Path: Breast & Pregnancy Flashcards Preview

Block 8 - Endo & Repro > Path: Breast & Pregnancy > Flashcards

Flashcards in Path: Breast & Pregnancy Deck (33)

What are inflammatory disorders of the breast?

acute mastitis
duct ectasia - may mimic cancer
traumatic fat necrosis - may mimic cancer


What is acute mastitis?

bacterial, complicates nursing
red, tender, maybe abscesses


What is duct ectasia?

unknown etiology, unilateral thickening of breast tissue
dilated ducts filled w necrotic debris and surrounded by inflammation


What is traumatic fat necrosis?

often forgotten or unnoticed trauma
unilateral irregular nodule


What is fibrocystic dz?

common, 20-40 yrs old, presents as lumpy breasts
separated into non-proliferative and proliferative


What is non-proliferative FCD?

no increased risk of carcinoma
fibrosis and cysts apocrine metaplasia
blue domed cysts


What is proliferative FCD?

has all the features of non-proliferative and:
epithelial hyperplasia (varying degrees)
sclerosing adenosis - lobular proliferation of small tubules


What are the benign breast tumors?

fibroadenoma: most common, <30, well circumscribed, mobile, firm nodule of benign glands and fibrous stroma
intraductal papiloma: papillary lesion in lactiferous ducts, may have serous or bloody discharge, may feel small subareolar tumor


What are some risk factors for invasive breast carcinoma?

increased length of reproductive life, obesity, exogenous estrogens (higher doses than OCPs)


What are the features of familial breast carcinomas?

mutations in BRCA1, BRCA2, p53 (Li-Fraumeni syndrome)
younger and bilateral tumors


What constitutes areas of concern on mammography?

irregular radiodensities and microcalcifications


What is the breast carcinoma category breakdown?

noninvasive: ductal CIS, lobular CIS
invasive: invasive ductal or lobular
ductal always more common


What is ductal CIS?

high grade DCIS: high grade nuclei, often with comedonecrosis (looks like pimple popping)
low grade DCIS: low grade nuclei, cribiform, solid, or papillary pattern
precursor for carcinoma


What is Paget's dz of the breast?

DCIS which has spread to the skin of the nipple
ulcerated, fissured, oozing nipple, mimics eczema, underlying mass in some
malignant ductal cells invading epidermis - stays in epidermis, not invasive


What is lobular CIS?

most premenopausal, often multifocal and bilateral
expansion and filling of acini of lobular unit w uniform, bland cells
MARKER, not precursor, of increased risk for invasive carcinoma


What are the 3 forms of LCIS that behave more like DCIS and should thus be treated as exceptions?

cells w pleomorphic nuclei
signet ring cells
ducts showing central necrosis


What are the features of invasive ductal carcinoma?

desmoplastic, fixed to adjacent structures, skin dimpling
scar like grossly
infiltrating malignant ductal epithelial cells w variable gland formation


What are the features of invasive lobular carcinoma?

more often multicentric and bilateral
similar to invasive ductal, but metastases more to peritoneum, ovary, endometrium, meninges, and GI
infiltrating, individual, low grade malignant cells often in single file


Where do all invasive breast carcinomas spread to?

axillary nodes, internal mammary nodes, lungs, bone and liver


What size of breast tumor indicates potential for good prognosis?

<2 cm


What are molecular prognostic markers of invasive breast carcinoma?

ER and PR + --> tamoxifen
Her 2 + --> herceptin
Ki-67 = proliferation marker


What are the molecular subtypes of invasive breast carcinoma?

luminal A: ER and/or PR +, Her 2-, low Ki-67 = better prognosis
luminal B: ER and/or PR +, Her 2 + or -, hi Ki-67 = poorer prognosis
triple negative (+ck 5/6 or EGFR) = basal like - poorer than A or B
only Her 2 + = poorer prognosis


What is Phyllodes tumors?

benign or malignant, based on stromal component
micro: stroma and glands, similar to fibroadenoma, but w hypercellular stroma and leaf-like pattern
benign and low grade malignant may recur
high grade malignant may recur and metastasize


What is gynecomastia?

enlargement of male breasts - ducts, but no lobules
associated w hormone imbalance --> hyperestrogenism
puberty, very aged, Klinefelters, leydig cell tumors, cirrhosis


What is toxemia?

pre-eclampsia: HTN, proteinuria, edema
eclampsia: more severe, convulsions, DIC and subsequent lesions
due to abnormal placentation or placental ischemia
primiparas or last tri typically


What is the most common site of ectopic pregnancy?

fallopian tubes, endometrium lacks villi


What are predisposing factors to ectopic pregnancy?



What are the outcomes of ectopic pregnancy?

hemorrhage, rupture, spontaneous regression


What comprises gestational trophoblastic dz?

hydatidiform moles: complete, partial, invasive
placental site trophoblastic tumor: rare


What is a complete mole?

bleeding, uterus large for dates, HCG elevated, vesicles on US, mass of grape like clusters
all villi show hydropic swelling w trophoblastic proliferation
*cytogenetics: 46XX or XY, empty egg fertilized by 1 or 2 sperm, DIPLOID
sometimes followed by choriocarcinoma


What is a partial mole?

uterus not enlarged, HCG less elevated, clinical dx by missed or spontaneous abortion
some villi enlarged w proliferation
*cytogenetics: TRIPLOID egg fertilized by two haploid or 1 diploid sperm
rarely followed by choriocarcinoma


What are precursor lesions to gestational choriocarcinoma?

hydatidiform mole
normal pregnancy
ectopic pregnancy


What is gestational choriocarcinoma?

malignant syncytial and cytotrophoblasts (no villi), hemorrhagic
direct spread and hematogenous spread
very curable