Flashcards in Repro - Pathology (Breast Pathology) Deck (60):
Draw an image depicting the layered structures of the breast, labeling the following: (1) Nipple (2) Lactiferous sinus (3) Major duct (4) Terminal duct (5) Lobules (6) Stroma.
See p. 584 in First Aid 2014 or Pg. 533 in First Aid 2013 for visual
What are 2 diseases/conditions that affect the nipple?
(1) Paget disease (2) Breast abscess
What are 2 diseases/conditions that affect the lactiferous sinus?
(1) Intraductal papilloma (2) Abscess/mastitis
What are 3 diseases/conditions that affect the major duct?
(1) Fibrocystic change (2) DCIS (3) Invasive ductal carcinoma
What is a disease/condition that affects the terminal duct?
What is a disease/condition that affects the lobules?
What are 2 diseases/conditions that affect the stroma?
(1) Fibroadenoma (2) Phyllodes tumor
Name 3 benign breast tumors.
(1) Fibroadenoma (2) Intraductal papilloma (3) Phyllodes tumor
What are the characteristics of a fibroadenoma of the breast?
Small, mobile, firm mass with sharp edges
What are the characteristics of an intraductal papilloma of the breast?
Small tumor that grows in lactiferous ducts. Typically beneath areola.
What are the characteristics of a phyllodes tumor of the breast?
Large bulky mass of connective tissue and cysts. "Leaf-like" projections.
What is the difference between a breast fibroadenoma and phyllodes tumor in terms of size?
Fibroadenoma - SMALL, mobile, firm mass with sharp edges; Phyllodes tumor - LARGE bulky mass of connective tissue and cysts. "Leaf-like" projections.
What age group is most commonly affected by fibroadenoma of the breast?
Most common tumor in those < 35 years old
What age group is most commonly affected by phyllodes tumor of the breast?
Most common in 6th decade
How does breast fibroadenoma relate to breast cancer?
Not a precursor to breast cancer
What effect does increased estrogen have on breast fibroadenomas?
Increase size and tenderness with increased estrogen (e.g., pregnancy, prior to menstruation)
How does intraductal papilloma relate to breast cancer?
Slight (1.5-2x) increased in risk for carcinoma.
What finding upon patient history or physical exam is associated with intraductal papilloma?
Serous or bloody nipple discharge.
How does phyllodes tumor relate to breast cancer?
Some may become malignant.
In what patient population are malignant breast tumors commonly found?
From where do malignant breast tumors usually arise?
Usually arise from terminal duct lobular unit.
Overexpression of which receptors are common in malignant breast tumors?
Ovexpression of estrogen/progesterone receptors or c-erbB2 (HER-2, an EGF receptor) is common
What is the more aggressive type of malignant breast tumors?
Triple negative (ER -, PR -, and Her2/Neu -) more aggressive
What impact does the type of malignant breast have?
Type affects therapy and prognosis
What is the single most important prognostic factor for malignant breast tumors?
Axillary lymph node involvement indicating metastasis is the single most important prognostic factor
Where are malignant breast tumors most often located?
Most often located in upper-outer quadrant of breast
What are 6 risk factors for malignant breast tumors?
Risk factors: (1) Increased estrogen exposure (2) Increased total number of menstrual cycles (3) Older age at 1st live birth (4) Obesity (increased estrogen exposure as adipose tissue converts androstenedione to estrone) (5) BRCA1 and BRCA2 gene mutations (6) African American ethnicity (increased risk for triple negative breast cancer)
What are the two main categories of malignant breast tumors? What are the specific types of breast tumors within each category?
(1) Noninvasive - Ductal carcinoma in situ (DCIS), Comedocarcinoma (subtype of DCIS), Paget disease (2) Invasive - Invasive ductal, Invasive lobular, Medullary, Inflammatory
What are characteristics that distinguish DCIS? More specifically, where is it located, from where does it arise, and how is it detected?
Fills ductal lumen. Arises from ductal atypia Often seen early as microcalcifications on mammography.
