16.1 - 16.4: Breast Pathology Flashcards
Breasts are derived from what layer, embryologically?
Skin layer
What is the milk line, and what is its significance?
The line from the axilla to the vulva, where the breasts develop from. This is where extra nipples can develop from
What is the functional unit of the breast?
Terminal duct-lobular unit—lobules make milk that drains via ducts to the nipple
All ducts and lobules of the breast have two layers of epithelium. What are these? What is the function of each?
- Luminal cell layer–protect the duct
- Myoepithelial cell layer–responsible for contraction of the duct during milk ejection
The highest density of breast tissue is where, anatomically?
Upper outer quadrant
What causes the breast TTP during menstruation?
Estrogen
What is galactorrhea?
Milk production OUTSIDE of lactation
True or false: galactorrhea is a symptom of breast cancer
False–never a s/sx
What causes milk ejection?
Nipple stimulation
What pituitary pathology can cause galactorrhea?
—-
Prolactinoma
What is the most common pathogen that causes acute mastitis?
S. Aureus
What makes breast tissue susceptible to mastitis with breast feeding?
Cracked develop during suckling, that allows for entry of pathogens
What are the s/sx of mastitis?
- Erythema
- Purulent nipple d/c
What is the treatment of mastitis? (2)
- Drainage (continue BF)
- ABX
What is the classic abx used in the treatment of mastitis?
Dicloxacillin
Should a woman who has mastitis continue breast feeding?
Yes–drains the area
What is periductal mastitis? In whom is it usually seen? How does it present?
- Inflammation of the subareolar ducts
- Usually seen in smokers
- Subareolar mass with nipple retraction
What type of epithelium lines the areolar ducts?
Columnar
What vitamin is the epithelium of the breast ducts dependent on? What is the significance of this?
Smokers lose the ability to use Vit A, causing the breast ductal tissue to turn to squamous.
This metaplasia to squamous causes an increase in keratin, which can clog the ducts and cause periductal mastitis
What causes the retraction seen with periductal mastitis?
Granuloma formation behind the nipple d/t chronic inflammation causes the recruitment of fibroblasts, and the retraction of the skin
What is mammary duct ectaisa?
Rare inflammation of the subareolar ducts that causes dilation of the subareolar ducts,
In whom does mammary duct ectasia develop in?
Multiparous, postmenopausal women
Green-brown nipple discharge = what breast pathology?
Mammary duct ectasia
What is the classic d/c associated with mammary duct ectasia?
Green-brown nipple discharge
What are the classic histological findings of mammary duct ectasia?
Chronic inflammation with plasma cells
Chronic inflammation with plasma cells on bx of the breast is indicative of what pathology?
Mammary duct ectasia
What is the usual cause of fat necrosis of the breast?
Trauma
How does fat necrosis of the breast usually present?
Mass on exam or calcification on mammography
What will biopsy of fat necrosis of the breast show?
Necrotic fat with associated calcification and giant cells
What causes the calcification of fat necrosis?
—–
Saponification-addition of Ca to fat necrosis
What is fibrocystic change of the breast? What causes this?
The development of cysts around the lobules of the mammary ducts, resulting in stress on the stroma, and resulting fibrosis
Variations in estrogen levels
In whom are fibrocystic changes of the breast most common? Why?
Premenopausal women–d/t wide variations in estrogen levels
What are the characteristic clinical findings of fibrocystic changes?
Lumpy breast in the upper, outer quadrant
What are the gross characteristics of fibrocystic changes?
Blue-domed cyst appearance on gross exam
Blue-domed appearance of a breast mass = ?
Fibrocystic changes
True or false: Fibrocystic change of the breast is benign, and carries NO increased risk for breast cancer
True
True or false: Fibrocystic change of the breast with apocrine metaplasia is benign, and carries NO increased risk for breast cancer
True
What is the one exception to the rule that metaplasia increases the risk for dysplasia?
Apocrine metaplasia
Is ductal hyperplasia of the breast benign or malignant? Does it carry an increased risk for cancer? If so, which type?
Benign, but there is a 2x risk for the development of invasive carcinoma
What is sclerosing adenosis of the breast, and is it benign or malignant? Does it carry an increased risk for cancer? If so, which type?
- Increase in glands and surrounding stromal tissue
- Benign, but there is a 2x risk for the development of invasive carcinoma
Does atypical hyperplasia of the breast increase the risk of developing into cancer? If so, which type?
Yes–5x for invasive carcinoma
What is sclerosing adenosis of the breast? Is there a risk of this developing into cancer? How is this often detected, and why?
- Proliferation of glands (adenosis) with fibrosis of the stroma between them (sclerosis)
- Benign, but increases risk for ca x2
- Found on mammography d/t Ca deposition
True or false: benign lesions of the breast that carry an increase in the chances of cancer, increase the risk for the development of cancer in BOTH breasts, regardless of which breast the lesion was seen in
True
What is an intraductal papilloma? What is the classical presentation of this, and why?
- Growth of ductal epithelial cells into the duct, with a fibrovascular core.
- Bloody nipple discharge, since the growth is vascularized, and fragile