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DIT Reproductive > Repro 17 - Breast > Flashcards

Repro 17 - Breast Flashcards

1
Q

What is Mastitis? What is the cause?

A

Infection of the breast due to S.aureus. Causes redness, pain, fever, can progress to abscess. Associated w/ breastfeeding.

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2
Q

What are seven medications known to cause gynecomastia?

A

[STACKED] Spironolactone. THC. Alcohol. Cimetidine. Ketoconazole. Estrogens. Digoxin.

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3
Q

What is the most common cause of breast lumps in women 25-50?

A

Non-proliferative (fibrocystic) changes.

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4
Q

What do we see histologically in non-proliferative breast (fibrocystic changes)?

A

Fibrosis is caused by hyperplasia of breast stroma. In the cysts we see fluid-filled cavities called “blue dome cysts”.

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5
Q

What are non-proliferative changes?

A

Used to be called fibrocystic changes, there is change in the fibrous and cystic tissue. These changes are non-proliferative. Most common cause of breast lumps in women 25-50. They fluctuate w/ hormone levels. They cause breast pain and multiple bilateral breast lesions. They can sometimes be caused by caffeine and dietary fat.

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6
Q

What the four proliferative breast diseases w/o atypia?

A

Sclerosing adenosis. Epithelial hyperplasia. Complex sclerosing lesion (radial scar). Fibroadenoma.

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7
Q

What is sclerosing adenosis of the breast?

A

A type of proliferative change w/o atypia, causes so much increase in glandular tissue (increased acini), that they become distorted and cause intralobular fibrosis. Can also causes some calcifications.

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8
Q

What is Epithelial hyperplasia of the breast?

A

A type of proliferative change w/o atypia, there is an increase in epithelial cell layers at the terminal duct of the lobule.

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9
Q

What is Complex sclerosing lesion (radial scar)?

A

A type of proliferative change w/o atypia, it is a scar w/ irregular shape that can look like cancer.

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10
Q

What are the 3 benign breast tumors?

A

Fibroadenoma. Intraductal papilloma. Phyllodes tumor.

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11
Q

What is the most common breast tumor in women under 25?

A

Fibroadenoma.

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12
Q

What is Fibroadenoma?

A

A type of proliferative change w/o atypia, it is the most common breast tumor in women under 25. It is a small, firm mass w/ regular edges, and it is mobile. It increases in size w/ estrogen exposure. Not a precursor to breast cancer.

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13
Q

What is intraductal papilloma?

A

A benign breast tumor, it is a small tumor found inside the lactiferous ducts. Causes serous/bloody nipple discharge. Carries a tiny risk of elevating to breast cancer.

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14
Q

What is Phyllodes tumor?

A

A type of benign breast tumor, it’s a large, bulky tumor w/ leaf-like projections on histology. They can become malignant.

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15
Q

What is the most common cancer in women?

A

Breast cancer.

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16
Q

At what time in a woman’s life is breast cancer the most common?

A

After menopause.

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17
Q

What is the most common location of breast cancer?

A

Upper outer quadrant.

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18
Q

What are risk factors for breast cancer?

A

Estrogen exposure: early menarche/late menopause, fewer pregnancies, less time breastfeeding, older age at 1st live birth. Obesity. Family history. BRCA mutation. HNPCC.

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19
Q

What are the 2 basic types of breast cancer?

A

Ductal vs lobular. Ductal arises from duct epithelium. Lobular arises from lobules.

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20
Q

What does “In situ” mean?

A

It means that the cancer cells are still where they arose and have not broken through the basement membrane.

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21
Q

What is Ductal carcinoma in situ (DCIS, intraductal carcinoma)? What are the 5 different types of ductal carcinoma?

A

Arises from ductal hyperplasia: Comedocarcinoma (causes caseous necrosis), Solid, Cribriform, Papillary, Micropapillary.

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22
Q

What is Paget disease of the breast?

A

Eczema-like patches on nipple and areola: this suggests underlying carcinoma (often DCIS).

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23
Q

What histological finding characterizes Lobular carcinoma in situ (LCIS)?

A

Signet ring cells: mucinous material in the cytoplasm that is pushing the nucleus into the periphery.

24
Q

How can we differentiate ductal carcinoma in situ vs lobular carcinoma in situ?

A

Ductal carcinoma in situ will always progress into metastasis. Lobular carcinoma in situ is not always the case. Also lobular carcinoma in situ will always have Singet ring cells and be positive for estrogen and progesterone receptors.

