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STEP COPY > Pathoma Breast > Flashcards

Pathoma Breast Flashcards

1
Q

Acute Mastitis

A
  • Bacterial infection of the breast, usually due to Staphylococcus Aureus
  • associated with breast feeding, fissures develop in the nipple providing a route of entry for microbes.
  • Presents as an erytematous breast with purulent nipple discharge, may progress to abscess formation
  • Tx: continued drainage (feeding), and abx (dicloxacillin)
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2
Q

Galactorrhea

A

-Milk production outside of lavtation

NOT a symptom of breast cancer

-Causes include nipple stimulation (common physiologic cause), prolactinoma of anterior pituitary (excess prolactin), drugs (dopamine agonist)

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3
Q

Periductal Mastitis

A

-Inflammation of the subareolar ducts

Usually seen in SMOKERS due to a relative Vitamin A deficiency resulting in squamous metaplasa of lactiferous ducts producing duct blockage and inflammation

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4
Q

Mammary Duct Ectasia (Chronic Mastitis)

A
  • Inflammation with dilation (ectasia) of the aubareolar ducts
  • Classically seen in multiparous postmenopausal women (IMPORTANT because this is a mass in postmenopause woman normally think CANCER)

Green-brown nipple discharge

see plasma cells on biopsy

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5
Q

4 Benign Breast Cancer Tumors

A
  1. Fibrocystic Change
  2. Intraductal Papilloma
  3. Fibroadenoma
  4. Phyllodes Tumor
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6
Q

Fibrocystic Change (Benign breast)

A

-Fibrosis and Cysts in breast in PREmenopausal woman. Hormone mediated.

“Lumpy Bumpy” breast

Cysts have blue-dome appearance on gross exam

Although benign, there is some fibrocystic changes that are associated with increased risk for invasive carcinoma in BOTH breasts

  1. fibrosis, cysts, apocrine metaplasia (no risk)
  2. ductal hyperplasia and sclerosing adenosis (2x)
  3. Atypical hyperplasia (5x increased risk)
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7
Q

Apocrine metaplasia in regards to fibrocystic change of breast tissue

A

-Although this is a metaplasia (think Barretts), this is NOT associated with any increased risk for invasive carcinoma of both breasts.

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8
Q

Intraductal Papilloma (breast)

A

-Papillary growth

Characterized by fibrovascular projections lined by epithelial (luminal) and myoepithelial cells

Bloody nipple discharge in PREmenopausal women

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9
Q

Intraductal Papilloma vs Papillary Carcinoma

A

Intraductal Papilloma: epithelial cells with myoepithelial cells BOTH, and occurs in premenopausal women

Papillary Carcinoma: NO myopithelial cells, only epithelial cells, in POSTmenopausal women

*Both present as bloody nipple discharge*

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10
Q

Fibroadenoma (breast)

A

-Tumor of fibrous tissue and glands

MOST common tumor in premenopausal women

Well circumscribed, mobile marble-like mass

-Estrogen sensitive- grows during pregnancy and may be painful during menstrual cycle

BENIGN, NO increased risk carcinoma

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11
Q

Phyllodes Tumor

A
  • Fibroadenoma-like tumor with overgrowth of fibrous component
  • Leaf-like projections

POSTmenopausal women

Can be malignant

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12
Q

Biggest risk factors for Breast Cancer

A

ALL are mostly related to estrogen exposure

  1. Female Gender
  2. Age (postmenopausal women)
  3. Early menarche/late menopause
  4. Obesity
  5. Atypical hyperplasia
  6. First-degree relative (mother, sister, daughter)
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13
Q

Ductal Carcinoma In Situ (DCIS)

A

Malignant proliferation of cells in ducts with NO invaseion of basement membrane

  • Often detected as calcification on mammography (DCIS does not usually produce a mass)
  • Comedo type is characterized by high-grade cells with necrosis and dystrophic calcification in the center of ducts
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14
Q

3 instances wehre mammographic calcifications can be seen

A
  1. Fibrocystic Change (especially slcerosing adenosis) where there are toommany glands and begin to sclerose and calcify
  2. Fat necrosis via saponification
  3. DCIS
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15
Q

Pagets Disease of the breast

A
  • DCIS that extends up the ducts to involve the skin of the nipple
  • Presents as nipple ulceration and erythema
  • Almost ALWAYS associated with an underlying carcinoma (unlike in vulvar carcinoma, where no increasd risk)
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16
Q

Invasive Ductal Carcinoma (breast) and 4 subtypes

A
  • Most common type of invasive carcinoma in the breast (account for >80% of cases)
  • Mass on PE (>2cm) or Mammography (>1cm)

Duct-like structures in a desmoplastic stoma.

1. Tubular carcinoma

2. Mucinous carcinoma

3, Medullary carcinoma

4. Inflammatory carcinoma

17
Q

Invasive Ductal Carcinoma

  1. Tubular Carcinoma
A

-well-differentiated tubules that LACK myoepithelial cells

good prognosis

18
Q

Invasive Ductal Carcinoma

  1. Mucinous Carcinoma
A

-characterized by carcinoma with abundant extracellular mucin (tumor cells floating in mucus pool)

avg age 70

Relatively good prognosis

19
Q

Invasive Ductal Carcinoma

  1. Medullary Carcinoma
A
  • characterized by large, high-grade cells growing in sheets with associated lymphocytes and plasma cells
  • well circumscribed mass that can mimic fibroadenoma

Increased in BRCA1 carriers

20
Q

Invasive Ductal Carcinoma

  1. Inflammatory Carcinoma
A

-Carcinoma in dermal lymphatics.

presents as inflamed, swolen breast (tumor cells block drainage of lymphatics) with no discrete mass, can be mistaken for acute mastitis

MUST RECHECK PT AFTER GIVE THEM ABX!!

-Poor prognosis (already in dermal lymphatics, easy spread)

21
Q

Pt presents with acute mastitis sx, what must you make sure of

A

-Give them abx for S. Aureus infection but MUST make sure they get better because Inflammatory Carcinoma (invasive ductal carcinoma) presents in SAME way

…inflamed swollen breast

22
Q

Lobular Carcinoma In Situ (LCIS) (breast)

A
  • Malignant proliferation of cells in lobules with no invasion basement membrane
  • LCIS does NOT produce mass, NO calcifications, discovered incidentally
  • Dyscohesive cells that lack E-cadherin adhesion protein
  • Tx: Tamoxifen
23
Q

Invasive Lobar Carcinoma

A
  • Invasive carcinoma that characteristically grows in a single-file pattern
  • Cells exhibit signet-ring morphology

-NO duct formation due to LACK of E. Cadherin

24
Q

Triple negative tumors

A

Negative ER, PR, HER2/neu

have poor prognosis because nothing to treat them with.

-AA women have increased propensity for triple negative

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