What is the ONLY finding in Fibrocystic Change of the Breast that is a risk factor for the development of carcinoma?
JUST Atypical Epithelial Hyperplasia! (NOT Blue-Domed Cyst, NOT Fibrosis)
What is the most common benign tumor in the breast?
Fibro-Adenomas
Fibroadenomas measure ___ cm in diameter and are well-_________ spherical nodules, usually well-circumscribed from the breast parenchyma and are freely ________ from the surrounding breast substance.
2-5 cm…ENCAPSULATED….moveable
What are freely moveable, encapsulated benign tumors of the breast?
Fibroadenomas
What are the two components to a fibroadenoma?
1.Fibrous Stroma 2.Glandular Epithelium
What is the black paint on the edge of a biopsy signify?
the SURGICAL MARGIN
Where is the most popular location for a FibroAdenoma?
UPPER, OUTER Quadrant
What age range is most susceptible to FibroAdenoma? What is their prognosis?
Young Women…99% benign, excellent prognosis
What is thought to be the etiology of fibrocytic change in the breast? What can this tell us about prognosis?
Sex hormones! So before puberty and after menopause fibrocytic changes should not occur.
What are the signs and symptoms of a woman with Fibrocystic disease/change in the breast? What % of women aged 20-50 actually have symptoms? Are you more likely to see it unilaterally or bilaterally?
palpable LUMPS in the breast, signs are found in approx. 50% of all women examined at biopsy/autopsy….10-15% of women have symptoms….BILATERAL disease
What is the most characteristic clinical feature of the IntraDuctal Papilloma? What are the 2 not as popular ones?
MOST: 1. A serous (yellow) or bloody discharge from the nipple……..Less popular: 2. A small areolar mass and 3. rarely nipple retraction
Which condition has Blue-Domed Cysts?
Fibrocystic Disease of the Breast
Which condition has encapsulation?
Fibroadenoma
Which 5 conditions have fibrous tissue?
- Fibrocystic disease of the breast and 2. Fibroadenoma 3.Chronic Mastitis 4.Fat necrosis of the breast 5.GyneCoMastia
What is a very strong reaction where the tumor cells infiltrating the tissue are surrounded by dense connective tissue that is produced by the host in response to the tumor?
A “Desmoplastic” reaction
What does a desmoplastic reaction do to the appearance of a tumor?
the tumor appears firm and gritty
What type of cancer is most closely associated with a desmoplastic reaction? What type of cancer explicitly is NOT associated with a desmoplastic reaction?
Associated: Invasive Ductal Cancer….Not Associated: Invasive Lobular Carcinoma
What is the most common etiology behind fat necrosis of the breast?
TRAUMA (secondary: prior surgery, radiation)
What 3 breast conditions can MIMIC a carcinoma because of fibrous scarring??
- Chronic Mastitis 2.Fat Necrosis 3.Fibrocystic Disease
What major anatomical breast structure is lacking in the male breast?
Lobules
What is gynecomastia caused by?
hormonal changes in puberty
What are the two ways gynecomastia can develop in adulthood?
1.Cirrhosis of the liver (thus unable to break down estrogen) 2. tumor (secreting estrogen)
In gynecomastia, what is presented directly under the areolar area?
a fibrous cap
How much less frequent is male breast cancer then in female? Which one spreads faster?
Male is 100x less, but it spreads much faster c/o less tissue
What are the 8 risk factors for malignant breast cancer?
1.Sex 2.Age 3.Race 4.Genetics 5.Hormones 6.Other Cancers 7.Fibrocystic Chang/Multiple Intraductal Papillomatosis
Breast Cancer Risk Factors- Sex: Females are affected ____ times more often than males.
100x
Breast Cancer Risk Factors-Age: Very rare before puberty and quite unusual in young women. The incidence slowly rises after the age of ___ years and peaks in postmenopausal women who are about ___ years of age.
35….60 yrs
Breast Cancer Risk Factors- Race: Uncommon in _______, and _______, and is most common in _________, espec. Jews.
Japanese, and Chinese……….Caucasians
Breast Cancer Risk Factors-Genetics: A history of familial cancer increases the risk for relatives be _____ fold and possibly higher in some families.
5-10 fold
Breast Cancer Risk Factors-Hormonal Factors: Women who are exposed to _________ for prolonged periods tend to develop breast cancer more frequently than those who are not. SO most at risk: early _____ or late ______.
estrogens … early period or late menopause
Breast Cancer Risk Factors-Hormonal Factors: Who is at greater risk: nulliparous women or women who have had multiple children?
Nulliparous…being pregnant stops the cyclic estrogen secretion
Breast Cancer Risk Factors-Hormonal Factors: The fact that many breast cancers have _______ receptors, and that growth of these cells can be inhibited or slowed down by synthetic ______.
estrogen receptors…anti-estrogen drugs
Breast Cancer Risk Factors-Presence of other Cancers: The incidence of breast cancers is increased in women who have cancer in ______, as well as those who have _______ or ________ cancer.
the other breast….. ovarian….endometrial (high estrogen!!!)
Breast Cancer Risk Factors- What are the ONLY two PREMALIGNANT neoplasias that are risk factors? How long does it take for these risk factors to spread?
1.Fibrocystic Changes 2.Multiple Intraductal Papillomas….several years
Breast Cancer Risk Factors- What are the 2 ‘other’ causes of breast cancer?
1.obesity (high fat diet) 2. moderate EtOH consumption
The main difference between an intraductal and invasive lesion is breaching of the ________.
Basement Membrane