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.