16.1 - 16.4: Breast Pathology Flashcards
1
Q
Breasts are derived from what layer, embryologically?
A
Skin layer
2
Q
What is the milk line, and what is its significance?
A
The line from the axilla to the vulva, where the breasts develop from. This is where extra nipples can develop from
3
Q
What is the functional unit of the breast?
A
Terminal duct-lobular unit—lobules make milk that drains via ducts to the nipple
4
Q
All ducts and lobules of the breast have two layers of epithelium. What are these? What is the function of each?
A
- Luminal cell layer–protect the duct
- Myoepithelial cell layer–responsible for contraction of the duct during milk ejection
5
Q
The highest density of breast tissue is where, anatomically?
A
Upper outer quadrant
6
Q
What causes the breast TTP during menstruation?
A
Estrogen
7
Q
What is galactorrhea?
A
Milk production OUTSIDE of lactation
8
Q
True or false: galactorrhea is a symptom of breast cancer
A
False–never a s/sx
9
Q
What causes milk ejection?
A
Nipple stimulation
10
Q
What pituitary pathology can cause galactorrhea?
—-
A
Prolactinoma
11
Q
What is the most common pathogen that causes acute mastitis?
A
S. Aureus
12
Q
What makes breast tissue susceptible to mastitis with breast feeding?
A
Cracked develop during suckling, that allows for entry of pathogens
13
Q
What are the s/sx of mastitis?
A
- Erythema
- Purulent nipple d/c
14
Q
What is the treatment of mastitis? (2)
A
- Drainage (continue BF)
- ABX
15
Q
What is the classic abx used in the treatment of mastitis?
A
Dicloxacillin
16
Q
Should a woman who has mastitis continue breast feeding?
A
Yes–drains the area
17
Q
What is periductal mastitis? In whom is it usually seen? How does it present?
A
- Inflammation of the subareolar ducts
- Usually seen in smokers
- Subareolar mass with nipple retraction
18
Q
What type of epithelium lines the areolar ducts?
A
Columnar
19
Q
What vitamin is the epithelium of the breast ducts dependent on? What is the significance of this?
A
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
20
Q
What causes the retraction seen with periductal mastitis?
A
Granuloma formation behind the nipple d/t chronic inflammation causes the recruitment of fibroblasts, and the retraction of the skin
21
Q
What is mammary duct ectaisa?
A
Rare inflammation of the subareolar ducts that causes dilation of the subareolar ducts,
22
Q
In whom does mammary duct ectasia develop in?
A
Multiparous, postmenopausal women
23
Q
Green-brown nipple discharge = what breast pathology?
A
Mammary duct ectasia
24
Q
What is the classic d/c associated with mammary duct ectasia?
A
Green-brown nipple discharge
25
What are the classic histological findings of mammary duct ectasia?
Chronic inflammation with plasma cells
26
Chronic inflammation with plasma cells on bx of the breast is indicative of what pathology?
Mammary duct ectasia
27
What is the usual cause of fat necrosis of the breast?
Trauma
28
How does fat necrosis of the breast usually present?
Mass on exam or calcification on mammography
29
What will biopsy of fat necrosis of the breast show?
Necrotic fat with associated calcification and giant cells
30
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What causes the calcification of fat necrosis?
-----
Saponification-addition of Ca to fat necrosis
31
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
32
In whom are fibrocystic changes of the breast most common? Why?
Premenopausal women--d/t wide variations in estrogen levels
33
What are the characteristic clinical findings of fibrocystic changes?
Lumpy breast in the upper, outer quadrant
34
What are the gross characteristics of fibrocystic changes?
Blue-domed cyst appearance on gross exam
35
Blue-domed appearance of a breast mass = ?
Fibrocystic changes
36
True or false: Fibrocystic change of the breast is benign, and carries NO increased risk for breast cancer
True
37
True or false: Fibrocystic change of the breast *with apocrine metaplasia* is benign, and carries NO increased risk for breast cancer
True
38
What is the one exception to the rule that metaplasia increases the risk for dysplasia?
