192- Histopath of the breast

Question 1

Normal breast anatomy: duct system

Answer 1

lobules come together to form terminal ducts which form major ducts which dilate to form lactiferous sinus right below the nipple

Question 2

three basic histological parts of breast

Answer 2

the purple (TDLU) the pink (stroma) and the white (fat)

Question 3

histology of TDLU. Where do most problems arise

Answer 3

Dual cell layer: inner epithelial cells (milk producing) and outer myoepithelial cells (for milk ejection). Majority of pathologies arise from epithelial cells in the TDLU

Question 4

Normal changes of breast

Answer 4

Menstrual: increasing vacuolation of myoepithelial cells
Lactation: proliferation of epithelial cells and increase in number of lobular units. Glandular tissue almost completely replaces fat and CT
Post-menopausal: increase in fat and CT

Question 5

Acute mastitis: when? why? what causes?

Answer 5

breast abcesses during breast feeding. S. aureus infection thru cracks in nipple

Question 6

Fibrocystic diseases: how do they present? types?

Answer 6

premenstrual pain and multiple lesions fluctuating in size. Fibrosis, cystic, sclerosing adenosis, epithelial hyperplasia

Question 7

sclerosing adenosis: what is it?

Answer 7

type of fibrocystic disease. Increase in number of acini and intralobular fibrosis. Associated with calcifications

Question 8

epithelial hyperplasia: what is it? characteristics? cancer risk?

Answer 8

Type of fibrocystic dz. increase in # of epithelial cell layers in TDLU. if it is atypical it can increase risk of CA. Occurs in women >30

Question 9

What drugs can cause gynecomastia

Answer 9

Some Drugs Create Awkward Knockers. Spironolactone, digitalis, cimetidine, alcohol, ketoconazole

Question 10

apocrine metaplasia

Answer 10

lots of eosinophils with granular cytoplasm

Question 11

Fibroadenoma: characteristics, epidemiology, Changes? cancer?

Answer 11

small, mobile, firm with sharp edges. Most common tumor <35 y/o. Increases size and tenderness with estrogen (pregnancy, menstruation). Not cancer precursor

Question 12

intraductal papilloma: characteristics, presentation, cancer

Answer 12

small tumor growing inside a dilated duct, usually beneath areola. Serous or bloody discharge. Slight risk of CA

Question 13

differentiate usual hyperplasia and atypical hyperplasia

Answer 13

Usual has cellular variability with irregular secondary spaces. Atypical has same type of cells with uniform spacing and is much more organized

Question 14

phyllodes tumor: characteristics, who gets it, cancer risk

Answer 14

large mass of CT and cysts. “leaf-like” projections of intralobular stroma. Most common in post-menopausal. Can become malignant so should be excised