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Patho > 26. Diesease Of The Breast > Flashcards

26. Diesease Of The Breast Flashcards

1
Q

2 breasts with the following sets of characteristics
2 mammary ridges- Right and left(highly modified, evolved apocrine sweat glands)
2 structures –TDLU( functional unit) + large ducts(transport)
2 cell lining – Epithelial and myoepithelial
2 stroma- Interlobular and intralobular
2 ovarian hormone- Progesterone and estrogen
2 pituitary hormone- Prolactine and oxytocine

A
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2
Q

developmental anomalies

A

milk line remenant
accessory axillary tissue
congenital nipple inversion
macromastia

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3
Q

Galactorrhea
define
causes
duration

A

Milk production outside of lactation
Abnormal if it persists for longer than 6 months after childbirth or discontinuation of breastfeeding
Causes include nipple stimulation (common physiologic cause), prolactinoma of the anterior pituitary (common pathologic cause), and drugs

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4
Q

what hormone stops or antagonized prolactin

A

dopamine

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5
Q

types of inflammation of breast mastistis

A

acute mastitis

periductal mastitis

duct ectasia

fat necrosis

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6
Q

Acute Mastitis
define
cause

A

S aureus is most common pathogen followed by streptococci.
Staphylococci - single or multiple abscesses
Streptococci - cellulitis
Treatment with antibiotics and continue breastfeeding.

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7
Q

acute mastistis presents as

A

Presents as an erythematous painful breast with purulent nipple discharge may progress to abscess formation.

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8
Q

periductal mastitis
aka
risk factor
presents as
develop to

A

AKA SMOLD squamous metaplasia of lac. duct (recurrent subareolar abscess, periductal mastitis, and Zuska disease).
> 90% are smokers
Relative deficiency of vitamin A associated with smoking or toxic substances in tobacco smoke alters the differentiation of the ductal epithelium
Painful erythematous subareolar mass with nipple retraction
Rarely develop in to squamous cell carcinoma

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9
Q

Duct ectasia

A

Dilation of the subareolar ducts
Palpable periareolar mass that is often associated with thick, white (green-brown) nipple secretions and occasionally with skin retraction
In the fifth or sixth decade of life, usually in multiparous women
Not associated with cigarette smoking

chronic inflammation with dilation

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10
Q

pathogenesis of duct ectasia

A

chronic inflammation

duct obstruction by inf. cells

dilation of duct

statis of secretions

inflammation again

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11
Q

Fat necrosis
cause
presentation

A

Necrosis of breast fat
Usually related to trauma (like biopsy, surgery etc….) Up to 50% of patients may not report trauma.
Presents as a mass on physical exam or abnormal calcification on mammography (due to saponification).

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12
Q

benign tumors of breast

A

fibroadenoma
phyllodes tumor
fibrocytic change

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13
Q

Fibroadenoma(FA)
epidemology
presents as
age
hormonally responsive or not

A

Commonest type of benign tumor of female breast.
Easily movable spherical masses in the breasts of young women in the 20- to 35-year- age group
Hormonally responsive (grows during pregnancy and late luteal phase, regresses after menopause) may be painful during the menstrual cycle.
By it self benign with no increased risk of carcinoma

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14
Q

fibroadenoma is known as what during clinical examination

A

breast mouse because it slips

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15
Q

Phyllodes tumor
name
define
age
arise
risk for carcinoma

A

Fibroadenoma like tumor with overgrowth of the fibrous component.
Most are found in women over 40 years of age (postmenopausal women).
Arises de novo (not from FA)
In contrast to fibroadenomas, the stroma of phyllodes tumors is hypercellular, and in 10% of cases it may be overtly malignant (overexpression of HOXB13).
Gain in ch1q

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16
Q

Non proliferative Breast Changes (Fibrocystic Changes)
epidemology
age
present as
place or laterality

A

Most common change in the premenopausal breast
20 and 40 years; peaks at or just before menopause
Presents as vague irregularity of the breast tissue (‘lumpy bumpy breast’) usually multiple and bilateral, mammographic densities/calcification or nipple discharge

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17
Q

fibrocytic change cycts have ………. appearance on gross exam

A

blue dome

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18
Q

Intraductal papilloma
define
present as
assoc. with cancer

A

Papillary growth, usually into a large duct typically beneath areola.

