Pathology of the breast

Question 1

what are the noninvasive malignant tumors of the breast?

Answer 1

• DCIS
• comedocarcinoma
• paget disease

Question 2

what are the invasive malignant tumors of the breast?

Answer 2

• invasive ductal
• invasive lobular
• medullary
• inflammatory

Question 3

what are the benign tumors of the breast?

Answer 3

• fibroadenoma
• intraductal papilloma
• phyllodes tumor

Question 4

what are the risk factors for malignant breast tumors?

Answer 4

• increased estrogen exposure
• increased total number of menstrual cycles
• older age at 1st live birth
• obesity / high fat diet
• BRCA1 and BRCA2 gene mutations
• African American ethnicity
• radiation exposure

Question 5

do malignant breast tumors occur pre or post menopause?

Answer 5

post menopausal

Question 6

malignant breast tumors are usually located in which quadrant?

Answer 6

upper lateral

Question 7

what is the single most important prognostic factor for breast cancer?

Answer 7

axillary lymph node involvement (the ONLY factor that matters)

Question 8

overexpression of what receptor is common in breast cancer? what is the ligand for this receptor?

Answer 8

HER-2

EGF

Question 9

what is the most common type of invasive carcinoma of the breast? what is the second most common?

Answer 9

ductal

lobular

Question 10

what are the two least common invasive carcinomas of the breast?

Answer 10

papillary

inflammatory

Question 11

which breast more commonly gets breast carcinoma?

Answer 11

left more than right

Question 12

what is the most common cause of nipple discharge?

Answer 12

papilloma (benign)

Question 13

what are the local / lymphatic / blood routes of spread for breast carcinoma?

Answer 13

local - skin, nipple, chest wall
lymphatic - lymph nodes
blood - lungs, liver, bones

Question 14

what are the 5 year survivals for stage 0, 1, 2 breast cancer?

Answer 14

stage 0 - 92%
stage 1 - 87%
stage 2 - 65%

stage 3 - 46%
stage 4 - 13%

Question 15

how does DCIS arise?

Answer 15

ductal atypia

Question 16

DCIS fills what structure?

Answer 16

ductal lumen

Question 17

how is DCIS visualized early on?

Answer 17

microcalcification on mammmography

Question 18

what is the defining feature of DCIS malignancy?

Answer 18

early malignancy without basement membrane penetration

basement membrane is intact

Question 19

is the DCIS lesion palpable?

Answer 19

no

Question 20

what is comedocarcinoma? what is the histology / pathology?

Answer 20

• subtype of DCIS
• ductal caseous necrosis
• central necrosis surrounded by cancer cells

Question 21

paget disease results from what?

Answer 21

underlying DCIS

Question 22

what is the gross appearance of paget disease?

Answer 22

eczematous patches on nipple

Question 23

what is important about comedocarcinoma? why?

Answer 23

basement membrane still intact

because it is a subtype of DCIS

Question 24

what are paget cells? what is their defining feature?

Answer 24

large cells in epidermis with CLEAR HALO?

Question 25

which breast carcinoma is made up of large epidermal cells with a CLEAR HALO?

Answer 25

paget disease (paget cells)

Question 26

what is the most common invasive breast carcinoma?

Answer 26

invasive ductal

Question 27

what is the 'worst' breast carcinoma?

Answer 27

invasive ductal

Question 28

what are the gross features of invasive ductal carcinoma?

Answer 28

firm, fibrous, "rock hard" mass with sharp margins

Question 29

what are the microscopic features of invasive ductal carcinoma? ****IMPORTANT****

Answer 29

small nests / cords of cells, duct like, or glandular cells with collagenous stroma ****IMPORTANT****

Question 30

which breast cancer type is often bilateral with multiple lesions in the same location, with an "Indian file" row of cells?

Answer 30

invasive lobular

Question 31

what is unique about invasive lobular carcinoma?

Answer 31

often bilateral with multiple lesions in the same location, with an "Indian file" row of cells

Question 32

histology for medullary breast carcinoma

Answer 32

fleshy, cellular, lymphocytic infiltrate

Question 33

peau d'orange is associated with which breast cancer type?

Answer 33

inflammatory

Question 34

what is the pathogenesis of inflammatory breast cancer?

Answer 34

- dermal lymphatic invasion by breast carcinoma | - neoplastic cells block lymphatic channels

Question 35

what is the most common breast tumor in patients under 35yo?

Answer 35

fibroadenoma

Question 36

is fibroadenoma a precursor to breast cancer?

Answer 36

no

Question 37

what is the microscopic appearance of fibroadenoma?

Answer 37

fibroblastic stroma enclosing glandular structures lined by epithelium

Question 38

where are intraductal papillomas located? where does it grow?

Answer 38

beneath areola grows in lactiferous ducts

Question 39

which breast tumor has serous or bloody nipple discharge?

Answer 39

intraductal papilloma

Question 40

what is the risk of progression to cancer for intraductal papilloma?

Answer 40

1.5-2x increased risk

Question 41

what is the most common breast tumor in patients in their 6th decade?

Answer 41

phyllodes tumor

Question 42

what is a phyllodes tumor? what is the appearance? can it become malignant?

Answer 42

- fast growing mass that forms from periductal stromal cells - large bulky mass with cysts and leaf like projections could become malignant

Question 43

what is the most important clinical manifestation of intraductal papilloma?

Answer 43

bloody nipple discharge

Question 44

what is the most common cause of "breast lumps" from age 25 to menopause? how does this present?

Answer 44

proliferative breast disease presents with premenstrual breast pain and multiple lesions

Question 45

is there an increased risk of cancer for proliferative breast disease?

Answer 45

no

Question 46

what are the histologic types of proliferative breast disease?

Answer 46

- fibrosis - cystic changes - sclerosing adenosis - epithelial hyperplasia

Question 47

proliferative breast disease: fibrosis histological type

Answer 47

hyperplasia of breast stroma

Question 48

proliferative breast diseasecystic changes

Answer 48

fluid filled, blue dome (ductal dilation)

Question 49

proliferative breast disease: sclerosing adenosis****

Answer 49

- increased acini and intralobular fibrosis - associated with calcifications - often confused with cancer - 1.5-2x increased risk of cancer development

Question 50

proliferative breast disease: epithelial hyperplasia****

Answer 50

- occurs in patient over 30yo - increase in number of epithelial cell layers in terminal duct lobules - increased risk of cancer with atypical cells

Question 51

what is the most common pathogen associated with acute mastitis? what is the pathogenesis?

Answer 51

s. aureus during breast feeding cracks in nipples occur and increase risk of bacterial infection

Question 52

what is the treatment for acute mastitis?

Answer 52

dicloxacillin

Question 53

what is the main cause of fat necrosis of the breast?

Answer 53

injury / trauma

Question 54

what are the three major causes of gynecomastia?

Answer 54

- hyperestrogenism (cirrhosis, testicular tumor, puberty, old age) - klinefelter syndrome - drugs (spironolactone, marijuana, digitalis, estrogen, cimetidine, alcohol, heroin, DA, D2 antagonists, ketoconazole)