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Endo > SM_196: Histology and Pathology of Breast > Flashcards

SM_196: Histology and Pathology of Breast Flashcards

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1
Q

____ is most common site of origin of breast cancer

A

Upper outer is most common site of origin of breast cancer

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2
Q

Describe breast anatomy

A

Breast anatomy

  • Skin and superficial fascia
  • Nipple and areola
  • Breast parenchyma: glandular epithelium (15-20 lobes), fibrous stroma, fibroadipose tissue
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3
Q

Describe histology of the nipple areolar complex

A

Nipple areolar complex

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4
Q

Breast ductal system consists of ____, ____, and ____

A

Breast ductal system consists of terminal duct lobular unit, breast duct, and nipple ducts

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5
Q

Describe basic breast histology

A

Basic breast histology

  • White: fat
  • Pink: fibrous stroma
  • Purple: epithelial cells
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6
Q

Describe histology of breast ducts

A

Breast ducts

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7
Q

____ are the site of most breast lesions including cancer

A

Terminal duct lobular units are the site of most breast lesions including cancer

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8
Q

Younger breast has more ____ stroma on histology

A

Younger breast has more fibrous stroma on histology

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9
Q

Older breast has more ____ stroma on histology

A

Older breast has more fatty stroma on histology

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10
Q

Describe histological changes in breast during pregnancy and lactation

A

Pregnancy and lactation breast

  • Number of lobules and acini within each lobule increase at expense of intralobular and extralobular stroma
  • Luminal epithelial cells with cytoplasmic vacuoles, often protruding into lumen
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11
Q

Postmenopausal breast consists largely of ____

A

Postmenopausal breast consists largely of adipose tissue containing a few residual breast ducts and blood vessels

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12
Q

Inflammatory processes of breast are ___, ___, and ___

A

Inflammatory processes of breast are acute mastitis, duct ectasia, and fat necrosis

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13
Q

Fever and enlarged red painful breast mass in nursing mother (during lactation) is ___

A

Fever and enlarged red painful breast mass in nursing mother (during lactation) is acute mastitis

  • Most commonly caused by Staphylococcus aureus entering through cracks on the nipple
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14
Q

Describe pathology of acute mastitis

A

Acute mastitis pathology

  • Neutrophils (polymorphonuclear cells: acute inflammatory cells) infiltrate the breast (mast) and cause inflammation (itis)
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15
Q

Older multiparous women with poorly defined palpable periareolar mass, unilateral discharge, and nipple pain / retraction is ____

A

Older multiparous women with poorly defined palpable periareolar mass, unilateral discharge, and nipple pain / retraction is ductal ectasia

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16
Q

Describe pathology of ductal ectasia

A

Ductal ectasia pathology

  • Ducts are dilated (ectasia) with chronic inflammation (mononuclear cells without multilobulation: lymphocytes and plasma cells)
  • Fibrosis and squamous metaplasia
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17
Q

Hard breast mass, calcifications on mammogram, due to trauma is ____

A

Hard breast mass, calcifications on mammogram, due to trauma is fat necrosis

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18
Q

Describe pathology of fat necrosis

A

Fat necrosis pathology

  • Hemorrhage and neutrophils early
  • Macrophages, fibrosis, and calcifications
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19
Q

This is ____

A

This is acute mastitis

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20
Q

___ is the most common breast finding and includes non-proliferative and proliferative lesions

A

Fibrocystic changes is the most common breast finding and includes non-proliferative and proliferative lesions

  • 20-50 years
  • Cyclic breast pain
  • Engorgement
  • Nodularity
  • Nipple discharge
  • Can also be asymptomatic and associated with mammographic findings
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21
Q

____ involve the terminal duct lobular unit and are dilated ducts with inner luminal epithelial cells and outer myoepithelial cells

A

Simple cysts involve the terminal duct lobular unit and are dilated ducts with inner luminal epithelial cells and outer myoepithelial cells

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22
Q

Non-proliferative breast lesions are ____, ____, and ____

A

Non-proliferative breast lesions are cysts, apocrine metaplasia, and fibroadenoma

