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PA3201 final > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

What is the lactiferous duct and sunis

A

duct- opens into the nipple

sinus- subadjecent to the nipple (dilation of the duct)

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2
Q

What are the two types of breast tissue

A

Epithelial

Stromal

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3
Q

What is the epithelial component of the breast tissue and why is it pathologically significant

A

<10% of total volume, contains the terminal duct lobular unit
-most lesions arise from epithelial tissue

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4
Q

What is the stromal component of the breasts and two sub divisions

A

Supportive stroma- loose connective tissue/adipose tissue

stromal tissue divides the breast into lobules creating interlobular and intralobular stroma

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5
Q

What is the dif between interlobular and intralobular stromal tissue

A

Intra- enclose each lobule, its acini and ducts, chiefly loose connective tissue/lymphocutes

Inter- separates one lobule from other- Adipose tissue, some connective tissue

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6
Q

What does more connective tissue and adipose tissue do in breasts

A

more connective tissue-> stops spread of cancerous growth

More adipose tissue-> invasive lesions can easily spread as adipose tissue ins less dense

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7
Q

Where is the most common loc for breast pathology

A

Upper outer quad is most dense and thus mc loc for breast cancer

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8
Q

Where does the upper outer quad and internal quad drain for breast tissue

A

Upper outer- Drains into axillary lymph nodes

Internal- Drains into internal mammary lymph nodes

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9
Q

What is galacteorrhea

A

Nipple discharge (may be a sign of breast pathology

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10
Q

What does bloody, purulent and greenish/brown discharge indicate

A

Bloody- typical for intraductal papilloma

Purulent- usually due to acute mastitis

Green/brown- Mammary duct ectasia

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11
Q

What is acute mastitis and two tyoes

A

Acute inflammation of the breast

Lactational mastitis- localized, painful inflammation of the breast associated with fever and malaise in breast-feeding women

Non lactational- Inflammation in non breast feeding women

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12
Q

What is granulomatous mastitis and what is it caused by

A

Tuberculous matasis- solitary, ill defined, unilateral hard lump

Breast implant- Rupture and leakage of SBI into surrounding tissue evokes chronic inflammatory process and later granulomatous inflammation

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13
Q

What is mammary duct extasia + age

A

occurs at 40-70

Periductal inflammation, elastic tissue destruction, resulting in duct ectasia and periductal fibrosis

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14
Q

What is galactocele

A

Cystic dilation of one or more ducts occurring during lactation

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15
Q

What is the mc benign breast condition

A

Fibrocystic change is the most common benign breast condition (lumpy breast presentation)

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16
Q

Fibrocystic change of the breasts features

A
  • cysric dilation of terminal ducts
  • relative increase in inter and intra lobular fibrous tissue
  • formation of cysts of varying sizes
  • most often in upper/outer quad

Palpable mass or modularity

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17
Q

What are the proliferative changes in fibrocystic breast conditions

A

Epithelial hyperplasia or epithliosis
–increase in the layers of epithelial cells over the basement membrane to three or more layer in the ducts (dictal hyperplasia) or lobules (lobular hyperplasia)

18
Q

How much of an increased relative risk of developing breast cancer if you have general proliferative changes or Proliferative fibrocystic changes

A

General= 1.5-2 fold increase

Proliferative= 4-5 fold

19
Q

Fibrocystic change vs breast cancer; side, nodules, menstural changes, pregnancy change, pain

A

Fibrocystic

  • bilateral
  • multiple nodules
  • menstural variation
  • cyclic pain
  • may regress during preg
20
Q

What are the benign neoplasms of the breast

A

Fibroadenoma (mc <35)
Phyloodes tumor (60s)
Intraductal papilloma

21
Q

What is a fibroademoma

A

Benign neoplasm

  • Palpable round moveable rubbry mass
  • increase in size during preg
  • may spontaneously disappear during preg
22
Q

What is phyllodes tumor

A

benign neoplasm (also called serocystic disease of Brodie)

-uncomon bulky leaf like tumor w aggressive clinical behaviour

23
Q

What is a intraductal papilloma

A

Benign neoplasm

-commonly presents as a bloody nipple discharge

24
Q

Risk factors of malig neoplasms of the breast

A
  • Age
  • First degree relative
  • long/intense estrogen exposure (endogenous, exogenous)
  • previous proliferative fibrocystic changes (especially atypical hyperplasia)
25
Q

What genetic muattions put you at a higher risk of Breast cancer

A

BRCA 1 (located on ch17)- found in 2/3 women w inherited breast and ovarian cancer

BRCA 2 (located on Ch 13)

Mutation in p53 tumor suppressor gene (ch17)

26
Q

What is Li Fraumeni syndrome and what causes It

A

is an inherited autosomal dominant disorder that is manifested by a wide range of malignancies that appear at an unusually early age

Associated w p53 mutations

27
Q

Additional risk factors of breast cancer

A
  • consumption of large amounts of animal fat
  • cigs
  • breast augmentation
  • alcohol
  • ionizing radiation
28
Q

What are the 2 classifications of carcinoma of the breast

A

Non invasive carcinoma- more favourable outcomes

invasive carcinoma- has propensity to invagde and metastasize in surrounding lymph nodes and other tissues

29
Q

What are the breast cancer varients and mc form

A
  • Pre invasive
  • Invasive ductal (MC)
  • Invasive lubular
  • Mucunous
  • tubular
  • medullary
30
Q

Infiltrating duct carcinoma fx

A

Diffusly infiltrating timor

-microscopic features include formatin of solid nests, cords, gland like streatcures, densely collegnized

31
Q

Invasive lobular carcinoma features

A

one wide fules of round regular tumor cells, infiltrating the stroma and arranged circumferentially around ducts

32
Q

Medullary carcinoma gross pathology

A

large grey white soft fleshy tumour replacing almost whole of the breast

-microscopically shows large tumor cells forming syncytuial arrangement and stroma infiltrated richly with lymphocytes

33
Q

4 common sites of metastisis of breast cancer

A

Brain
Bones
Lungs
Liver

34
Q

What constitutes a triple negative breaast cancer

A

Defined by absent expression of:

  1. Estrogen receptor
  2. Progesterone receptor
  3. HER2
  • these tend to be more aggressive than other types of breast cancer
  • no targeted tx
35
Q

What is paget disease of the nipple and what is it associated w

A

presents as an exzematous eruption on the nipple and areola

-associated with an underlying invasive intraductal carcinoma

36
Q

What determines prognosis of breast cancer

A 
Axllary lymp node status
Size of tumor
Histological type and grade of tumor
Estrogen and progesterone receptor status
Overexpression of c-erbB2
37
Q

What is the role of estrogen and progesterone receptor testing

A
  • if a cancer is fed by estrogen its called estrogen receptor positive
  • if cancer is fed by progesterone its called progesterone receptor positive

-this shows that it can be tx with hormonal therapies

38
Q

What % of cancers are ER+ and PR+

A

75% are ER+
65% are PR+
-the more hormone receptos the cancer cells have the better their response to hormone therapy

39
Q

What is gynecomastia

A

Benign condition that causes hypertrophy of male breast

-enlargement mainly due to ducts proliferation and periductal stroma

40
Q

Causes of gynecomastia

A

Disease associated with increased estrogen levels or decreased androgen levels

  • Klinefelter
  • idiopathic
  • side effect of drugs
41
Q

What type of breast cancers are mc in men (compared to women)

A

men= invasive ductal carcinomas

women=lobular carcinomas

PA3201 final (20 decks)

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