What is a common subtype of DCIS? What distinguishes it on histology?
Comedocarcinoma; Ductal, caseous (central) necrosis
From what does Paget's disease result? How does it present in clinic and on histology? What does such a presentation suggest?
Results from underlying DCIS; Eczematous patches on nipple; Paget cells = large cells in epidermis with clear halo; Suggests underlying DCIS
Besides the breast, where else can Paget's disease be seen? What relevance does this finding have to underlying malignancy?
Also seen on vulva, though does not suggest underlying malignancy
What are the histological and gross characteristics of invasive ductal carcinoma?
Firm, fibrous, "rock-hard" mass with sharp margins and small, glandular, duct-like cells. Grossly, see classic "stellate" infiltration.
What is the most common tumor of all breast cancers? For what else is it known?
Invasive ductal carcinoma; Most common (75% of all breast cancers); Worst and most invasive
What histological finding characterizes invasive lobular carcinoma?
Orderly row of cells ("Indian file")
In what way do invasive lobular carcinoma lesions typically form?
Often bilateral with multiple lesions in the same location
What clinical/histological finding distinguishes invasive medullary carcinoma of the breast?
Fleshly, cellular, lymphocytic infiltrate
What kind of prognosis does invasive medullary breast cancer have?
What is invaded in invasive inflammatory breast cancer?
Dermal lymphatic invasion by breast carcinoma.
What is the clinical finding associated with inflammatory breast cancer? What is the mechanism behind this?
Peau d'orange (breast skin resembles orange peel); neoplastic cells block lymphatic drainage.
What is the survival like for inflammatory breast cancer?
50% survival for 5 years
What is the most common cause of "breast lumps" from age 25 to menopause?
Proliferative breast disease
How does proliferative breast disease present?
Presents with premenstrual breast pain and multiple lesions, often bilateral
Describe the size of the mass seen in proliferative breast disease.
Fluctuation in size of mass.
Does proliferative breast disease indicate an increased risk of carcinoma?
Usually does not indicate increased risk of carcinoma
What are the histological types of proliferative breast disease? What are the defining histological characteristics of each?
Histologic types: (1) Fibrosis - hyperplasia of breast stroma (2) Cystic - fluid filled, blue dome (3) Sclerosing adenosis - increased acini and intralobular fibrosis (4) Epithelial hyperplasia - increase in number of epithelial cell layers in terminal duct lobule
Which histologic type of proliferative breast disease is associated with ductal dilation?
Which histologic type of proliferative breast disease is often confused with cancer? What is the increased risk of developing cancer with this condition?
Sclerosing adenosis - Often confused with cancer. Increased risk (1.5-2X) of developing cancer
In what age group does the epithelial hyperplasia type of proliferative breast disease occur?
Occurs in women > 30 years old
What increased risk does the epithelial hyperplasia type of proliferative breast disease cause?
Increased risk of carcinoma with atypical cells
Which histologic type of proliferative breast disease is associated with calcifications?
How can acute mastitis present? What increases the risk for the condition? What is the most common pathogen?
Breast abscess; during breast-feeding, increased risk of bacterial infection through cracks in the nipple; S. aureus is the most common pathogen
How is acute mastitis treated?
Treat with dicloxacillin and continue breast-feeding.
What is the physical finding of fat necrosis? What causes it?
A benign, usually painless lump; Forms as a result of injury to breast tissue
What is seen on mammography and biopsy in patients with fat necrosis?
Abnormal calcification on mammography; Biopsy shows necrotic fat, giant cells
What is important to consider when taking a patient's history when you are considering fat necrosis on your differential diagnosis?
Up to 50% of patients may not report trauma
In what patient population does gynecomastia occur?
Occurs in males.
From what 3 categories of things can gynecomastia result?
Results from (1) hyperestrogenism (2) Klinefelter (3) Drugs
What are examples of conditions causing gynecomastia due to hyperestrogenism?
Hyperestrogenism (cirrhosis, testicular tumor, puberty, old age)