 16

Most common masses found ages 15-35

Answer 16

fibroadenoma

Question 17

Mass or lesion in breast over 50

Answer 17

cancertill proven otherwise

Question 18

Common masses seen from 35-50

Answer 18

fibrocystic change, cancer, cyst

Question 19

Periductal mastitis, Mammary duct ectasia ,Fat necrosis , acute mastitis all examples of

Answer 19

Inflammatory conditions

Question 20

Proliferative breast disease without atypia or with atyppia

Nonproliferative breast changes :(fibrocystic changes)

Answer 20

Benign epithelial lesions

Question 21

NOn-proliferative breast changes or _______ seen more in premopausal women from 35-50 and is most common benign lesion of breast

Answer 21

fibrocystic change

Question 22

May present as lumpy breast, mass, calcifications, nipple discharge

Pain, tenderness, pain may occur in the premenstrual phase of the cycle

Masses may be multiple and/or bilateral and may fluctuate in size

Answer 22

Non- proliferative Breast Change

Fibrocystic

Question 23

Cysts
Fibrosis
Apocrine metaplasia

are all examples of:

Answer 23

non-proliferative breast lesion

(fibrocystic)

Question 24

What is this?

Answer 24

Blue domed cysts; non-proliferative fibrocystic breast change

Question 25

What is this? is it malignant?

Answer 25

Apocrine cyst: a non-proliferative breast thing see blue calcificaitons in middle and some hyperplasia but its BENIGN

Question 26

Moderate, florid hyperplasia Sclerosing adenosis complex sclerosing lesions Papillomas all examples of:

Answer 26

Proliferative breast disease w/out Atypia

Question 27

Moderate, florid hyperplasia, Sclerosing adenosis, complex sclerosing lesions, Papillomas How do we detect these things?

Answer 27

Proliferative Breast Disease Without Atypia :RARELY form mass thus incidental findings and from Calcficaitons

Question 28

Lumen filled by **heterogeneous** population of cells Different morphologies myoepithelial and epithelial Irregular slit like fenestrations, prominent at periphery

Answer 28

Ductal hyperplasia

Question 29

Enlarged lobule, c**ircumscribed edge**, **Preserved** background lobular architecture, Compressed and distorted acini, Dense stroma, **calcifications**

Answer 29

Sclerosing Adenosis | (proliferative w/out atypia)

Question 30

Complex Sclerosing Lesion ## Footnote Most common between \_\_\_\_and \_\_\_\_years of age rarely palpable and detected on mammograpy

Answer 30

40 and 60

Question 31

Mammography shows a stellate or spiculated lesion with a central core

Answer 31

Complex scerosing lesion \*\*need to get biopsy to confim and then EXCISION

Question 32

Stellate lesions with central hyalinized stroma and entrapped glands RAdial scar see dialted ducts at the periphery

Question 33

how old are people that get benign Papilloma of breast? Where is it usually located? What is our pirmary symptom?

Answer 33

any age central breast nipple discharge (often bloody)

Question 34

Pt has recently notice blood in her sportbra after seh works out. She is 30, with no significant history for breast cancer. ON physical exam you palpate a subareolar mass. Dx

Answer 34

likely papilloma dt central location and nipple discharge

Question 35

has branching fibrovascular core within duct and see epithelial hyperplasia Dx and what symptom would pt likely have?

Answer 35

Papilloma (bening) nipple discharge

Question 36

What kind of atypical proliferative breast disease is there?

Answer 36

atypical ductal or lobar hyperplasia

Question 37

resembles in situ carcinoma but lacks qualitative or quantitative features of dx

Answer 37

image is atypical ductal hyperplasia; can have lobule too

Question 38

What causes significant increase risk for invasive carcinoma DCIS or LCIS Moderate is atypia in duct or lobule

Question 39

Fibroadenoma, Phyllodes tumor and Sarcomas are examples of what type of tumor?

Answer 39

Stromal Tumor

Question 40

Most common tumor in young adults (peak at 3rd dec) solitary, well circumbscribed, movable, painless

Answer 40

Fibroadenoma: stromal cell tumor histology see lots of stroma, compressed myoeplithilium or compressed ducts

Question 42

Fibroepithelial tumor that is benign or malignant seen in the 5th and 6th decade, only Discreate **palpable** mass with **RAPID growth**

Answer 42

Phyllodes Tumor

Question 43

Interlacing clefts, not encapsulated but circumscribed: cysts/neocrosis or hemorrhage inside

Answer 43

Phyllodes tumor

Question 44

leaf like or epithelium lined clefts, cyts, with increased stromal activity and stromal overgrowth

Answer 44

PHyllodes turmor or cystosarcoma phyllodes

Question 45

Malignant features of Phyllodes tumor

Answer 45

high stromal cellularity, increased midosis (\>2-5 per field is low grade) (\>5-10 per field is High) cellular pleomorphism, infiltrating border, necrosis

Question 46

Prognosis of Phyllodes tumor

Answer 46

Benign: may recur Low grade: may recur, rarely mets High grade: aggressive, distant mets 1/3 cases and Axillary nodes common