25
Q

What is the most common invasive breast cancer?

A

Invasive ductal carcinoma (70-80%).

26
Q

What is Invasive breast cancer?

A

It is the most common breast cancer, causes firm, rock-hard mass w/ sharp margins. They are fixed and immobile. Histology shows glandular duck-like cells w/ starlight pattern.

27
Q

What is invasive lobular carcinoma?

A

It is associated w/ inactivation of e-cadherin genes. It is ER(+), PR(+) (estrogen receptor, progesterone receptor), Signet ring cells.

28
Q

What is Medullary carcinoma?

A

Fleshy, cellular mass w/ lymphocytic infiltrates.

29
Q

What is Inflammatory carcinoma of the breast?

A

A way that invasive carcinoma might present: Invasion of dermal lymphatics leads to visible inflammatory changes: Peau d’orange, dimpling of the breast, nipple retraction,

30
Q

What are SERMs?

A

Selective estrogen receptor modulators, they bind to estrogen receptors but they can be agonists or antagonists in different tissues.

31
Q

What is Tamoxifen?

A

A SERM, it is an estrogen antagonist in breast tissue but estrogen agonist in endometrial tissue: can cause endometrial cancer. Used to treat primary breast cancer (only if its ER(+)), prevent recurrence, and primary prevention in some high risk women LCIS.

32
Q

What is Raloxifene?

A

A SERM, it is an estrogen agonist in bone And estrogen antagonist in the breast. Used for osteoporosis and sometimes for breast cancer. Does not increase risk of endometrial cancer.

33
Q

What is Anastrozole?

A

It inhibits production of estrogen by inhibiting aromatase. Used in postmenopausal women w/ breast cancer. Causes more osteoporosis and risk of fracture.

34
Q

What Organism is most commonly responsible for acute mastitis?

A

S.aureus.

35
Q

What are some of the causes of gynecomastia?

A

Puberty. Cirrhosis. Testicular tumors. Klinefelter syndrome. Drugs [STACKED].

36
Q

What is the classic presenting complaint in a patient w/ intraductal papilloma?

A

Serous/bloody “Straw-colored” nipple discharge.

37
Q

What breast pathology Is the most common breast mass in postmenopausal women?

A

Invasive ductal carcinoma.

38
Q

What breast pathology is the most common breast mass in premenopausal women?

A

Fibrocystic change of the breast.

39
Q

What breast pathology is the most common form of breast cancer?

A

Invasive ductal carcinoma.

40
Q

What breast pathology has small, mobile, firm mass w/ sharp edges in a 24y.o woman?

A

Fibroadenoma.

41
Q

What breast pathology has a histological finding of leaf-like projection?

A

Phyllodes tumor.

42
Q

What breast pathology causes Signet ring cells?

A

Lobular carcinoma in situ. Invasice lobular carcinoma.

43
Q

What breast pathology is associated w/ loss of e-cadherin cell adhesion gene on chromosome 16?

A

Invasive lobular carcinoma.

44
Q

What breast pathology is always ER(+) and PR(+)?

A

Lobular carcinoma in situ. Invasive lobular carcinoma.

45
Q

What breast pathology commonly presents w/ nipple discharge?

A

Intraductal papilloma.

46
Q

What breast pathology presents w/ eczematous patches on nipple?

A

Paget disease.

47
Q

What breast pathology has multiple bilateral fluid-filled lesions w/ diffuse breast pain?

A

Fibrocystic change of the breast.

48
Q

What breast pathology has firm, fibrous mass in a 55-y.o woman?

A

Invasive ductal carcinoma.

49
Q

A 58 y.o postmenopausal woman is on tamoxifen. What is she at increased risk of acquiring?

A

Endometrial cancer: tamoxifen might be an antagonist for estrogens in the breast but is an agonist in the uterus.

50
Q

RFF: Most common cancer in women in the US?

A

Breast cancer.

51
Q

RFF: Most common benign breast tumor.

A

Fibroadenoma.

52
Q

RFF: Most common malignant breast tumor?

A

Invasive ductal carcinoma.

53
Q

RFF: Blue dome cyst in breast.

A

Non-proliferative fibrocystic change.

54
Q

RFF: Treatment for ER(+) breast cancer.

A

Tamoxifen.

55
Q

RFF: Red, itchy, swollen rash on the areola and nipple.

A

Paget disease.

DIT Reproductive (18 decks)

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