22 - Breast

Question 1

Multifocal, bilateral blue-brown cysts (blue dome cysts) of the breast, measuring 1-5 cm diameter, filled with serous turbid fluid. Occurs normally in the menstrual cycle; histologically, cysts are lined with large and polygonal with abundant granular, eosinophilic cytoplasm and small, round, deeply chromatic nuclei (apocrine metaplasia); almost always benign.

Answer 1

Fibrocystic change

Question 2

Defined as having more than two layers of lining epithelium (normally, one layer for luminal, and another for myoepithelial cells).

Answer 2

Epithelial hyperplasia

Question 3

Type of fibrocystic change characterized by proliferation of luminal spaces (adenosis) lined by epithelial cells and myoepithelial cells with massive stromal fibrosis; important as it appears like carcinoma.

Answer 3

Sclerosing adenosis

Question 4

Clinically presents with bloody or serous discharge; tumors usually are solitary and less than 1 cm in diameter, consisting of delicate, branching growths within a dilated duct; microscopically, composed of multiple papillae, each having a connective tissue core covered by double layer of epithelial cells (important distinguishing point from carcinoma counterpart).

Answer 4

Intraductal papilloma

Question 5

These are stellate lesions characterized by a central nidus of entrapped glands in a hyalinized stroma; important as it appears like carcinoma

Answer 5

Complex sclerosing lesion/Radial scar

Question 6

Basically, DCIS without full duct involvement; involves monomorphic proliferations of cells (vs. heterogeneous in epithelial hyperplasia).

Answer 6

Atypical ductal hyperplasia (ADH)

Question 7

Basically, LCIS but <50% of acini in a lobule are involved; composed of monomorphic, loosely cohesive cells, with absence of E-cadherin.

Answer 7

Atypical lobular hyperplasia (ALH)

Question 8

Most common location of breast carcinoma.

Answer 8

Upper outer quadrant (50%)

Question 9

The two non-invasive breast carcinomas; both of which arise from terminal duct lobular unit (TDLU).

Answer 9

Ductal CIS (DCIS) and Lobular CIS (LCIS)

Question 10

Immunostain to determine presence of myoepithelial layer; an important immunostain to distinguish in situ disease from infiltrating carcinomas.

Answer 10

p63

Question 11

A distinct type of DCIS characterized by highly pleomorphic nuclei of cells (high-grade nuclei) with extensive central necrosis; with calcifications either from calcified necrotic debris or secretory material.

Answer 11

Comedocarcinoma

Question 12

Clinically presents as an eczematoid lesion on the breast; associated with an invasive carcinoma in most cases; cause is an underlying DCIS that extended up to the lactiferous ducts and skin.

Answer 12

Paget disease of the nipple

Question 13

CIS composed of monomorphic cells with bland round nuclei (low-grade nuclei) that occur in loosely cohesive clusters within the lobules; tend be more commonly bilateral.

Answer 13

LCIS

Question 14

Most common of the infiltrating carcinomas; associated more with DCIS; characterized with intense desmoplasia that produces a hard palpable mass; microscopically, ranges from well-differentiated (tubule formation) to poorly differentiated (sheets of anaplastic cells); 50-65% are ER(+), HER2 (+) (luminal).

Answer 14

Invasive (ductal) carcinoma (No special type)

Question 15

The system used in grading invasive carcinomas of no special type.

Answer 15

Nottingham system (Tubule formation, Nuclear grade, and Mitosis)

Question 16

Infiltrating carcinoma with cells looking like those seen in LCIS; only in single-file conformation (Indian filing); reflecting loss of E-cadherin function, a molecule necessary for cohesion of breast epithelial cells; associated with adjacent LCIS in 2/3 of cases.

Answer 16

Invasive lobular carcinoma

Question 17

Clinically presents as an enlarged, swollen, erythematous breast with a palpable mass; histologically high-grade; involves dermal lymphatic spaces, which explains the characteristic peau d’orange appearance; poor prognosis.

Answer 17

Inflammatory carcinoma

Question 18

Infiltrating carcinoma composed of sheets large anaplastic cells, with increased mitosis, with well-circumscribed pushing borders with a pronounced lymphoplasmacytic infliltrate; increased incidence in patients with BRCA1 mutations; usually triple-negative breast cancer; poor prognosis.

Answer 18

Medullary carcinoma

Question 19

The most common benign neoplasm of the female breast; grossly, discrete, usually solitary, freely movable nodule, 1 to 10 cm in diameter, easily shelled out lesion of the breast; histologically there is a loose fibroblastic stroma containing duct-like, spaces lined by a layer of epithelium that are regular and have a well-defined, intact basement membrane.

Answer 19

Fibroadenoma

Question 20

Biphasic tumor composed of highly cellular stromal elements forming leaf-like projections and epithelial elements; usually benign and localized; ominous changes suggesting malignancy include increased stromal cellularity, anaplasia, high mitotic activity, rapid increase in size, and infiltrative margins.

Answer 20

Phyllodes tumor

Question 21

Characterized by increase in connective tissue and epithelial hyperplasia of the ducts; lobule formation is rare.

Answer 21

Gynecomastia

Question 22

Reason why male breast cancer tend to have less favorable prognosis than female breast cancer.

Answer 22

Less tissue for the tumor to invade in order to produce metastases