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Flashcards in Repro-Endo: Breast Deck (30):
1

Responsible for Milk production in the Lobules?

Luminal Cell Layer

Inner cell layer ining the Ducts and Lobules

2

Responsible for Contractile function, propelling the Milk?

Myoepithelial Cell Layer

Outer cell layer lining the Ducts and Lobules

3

Galactorrhea?

Milk production outside of Lactation

Not a symptom of Breast cancer

A/w Nipple stimulation, Prolactinoma, Drugs (Oxytocin, Ptocin)

4

  • Erythematous Breast w/ Purulent Nipple discharge
  • Pain and Fever
  • Abcess or mass may be felt w/in Breast or behind Nipple
  • A/w Breast-feeding
  • Fissures / Cracks develop in the Nipple
    --> Route of Entry for Microbes
  • Bacterial infection of the Breast, Staphylococcus aureus
  • Tx: Continued drainage (Breast-feeding) and ABX (Dicloxacillin or Cephalexin) check for Methicillin Resistance

Acute Mastitis

5

  • Inflammation of the Subareolar ducts
  • Subareolar mass w/ Nipple Retraction
  • Relative Vit. A deficiency (Retinoid)
    --> Highly specialized cells require Vit. A (Keratin)
    --> Squamous metaplasia of Lactiferous Ducts
    --> Duct blockage and Inflammation
  • A/w Smoking

Periductal Mastitis

6

  • Periareolar Mass w/ Green-brown Nipple discharge
    (Inflammatory debris)
  • Main ducts fill up w/ Depris
    --> Dilation, Rupture, Inflammation
  • May produce Skin and Nipple retraction
  • Multiparous Postmenopausal Women
  • Chronic Inflammation w/ Plasma cells
  • Inflammation w/ Dilation (Ectasia) of Subareolar ducts
  • Tx: ABX and Surgery

Mammary Duct Ectasia

7

  • Benign, Painless, Breast Mass on physical exam
  • Abnormal Calcification on Mammography
    (Saponification)
  • Lipid-laden Macrophages w/ Foreign body Giant cells
  • Dystrophic Calcification
  • Biopsy --> Necrotic fat w/ Calcification of Giant Cells
  • Necrosis of Breast fat

Fat Necrosis

8

(3) Benign Breast Tumors

  1. Fibroadenoma
  2. Intraductal Papilloma
  3. Phyllodes Tumor

9

Most common change in Premenopausal Breast?

Fibrocystic change

10

Fibrocystic changes of the Breast?

  • "Breast lumps" "Lumpy" vague irregularity of Breast tissue
  • 25 - 50 y.o.
  • Premenstrual Breast Pain - Bilateral
  • Multiple Lesions --> NOT RISK Cancer
  • Fibrosis - Hyperplasia of Breast Stroma (5x Risk)
  • Cystic - Fluid filled, "Blue-dome appearance" Ductal dilation.
  • Sclerosing adenosis - Increased Acini and Intralobular Fibrosis --> Calcification (slight risk cancer 1.5 - 2x)
  • Epithelial hyperplasia - Increase Epithelial cell layers in Terminal Duct lobule

11

Intraductal Papilloma

  • "Straw colored and Bloody" Nipple Discharge
  • Premenopausal woman
  • Small Tumor, Grows in Lactiferous Ducts or Sinuses
    • Typically beneath Areola
  • NO increased risk of Cancer
  • Fibrovascular projections lined by Epithelial (Luminal) and Myoepithelial cells (1.5 - 2x risk of Carcinoma)
  • Must be distinguished from Papillary Carcinoma
  • Tx: Surgical excision

12

Papillary Carcinoma?
Distinguished from IntraDuctal Papilloma

  • Papillary Carcinoma
    • Fibrovascular projections  Lined by Epithelial cells WITHOUT Myoepithelial cells
    • Risk of Papilary Carcinoma Increases w/ Age
      --> Postmenopausal women
  • Intraductal Papilloma
    • ​Fibrovacular projections Lined by Epithelial cells WITH Myoepithelial cells

13

  • Small, Well circumscribed "Mobile - Marble like mass"
  • Discrete and Movable, Painless / Painful
  • Premenopausal, < 25 y.o.
  • Sharp Edges
  • Estrogen sensitive - Grows during Pregnancy and Painful during Menses, Increases in size w/ Estrogen lvls
  • Tumor of Fibrous Tissue and Glands and Stroma
  • Benign Tumor, No Risk for Carcinoma
  • Most common Benign Neoplasm in

Fibroadenoma

14

  • LARGE Bulky mass of Connective tissue Stromal cells
  • Fibroadenoma-like Tumor with Overgrowth of the Fibrous component 'Leaf-like' projections
  • 50 - 60 y.o.
  • Post-menopausal women
  • Can be Malignant
    • Serial mammograms and Biopsy as it grows
    •  
  • Tx: Wide excision