Apocrine metaplasia
39
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
40
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
41
Does atypical hyperplasia of the breast increase the risk of developing into cancer? If so, which type?
Yes--5x for invasive carcinoma
42
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
43
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
44
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
45
What are the two cell types that form the intraductal papilloma?
Ductal epithelial cells, and the myoepithelial cells
46
In whom are intraductal papillomas usually seen in? Intraductal papillary carcinoma?
- Premenopausal woman = papilloma
| - Postmenopausal woman = carcinoma
47
What is the key histological difference between the intraductal papilloma and intraductal papillary carcinoma?
Lack of myoepithelial cells with intraductal papillary carcinoma
48
What are fibroadenomas?
Benign tumor of fibrous tissue and glands
49
What is the most common benign neoplasm of the breast?
Fibroadenoma
50
What are the clinical features of fibroadenomas?
Well circumscribed, mobile, marble-like mass
51
Are fibroadenomas estrogen sensitive?
Yes
52
Is there a risk for the development of carcinomas from fibroadenomas? If so, which type?
No
53
What are the general histological characteristics of fibroadenomas?
Glandular tissue encapsulated in fibrous tissue (sharply demarcated)
54
What are Phyllodes tumors?
Fibroadenomas-like tumors with *overgrowth of the fibrous component*
55
What are the classic histological findings of phyllodes tumors? What causes this?
Leaf-like projection--Fibrous tissue pushes out
56
Leaf-like projections on histology from a breast mass = ?
Phyllodes tumor
57
In whom are phyllodes tumors most commonly seen?
Postmenopausal women
58
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Are Phyllodes tumors malignant?
----
Can be
59
What are the the top three cancers by incidence?
1. Breast/prostate
2. Lungs
3. Colorectal
60
What are the top three cancers by mortality?
1. Lungs
2. Breast/prostate
3. Colorectal
61
All of the risk factors for the development of breast cancer generally involve what?
Higher estrogen exposure
62
Why is obesity related to breast cancer?
Adipose converts androgens to estrone
63
What are the relatives who, if they have cancer, increase the risk for you to develop cancer?
Mother, sister, daughter (1st degree relatives)
64
What is Paget's disease of the nipple? How does it present?
DCIS that grows to involve the duct and skin
Presents as a nipple ulceration and erythema
65
What does DCIS become when it invades the BM?
IDC (invasive ductal CA)
66
What is ductal carcinoma in situ?
Tumor of the mammary ducts that has NOT invaded the basement membrane
67
How is DCIS appear on mammography?
Calcifications
68
What is comedocarcinoma? Why does it occur?
- DCIS that has caseous necrosis
| - Occurs because there is no blood supply to the center of the duct
69
Can you feel DCIS?
No--need mammogram
70
What are the two benign lesions of the breast that can show calcifications on mammography?
- Fat necrosis
| - Sclerosing adenosis
71
What are the histological characteristics of Paget's disease of the nipple?
Large cells with a clear halo about the nucleus
72
What is the most common type of invasive breast cancer?
Invasive ductal carcinoma
73
What are the clinical features of invasive ductal carcinoma?
Presents as a mass with dimpling of the skin or retraction of the nipple
74
What are the histological characteristics of ductal carcinoma?
Duct-like structures in a desmoplastic stroma
75
Duct-like structures in a desmoplastic stroma = which breast pathology?
invasive ductal carcinoma
76
What are the four subtypes of ductal carcinoma?
- Tubular
- Mucinous
- Medullary
- Inflammatory
77
What is the prognosis for the tubular subtype of ductal carcinoma?
Good
78
What are the histological characteristics of the tubular subtype of ductal carcinoma?
Tubular structures within a sea of desmoplasia and fibrous tissue
79
What are the histological characteristics of the mucinous subtype of ductal carcinoma?
Mucinous glands in a ton of mucus
80
What is the prognosis for the mucinous subtype of ductal carcinoma?
Good ("can't go anywhere because stuck in mucus")
81
What are the clinical features of inflammatory ductal carcinoma? What causes this?
