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Year 2 OBGYN > Pathology of the breast > Flashcards

Pathology of the breast Flashcards

1
Q

what are the noninvasive malignant tumors of the breast?

A
  • DCIS
  • comedocarcinoma
  • paget disease
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2
Q

what are the invasive malignant tumors of the breast?

A
  • invasive ductal
  • invasive lobular
  • medullary
  • inflammatory
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3
Q

what are the benign tumors of the breast?

A
  • fibroadenoma
  • intraductal papilloma
  • phyllodes tumor
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4
Q

what are the risk factors for malignant breast tumors?

A
  • 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
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5
Q

do malignant breast tumors occur pre or post menopause?

A

post menopausal

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6
Q

malignant breast tumors are usually located in which quadrant?

A

upper lateral

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7
Q

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

A

axillary lymph node involvement (the ONLY factor that matters)

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8
Q

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

A

HER-2

EGF

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9
Q

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

A

ductal

lobular

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10
Q

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

A

papillary

inflammatory

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11
Q

which breast more commonly gets breast carcinoma?

A

left more than right

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12
Q

what is the most common cause of nipple discharge?

A

papilloma (benign)

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13
Q

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

A

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

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14
Q

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

A

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

stage 3 - 46%
stage 4 - 13%

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15
Q

how does DCIS arise?

A

ductal atypia

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16
Q

DCIS fills what structure?

A

ductal lumen

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17
Q

how is DCIS visualized early on?

A

microcalcification on mammmography

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18
Q

what is the defining feature of DCIS malignancy?

A

early malignancy without basement membrane penetration

basement membrane is intact

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19
Q

is the DCIS lesion palpable?

A

no

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20
Q

what is comedocarcinoma? what is the histology / pathology?

A
  • subtype of DCIS
  • ductal caseous necrosis
  • central necrosis surrounded by cancer cells
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21
Q

paget disease results from what?

A

underlying DCIS

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22
Q

what is the gross appearance of paget disease?

A

eczematous patches on nipple

23
Q

what is important about comedocarcinoma? why?

A

basement membrane still intact

because it is a subtype of DCIS

24
Q

what are paget cells? what is their defining feature?

A

large cells in epidermis with CLEAR HALO?

25
Q

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

A

paget disease (paget cells)

26
Q

what is the most common invasive breast carcinoma?

A

invasive ductal

27
Q

what is the ‘worst’ breast carcinoma?

A

invasive ductal

28
Q

what are the gross features of invasive ductal carcinoma?

A

firm, fibrous, “rock hard” mass with sharp margins

29
Q

what are the microscopic features of invasive ductal carcinoma? IMPORTANT

A

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

IMPORTANT

30
Q

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

A

invasive lobular

31
Q

what is unique about invasive lobular carcinoma?

A

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

32
Q

histology for medullary breast carcinoma

A

fleshy, cellular, lymphocytic infiltrate

33
Q

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

A

inflammatory

34
Q

what is the pathogenesis of inflammatory breast cancer?

A
  • dermal lymphatic invasion by breast carcinoma

- neoplastic cells block lymphatic channels

35
Q

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

A

fibroadenoma

36
Q

is fibroadenoma a precursor to breast cancer?

A

no

37
Q

what is the microscopic appearance of fibroadenoma?

A

fibroblastic stroma enclosing glandular structures lined by epithelium

38
Q

where are intraductal papillomas located? where does it grow?

A

beneath areola

grows in lactiferous ducts

39
Q

which breast tumor has serous or bloody nipple discharge?

A

intraductal papilloma

40
Q

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

A

1.5-2x increased risk

41
Q

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

A

phyllodes tumor

42
Q

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

A
  • fast growing mass that forms from periductal stromal cells
  • large bulky mass with cysts and leaf like projections

could become malignant

43
Q

what is the most important clinical manifestation of intraductal papilloma?

A

bloody nipple discharge

44
Q

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

A

proliferative breast disease

presents with premenstrual breast pain and multiple lesions

45
Q

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

A

no

46
Q

what are the histologic types of proliferative breast disease?

A
  • fibrosis
  • cystic changes
  • sclerosing adenosis
  • epithelial hyperplasia
47
Q

proliferative breast disease: fibrosis histological type

A

hyperplasia of breast stroma

48
Q

proliferative breast diseasecystic changes

A

fluid filled, blue dome (ductal dilation)

49
Q

proliferative breast disease: sclerosing adenosis**

A
  • increased acini and intralobular fibrosis
  • associated with calcifications
  • often confused with cancer
  • 1.5-2x increased risk of cancer development
50
Q

proliferative breast disease: epithelial hyperplasia**

A
  • occurs in patient over 30yo
  • increase in number of epithelial cell layers in terminal duct lobules
  • increased risk of cancer with atypical cells
51
Q

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

A

s. aureus

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

52
Q

what is the treatment for acute mastitis?

A

dicloxacillin

53
Q

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

A

injury / trauma

54
Q

what are the three major causes of gynecomastia?

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

Year 2 OBGYN (33 decks)

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