Pathology-Breast Lecture Flashcards
(44 cards)
What type of lesions can occur in the tissue indicated below?
1) Terminal duct lobular unit: Cysts, sclerosing adenosis, small duct papilloma, hyperplasia (typical + atypical) and carcinoma. #2) Lobular stroma: fibroadenoma and phylloides tumor. #3) Large ducts and lactiferous sinuse: duct ectasia, subareolar abscess, duct papilloma and Paget disease. #4) Interlobular stroma: fat necrosis, lipoma, fibrous tumor, fibromatosis, sarcoma.
What is the normal architecture of breast tissue on histology?
Terminal duct lobular units, interlobular stroma, intralobular stroma and benign calcifications.
How does histology of young breast tissue compare to that of a woman in her 30’s?
Young female: Little fat, collagenous interlobular stroma. Late 30’s: more fat, less collagen, calcifications.
Common clinical presentations in breast pathology?
Pain, palpable mass, lumpiness, nipple discharge and mammogram abnormality.
Calcifications seen in DCIS?
Small, irregular numerous, clustered, linear and branching. Note that DCIS rarely presents as a mass.
Non-proliferative epithelial breast changes
Duct ectasia, cysts, apocrine change, mild hyperplasia, adenosis and fibroadenoma.
Proliferative epithelial breast disease without atypia. Which ones have increased relative risk for breast cancer of 1.5-2.0 RR?
Hyperplasia, sclerosing adenosis, papilloma, complex sclerosing lesions (radial scar) and fibroadenoma with complex features. Sclerosing adenosis, radial scar and papillomas may mimic carcinoma and have increased risk.
Proliferative epithelial breast disease with atypia
Atypical ductal and lobular hyperplasia
Carcinoma in situ of the breast
Lobular CIS and Ductal CIS.
A 20-40 year old woman presents with a lumpy-bumpy breast. Biopsy is shown below. What is the most likely cause of her condition?
Fibrocystic changes: note the cyst with apocrine metaplasia (granular eosinophilic cells w/retained myoepithelial cells) and larger cyst. These occur in women in their reproductive years because they are estrogen sensitive. Note that theses are NOT associated with an increased risk of cancer.
Gross appearance of cysts with apocrine metaplasia
Blue dome appearance.
What cells are found in a normal lobular duct?
Luminal epithelial cell and myoepithelial cells.
What is your diagnosis of this breast biopsy?
Note that the duct is distended by a heterogenous population of cells and slit-like penetrations around the periphery. This is typical of ductal hyperplasia.
A 30 year old woman presents with a palpable breast mass and mammogram abnormality. Biopsy of the mass is shown below. What is causing her condition?
Note the enlarge terminal duct lobular units, distorted acini, dense stroma and calcifications. This is characteristic of sclerosing adenosis.
A 34 year old woman presents with a radiodense irregular central breast mass. Biopsy of the mass is shown below. What is causing her condition?
Radial scar. The tumor has irregular borders, a dense fibrotic stroma w/hyalinized entrapped tubules and cysts at the periphery.
A 40 year old woman presents with bloody nipple discharge. Biopsy is shown below. What is causing her condition?
Intraductal papilloma. These are benign, papillary lesions with multiple branching vascular cores and arise in large lactiferous ducts near the nipple. Note that they will still have the normal 2 cell layers of the ducts.
What is the increase in relative risk for developing breast cancer if you have atypical ductal or lobular hyperplasia?
4-5
A patient presents with the breast biopsy shown below. What is your diagnosis?
Atypical ductal hyperplasia. Note the monomorphic cells, evenly spaced in the lumen with some slit-like spaces at the periphery and cookie cutter spaces in the middle. This is different from DCIS due to partial, instead of full, involvement of the ducts.
A patient presents with the breast biopsy shown below. What is your diagnosis?
Atypical lobular hyperplasia. Note the small monomorphic cells filling the lumens. This is different from LCIS due to limited involvement in of the lobules. Note that these cells become dyscohesive and invade in lines.
What is the most common carcinoma in situ of the breast? Which carries a risk for invasive carcinoma in either breast?
DCIS = 80%. LCIS = 20%. DCIS carries 30% risk of invasive ductal CA in same area if left untreated. LCIS carries 30% risk of invasive CA in either breast.
Subtypes of DCIS. What is the increase in relative risk of invasive CA if you are diagnosed with any of these lesions?
Comedocarcinoma (high grade w/nuclear atypia and central necrosis), Non-comedocarcinoma (solid, cribriform, papillary, micro papillary) and Paget disease. These lesions increase relative risk for invasive CA by 8-10x.
A 45 year old woman presents with an irregular mammography shown below. The biopsy is shown below. What is your diagnosis?
Note the branching and linear calcifications, this is a sign of DCIS. The chalky, tan-white areas hint at fat necrosis or DCIS. The calcifications and central necrosis in the lumen of the ducts indicate Comedo type DCIS and nuclear atypia would be seen on higher power.
A 45 year old woman presents with an irregular mammography and the biopsy is shown below. What is your diagnosis?
Noncomedo DCIS - cribriform type. Note the monomorphic cells w/cookie cutter spaces distending the entire duct. Calcifications and low to high grade cells are also present.
What variants of noncomedo type DCIS are shown below?
Solid type on the left and micro papillary (no fibrovascular cores) type.