Peu d'orange--inflammation of the breast d/t blockage of the dermal lymphatics
82
What are the histological characteristics of inflammatory carcinoma?
Neoplastic cells within the lymphatics
83
What two pieces do you need to diagnose inflammatory carcinoma? What is the prognosis?
-Histological findings + clinical inflammation
Poor prognosis
84
Inflammatory carcinoma of the breast looks similar clinically to what pathology? What may lead you to suspect carcinoma?
- Mastitis
| - Failure of mastitis to resolve with abx
85
What are the histological characteristics of medullary carcinoma of the breast?
High grade Atypia in a sea of inflammatory cells
86
BRCA1 mutations have a large increase in what type of breast cancer?
Medullary subtype of invasive ductal carcinoma
87
What is lobular carcinoma in situ?
Tumor of the lobules of the breast that have not invaded the BM
88
Does LCIS produce mass or calcification?
No
89
True or false: LCIS is usually multifocal, and bilateral
True
90
What is the classic histological characteristic of LCIS? Why does this occur?
Dyscohesive cells in the lobules d/t a lack of E-cadherin
91
What is the protein that LCIS lacks? What histological characteristics does this cause?
- E-Cadherin
| - Discohesive
92
What is the major significance of lobular carcinoma in situ?
Major risk factor for the future development of breast cancer
93
What is the treatment for LCIS? What is not? Why?
- Tamoxifen
| - Not resected, since it is a risk factor for CA, not CA in itself
94
What is the MOA of tamoxifen? Trastuzumab?
- Tamoxifen = ER receptor antagonist
| - Trastuzumab = Her2/neu receptor antagonist
95
Is the risk for LCIS developing into cancer high or low
Low risk factor
96
What are the histological characteristics of *invasive* lobular carcinoma? Why?
- Grows in a single file pattern (indian file)
| - Lack of E-Cadherin
97
What is the single most important prognostic factor for breast cancer (in terms of TNM staging)?
Metastases
98
What is the single most **useful** prognostic factor for breast cancer? Why?
- Spread to lymph nodes
| - More useful than mets, since most patients do not present with mets
99
What is the means by which we ascertain if there is spread of breast cancer via the lymphatic system? How does this work?
Sentinel lymph node biopsy--inject radioactive dye and assess which tier of lymph nodes has cancer
100
What are the three key prognostic factors for the responsiveness of breast cancer to therapy?
- ER+
- PR+
- HER2/neu gene amplification
101
What is the cause of upregulation of the HER2/neu receptor?
Gene amplification
102
Why is it that ER or receptor tagging leads to the development of dark nuclei? Why is this not seen with HER2/neu?
- The receptors translocates to the nucleus to alter gene expression
- HER2/neu is a surface receptor
103
What is triple negative breast cancer, and what is the prognosis for this? In what ethnicity is this usually seen in?
- HER2/neu -, ER- and PR- breast cancer-----poor prognosis
| - African americans
104
Tumor at a premenopausal age is suggestive of what sort of cancer etiology?
Hereditary
105
Multiple tumors is suggestive of what sort of cancer etiology?
Hereditary
106
BRCA1 gene mutation increases the risk for what two cancers?
Breast and ovarian
107
BRCA2 mutation increases the risk for what cancer?
Breast carcinoma in males
108
What type of ovarian cancer odes BRCA1 predispose patients to?
Serous cystadenoma and fallopian tube tumors
109
Why doesn't prophylactic mastectomy reduce the risk for breast cancer to 0?
Usually still breast tissue remaining in axilla or pectoralis muscles
110
Where, anatomically, does male breast cancer develop?
Subareolar mas under the nipple
111
What type of breast cancer do males usually get? Why? What are the two hereditary etiologies of male breast cancer?
- Invasive ductal CA (no lobules for CA to develop in)
| - BRCA2 or Klinefelter syndrome
112
What is the genotype for Turner's syndrome? klinefelters?
- Turners = X0
| - Klinefelters = XXY