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23
Q

Describe pathology of apocrine metaplasia

A

Apocrine metaplasia pathology

  • Apocrine: glands that release some of their cytoplasm in their secretions (apical snouts)
  • Large polygonal cells lining ducts
  • Eosinophilic (red) finely granular cytoplasm
  • Small nuceli with prominent nucleoli
  • Metaplasia: change in type of lining epitheliu,m
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24
Q

Firm, rubbery, mobile, rounded breast mass is ____

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A

Firm, rubbery, mobile, rounded breast mass is fibroadenoma

  • Most common benign neoplasm of female breast
  • 20-35 years old
25
Mass with smooth circumscribed borders oriented parallel to skin on US is \_\_\_
Mass with smooth circumscribed borders oriented parallel to skin on US is fibroadenoma
26
Describe pathology of fibroadenoma
Fibroadenoma pathology * Circumscribed mass with whorled cut surface * Biphasic: neoplastic stroma (fibro) induces a glandular epithelial proliferation (adeno), mass forming (oma)
27
Fibroadenoma has \_\_\_
Fibroadenoma has well defined circumscribed border between fibroadenoma and normal fatty breast tissue
28
Phyllodes tumor is ___ breast lesion that presents as ____ in women aged \_\_\_\_
Phyllodes tumor is NOT benign breast lesion that presents as a rapidly enlarging mass in women aged 30-35 years
29
Describe pathology of phyllodes tumor
Phyllodes tumor pathology * Leaf like * Benign to sarcomatous proliferation (requires wide margin, high recurrence rate)
30
This is \_\_\_
This is fibroadenoma
31
Describe relative risk of benign breast disease
Benign breast disease * Non-proliferative: minimal to no increase in risk for developing breast carcinoma * Proliferative without atypia: 1.5-2x * Proliferative with atypia: 4-5x
32
Proliferative breast lesions without atypia are \_\_\_\_, \_\_\_\_, \_\_\_\_, and \_\_\_\_
Proliferative breast lesions without atypia are usual ductal hyperplasia, sclerosing adenosis, radial scar, and intraductal papilloma
33
Describe pathology of usual ductal hyperplasia
Usual ductal hyperplasia pathology * Usual: cells look like cells in background terminal duct lobular units (no atypia) * Ductal: cells that proliferate * Hyperplasia: increase in cell number
34
Describe pathology of sclerosing adenosis
Sclerosing adenosis pathology * Lobulocentric proliferation: centered around normal terminal duct lobular units * Sclerosing: fibrosis of stroma * Adenosis: increased number of acini
35
Describe pathology of radial scar
Radial scar pathology * Radial: stellate configuration * Scar: central nidus of small entrapped glands in hyalinized stroma * Dilated glands at periphery with cysts or hyperplasia
36
Mass below nipple with bloody nipple discharge is \_\_\_\_
Mass below nipple with bloody nipple discharge is intraductal papilloma
37
Describe pathology of intraductal papilloma
Intraductal papilloma pathology * Intraductal: involves large excretory ducts * Papillae: fibrovascular stalks lined by both myoepithelial cells (inner) and benign epithelial cells (outer) * Mass forming (oma)
38
This is \_\_\_\_
This is usual ductal hyperplasia
39
Proliferative breast lesions with atypia are ____ and \_\_\_\_
Proliferative breast lesions with atypia are atypical ductal hyperplasia and atypical lobular hyperplasia
40
Pathology of atypical ductal hyperplasia
Atypical ductal hyperplasia pathology * Atypical: cytologic atypia (monotonous cells) and architectural atypia (Roman bridges, cribriform structures) * Ductal: luminal epithelial proliferation * Hyperplasia: increased number of cells
41
Late 40s, either breast and any quadrant, nonspecific presentation, and microcalcifications on mammography is \_\_\_\_
Late 40s, either breast and any quadrant, nonspecific presentation, and microcalcifications on mammography is atypical ductal hyperplasia
42
Incidental finding on core breast biopsy, multicentric and bilateral is \_\_\_\_