Phyllodes Tumor

15

(9) Risk Factors for Breast Cancer

  1. Early Menarch / Late Menopause
  2. Nullparity (Fewer Pregnancies, Less Time Breast-feeding)
  3. Hormone Replacemnt Therapy (Est. w/out Prog.)
  4. Endometrial cancer, Ionizing XRT, Smoking
  5. Older age at 1st Live Birth
  6. Obesity (aromatization of androstenedione to Estrone)
  7. Family History / Ash. Jew - BRCA mutation, First-degree relative (BRCA 1, BRCA2, p53, RAS, ERBB2, RB1)
  8. Atypical Hyperplasia
  9. HNPCC - Hereditary Nonpolyposis Colorectal Cancer

16

(3) Overexpression of Receptors in Breast Cancer

  1. Estrogen
  2. Progesterone
  3. HER2/neu (ERBB2 gene)

17

(5) Types of DCIS

  1. Comedocarcinoma (necrotic center)
  2. Solid
  3. Cribiform (sieve-like)
  4. Papillary
  5. Micropappilary

18

  • Cells Fill the Ductal Lumen - Ductal Atypia
  • Microcalcifications / Mammographic calcifications
  • No Invasion into the Basement membrane
    • Early Malignancy (1/3) invade
  • Malignant proliferation of cells w/in Ducts
  • Biopsy of Calcifications --> Benign vs. Malignant
  • Hitological subtypes based on Architectures

DCIS (Ductal Carcinoma In Situ)

19

  • Histological architecture shows High-grade cells w/ Necrosis and Dystrophic Calcifications w/in the Center of Ducts of Breast
  • Ductal
  • Caseous Necrosis

Comedocarcinoma of DCIS

20

  • Nipple Ulceration (Eczematous) and Erythema
  • DCIS that Extends up the Lactiferous Ducts
  • Involves the Skin of the Nipple
  • Paget cells = Large cells in Epidermis w/ Clear Halo
  • A/w underlying DCIS - Carcinoma

Paget Disease of the Breast

21

  • Firm, Fibrous, "Rock-hard" mass w/ Sharp margins
  • Small, Glandular Duct-like Structures in a Desmoplastic Stroma (70 - 80% of all Breast cancers gray-white tumor
  • "Stellate" infiltration - "Star-like" - Fibroplasia
  • Mass Detected: Physical exam or Mammography
  • A/w Dimpling of Skin or Retraction of Nipple
  • (4) Subtypes
    • Tubular carcinoma
    • Mucinous carcinoma
    • Medullary carcinoma
    • Inflammatory carcinoma

IDC (Invasive Ductal Carcinoma)

22

Characteristics of Tubular Carcinoma - IDC?

  • Well-differentiated Tubules
  • Develops in the Terminal ductules
  • Lack Myoepithelial cells
  • Relatively good prognosis

23

Characteristics of Mucinous Carcinoma - IDC?

  • Abundant Extracellular Mucin
  • 'Tumor cells floating in a Mucus pool'
  • Older women (avg. age ~ 70 y.o.)
  • Relatively Good prognosis

24

Characteristics of Medullary Carcinoma - IDC?

  • Large, High-grade cells Growing in Sheets w/ associated Lymphocytes infiltrate and Plasma cells
  • Well-circumscribed Mass
  • Mimics Fibroadenoma on Mammography
  • Increased incidence in BRCA1 carriers
  • Relatively good prognosis

25

Characteristics of Inflammatory Carcinoma - IDC?

  • Inflamed and Swollen Breast
  • Peau d'orange
  • No Discrete mass
  • Dimpling of Breast - Nipple retraction
  • Often mistaken for Acute Mastitis
  • Tumor cells block drainage of Dermal Lymphatics
  • Poor prognosis

26

  • "Signet ring cells"
  • ER+ / PR+
  • Dyscohesive Cells Lacking E-cadherin adhesion protein
  • Multifocal and Bilateral
  • Malignant proliferation of cells in Lobules w/ no Invasion of the Basement membrane
  • Does not produce a Mass or Calcifications
  • Discovered incidently on Biopsy

LCIS (Lobular Carcinoma In Situ)

27

  • Orderly Linear rows of cells - "Indian File"
  • or in Concentric circles ("Bull's eye") in the Stroma
    Grows in a single-file pattern
  • "Signet-ring" morphology
  • Inactivation of E-cadherin genes Chromosome 16
    --> No duct formation

ILC (Invasive Lobular Carcinoma)

28

  • Fleshy, Cellular, Lymphocytic Infiltrate
  • Good Prognosis

Medullary Invasive Carcinoma

29

Risk factors for Gynecomastia?

  • Hyperestrogenism (Cirrhosis, Testicular tumor, Puberty, Klinefeller Syndrome
  • Drugs "STACKEDD F's, H's and DD's!"
  • Spironolactone (SHBG displacement)
  • THC - Marijuana
  • Alcohol
  • Climetidine
  • Ketoconazole (SHBG displacement)
  • Estrogens
  • Digoxin, DES (activates Estrogen receptors)
  • Flutamide, Heroin, and Dopamine D2 antagonists

30

Risk Factors for Breast Cancer in Men?

  • Inactivation of BRCA2 suppressor gene
  • Klinefelter syndrome
    • Increased Aromatization of Androgens to Estrogens in Leydig cells
    • Decreased responsiveness of Testosterone to Androgen receptors