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Flashcards in Normal breast and Benign disease Deck (39)
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1

Where does the majority of the breast cancer spread to?
Where do cancers that arise on the medial aspect of the breast spread to?

Axillary node

Mediastinal LNs

2

functional unit of the breast
- what does it branch into?

terminal duct unit (smallest branch)
- stops branching into more ducts, but ends up in a cluster of small tubules (acini) and becomes the terminal duct lobular unit
- area where most of the changes occur that can malignant or premalignant

3

What area of the breast does the majority of malignant or premalignant changes occur?

Terminal duct lobular unit

4

The entire ductal system is lined by?

Two cell layers
1. Outer: myoepithelial layer - contractile properties important in propelling milk in lumen, and supports inner layer
- in case of malignancy, myoepithelial layer is lost
2. Inner: epithelial layer - production of milk - single cuboidal epithelium

- any change in two cell layer is pathological

5

Difference between stroma lining the terminal duct lobular unit and the stroma between the lobules

INTRAlobular stroma:
specialized stroma (also fibrous) that is hormone responsive

INTERlobular stroma:
regular fibrous tissue liek any where else in body

6

Diff between male and female breast?

Same until puberty
- then females develop lobules (+ TDLU)
- both have ducts and stroma

7

At puberty, what stimulates the lobules to grow?

E + P
- formation of actual lobules occur

8

During the menstrual cycle, what happens to breast development?

Increased size/nodularity of lobules

9

What happens to breasts during pregnancy?

Maximum stimulation with hormones:
1. epithelial vacuolization
- LOTS more acini
Entire lobule increases in size

2. secretion in lumina
- Epithelial cells start increasing milk prod.
- Continues to be in this state during lactation and regresses when finished

10

What happens to breast tissue during menopause?

Involution of TDLUs
Duct system remains
Decrease in interlobular stroma
More fatty tissue comes in

11

Sites of ectopic breast tissue

Usually along midline (during development of fetus)
- most prominant is in the axilla

12

Juvenile hypertrophy

doesnt stay in nl range
- results in really large breasts --> discomfort

13

In gynecomastia, what proliferates?

mostly the stroma

14

Inflammatory lesions

1. acute mastitis
2. chronic mastitis
3. periductal mastitis
4. fat necrosis

15

Acute mastitis

young female - common in lactating breast

Cracked or inflammed nipple allows entry of staph and grows in milk in ducts
--> neutrophils come in -->
abscess forms

* can resemble cancer

16

Chronic mastitis

Perimenopausal women
Nonbacterial inflammation due to duct obstruction
-->
Dilation of duct (duct ectasia)
PLasma cell mastitis
Granulomatous mastitis
Healing by fibrosis

17

Periductal mastitis
(aka recurrent subareolar abscess, squamous metaplasia of lactiferous ducts, Zuska disease)

recurrent subareolar abcess

Painful erythematous subareolar mass
- 90% are smokers
- instead of having the double layered cuboidal epithelium, the outer squamous cells advance into the ducts

18

Fat necrosis
- Benign or malignant?
- Cause?
- Microscopic

Benign
Caused by ischemia or trauma
Ill defined palpable mass - mimics carcinoma

Microscopic:
early: necrotic fat cells, neutrophils
later: macrophages, glycoproteins, fibrosis Ca2+

19

Benign neoplasms o the breast

1. Fibroadenoma (most common
2. Lactating adenoma
3. Phyllodes tumor
4. (Intraductal) Papillloma

20

Fibroadenoma

derived from TDLU
- very well circumscribed
- mobile
- terminal ducts become squished by fibrous tissue
- NOT proliferating

21

Lactating adenoma

presents in pregnancy or lactation
- assoc. w/ rapid increase in size during pregnancy

soft circumscribed mass

Small tubular structure with lactational changes

22

Phyllodes tumor

large fleshy tumors
"leaflike projections" into cystic spaces
Spectrum: benign --> high grade

Most common in 5th decade
- some can become malignant

23

Which if the benign breast tumors can become malignant?

Phyllodes tumor

24

Intraductal papilloma

benign, 1 cm, subareolar (beneath areola) - papillary mass in large duct

Bloody nipple discharge (rule out carcinoma)

25

Fibrocystic change
- Cause
- Menopause FX
- Painful?
- Premalignant?
- Types

Idiopathic,

Most common disorder/change in breasts

Decreases progressively after menopause.

Asymptomatic, pain, nodularity
Can be innocuous to pre-malignant
can have:
1. cysts
2. ductal hyperplasia
3. apocrine metaplasia
(NO CHRONIC MASTITIS)

26

3 types of fibrocystic change

1. Nonproliferative FCC
- cyst/fibrosis
- epith hyperplasia ABSENT

2. Proliferative FCC
- cyst/fibrosis
- epith hyperplasia present

3. Sclerosing adenosis
- marked fibrosis --> compress/distorts lumens of acini/ducts
- hard rubbery like Ca

27

Two types of proliferative fibrocystic disease (has epithelial hyperplasia)

1. lobular hyperplasia (acinar epithelium)
- atypical lobular hyperplasia
- LCIS (lobular Ca in situ)

2. Ductal hyperplasia (terminal duct)
- Usual hyperplasia
- atypical ductal hyperplasia
- DCIS (Ductal Ca in situ)

28

Lobular carcinoma in situ (LCIS)

increased risk of breast cancer on both sides
- both lobular and ductal carcinoma

29

Breast pathology with minimal/no risk of breast carcinoma

1. Fibroadenoma W/O complex feat
2. cysts
3. duct ectasia
4. apocrine metaplasia
5. mild hyperplasia

30

Breast pathology with slight risk of breast carcinoma (1.5-2x)

1. Fibroadenoma WITH complex feature
2. (Intraductal) papilloma
3. Sclerosing adenosis
4. Moderate--florid Epithelial Hyperplasia