Incidental finding on core breast biopsy, multicentric and bilateral is atypical lobular hyperplasia * Multicentric: involves multiple quadrants of some breast * Bilateral: involves both breasts
43
Describe atypical lobular hyperplasia on pathology
Atypical lobular hyperplasia on pathology * Lobular: uniform, small, dyscohesive cells * Round nuclei that may be peripheral: look like plasma cells * Intracytoplasmic lumens
44
One duct is partially involved by monotonous ductal epithelial cells that form punched out secondary lumens (cribriform spaces). This is \_\_\_\_ Relative risk of developing breast cancer is \_\_\_\_
One duct is partially involved by monotonous ductal epithelial cells that form punched out secondary lumens (cribriform spaces). This is atypical ductal hyperplasia Relative risk of developing breast cancer is 4-5 fold
45
In situ carcinoma consists of ____ and \_\_\_\_
In situ carcinoma consists of ductal carcinoma in situ and lobular carcinoma in situ
46
Describe in situ carcinoma
In situ carcinoma * In situ: in its original place or position * Carcinoma: cancer arising from epithelial cells * Noninvasive: has not penetrated the limiting basement membrane and remains within this normal boundary (intact outer layer of myoepithelial cells) * Arise from terminal duct lobular unit Relative risk of cancer is 8-10x
47
Ductal carcinoma in situ \_\_\_
Ductal carcinoma in situ fills and disorts duct spaces
48
Lobular carcinoma in situ \_\_\_\_
Lobular carcinoma in situ expands but does not alter acini of lobules
49
Ductal carcinoma is frequently associated with \_\_\_\_
Ductal carcinoma is frequently associated with calcifications (secretory material or necrotic debris) (5% in unscreened and 40% in screened populations)
50
Describe pathology of ductal carcinoma in situ
Ductal carcinoma in situ pathology * Architectural patterns: solid, cribriform, papillary * Comedo: extensive central necrosis * Nuclear grade * Low (bland and monotonous): cells look like each other * High (pleimorophic cells): cells with varying sizes and shapes
51
Lobular carcinoma in situ is rarely associated with \_\_\_
Lobular carcinoma in situ is RARELY associated with calcifications (incidental)
52
Describe pathology of lobular carcinoma in situ
Lobular carcinoma in situ pathology * Uniform monomorphic cells with bland round nuclei in loosely cohesive clusters * Intracellular mucin
53
This is \_\_\_ Treatment involves \_\_\_
This is ductal carcinoma in situ Treatment involves surgery
54
Invasive breast carcinoma consists of ___ and \_\_\_
Invasive breast carcinoma consists of invasive ductal carcinoma and invasive lobular carcinoma * Invasive: has penetrated the limiting basement membrane, spreading beyond it, and infiltrating into the stroma * Characterized by a lack of the outer layer of myoepithelial cells: negative for myoepithelial cell makrers such as p53 and smooth muscle myosin heavy chain * Desmoplastic stroma: pale blue-gray stroma reacting to the infiltration
55
Hard palpable fixed breast that comprises 70-80% of all breast cancers is \_\_\_\_
Hard palpable fixed breast that comprises 70-80% of all breast cancers is invasive ductal carcinoma
56
Describe pathology of invasive ductal carcinoma
Invasive ductal carcinoma pathology * Well developed tubules with low grade nuclei to sheets of pleomorphic cells * 2/3 express estrogen receptor (ER) and progesterone receptor (PR) and 1/3 overexpress HER2
57
\_\_\_\_ comprise 20% of all breast cancers and 10-20% are bilateral
Invasive lobular carcinoma comprise 20% of all breast cancers and 10-20% are bilateral
58
Describe pathology of invasive lobular carcinoma
Invasive lobular carcinoma pathology * Cells identical to atypical lobular hyperplasia and lobular carcinoma in situ * Mutations in E-cadherin (surface protein that allows for normal cohesion of breast epithelium) * Invade individually and aligned in single file strands * Almost all epxress ER and PR, rarely overexpress HER2 * Metastasis: CSF, serosal surfaces, GI tract, ovary, uterus, bone marrow
59
This is \_\_\_
This is invasive ductal carcinoma

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