Classically presents as Unilateral serous or bloody nipple discharge in a premenopausal woman.

Benign, but associated with 1.5 to 2.0 x risk of Carcinoma, higher risk if multiple papilloma.

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19
Q

differnece between papilloma and papillary carcinoma
epithelial cell
myoepithelail cell
mainly in

A

present in both
present in papilloma
pre menopause in papilloma post in carcinoma

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20
Q

Gynecomastia
define
physologic and pathologic
risk for cancer

A

(Greek gyne, woman, and mastós, “breast”).
Breast enlargement in males is usually the result of an increased estrogen/ androgen ratio.
Physiologic in newborn, pubertal(2/3 of them), and elderly males.
Pathologic causes include cirrhosis, Klinefelter syndrome (40% of them), testicular tumors, and drugs (Spironolactone, Cimetidine, Finasteride, Ketoconazole).
The relative risk of breast cancer is increased in men with gynecomastia, although the absolute risk is relatively small.

21
Q

Proliferative Breast Disease With Atypia
define plus type

A

Atypical hyperplasia is a clonal proliferation having some, but not all, of the histologic features of carcinoma in situ.
Two forms, atypical ductal hyperplasia and atypical lobular hyperplasia.

22
Q

Carcinoma in situ
define
types in breast
may lead to

A

It is a Latin phrase that means “on-site”.
Neoplastic cells (malignant) limited to ducts and lobules by the basement membrane, doesn’t invade into lymphatics and blood vessels and cannot metastasize.
Two types DCIS and LCIS.
Both may display a variant called Paget’s disease of the nipple

23
Q

Ductal carcinoma insitu (DCIS)
define
laterality

A

Malignant proliferation of cells in ducts with no invasion of the basement membrane.
10-20% bilateral.
DCIS does not usually produce a mass and often detected as calcification on mammography.
Grade: low, intermediate, and high
Progression varies by grade: for low grade, 0-10% progress to invasive disease vs. 40% for high grade.

24
Q

Morphologic types of ductal carcinoma in situ (DCIS)

A

comedo very aggressive
cribriform
solid
micropapillary

25
Q

Lobular carcinoma in situ (LCIS)
define
presentation
laterality

A

Malignant proliferation of cells in lobules with no invasion of the basement membrane.
LCIS does not produce a mass or calcifications and is usually discovered incidentally on biopsy.
Characterized by discohesive cells lacking E-cadherin adhesion protein
Often multifocal (75%) and bilateral (40%).

26
Q

Paget disease of the nipple
from
appearnace
association

A

DCIS and rarely LCIS can spread from lactiferous ducts in to the contagious skin of nipple with out violating the basement membrane barrier.
Appears eczematous or ulcerated
Paget disease of the breast is almost always associated with an underlying in situ lesion or carcinoma (50% to 60% have underlying lump or mass).

27
Q

Breast cancer is the most common and the second deadly cancer in women.

The estimate is that 1 in 8 (9)women will develop breast cancer during her life span.

Breast cancer is rare in women younger than age 25 and increases in incidence rapidly after age 30

A
28
Q

which breast affected more rt or lt

A

left

29
Q

symptoms or presentations of breast cancer

A

skin dimpling
nipple retraction
edema peau de orange
abnormal contours

30
Q

risk factors for breats cancer

A

female
old
white jew
relative with breast cancer
early menarche
late menopause
no children

31
Q

risk factor for BC associated with other breast lesions

A

fibrocystic change
DCIS
cancer of other breast
atypical ductal and lobuar hyperplasia

32
Q

breast cancers list

A

Hereditary breast cancer

33
Q

Hereditary breast cancer
due to

A

10% of breast cancers
Multiple first-degree relatives with breast cancer, tumor at an early age, and multiple tumors
80–90% due to two BRCA1 and BRCA2

34
Q

BRCA 1 AND 2 difference

A

2 estrogen receptor positive

35
Q

Male breast cancer

A

Represents < 1% of all breast cancers(1:100=M:F)
Subareolar mass in older males
May produce nipple discharge
Associated with BRCA2 mutations and 3–8% associated with Klinefelter syndrome and decreased testicular function
Often presents at high stage since minimal breast substance ( chest wall and skin invasion early)
Share many features of female carcinoma with regards to risk factor, histologic type, and prognosis.

36
Q

Morphologic types of invasive carcinoma.

A

Invasive ductal carcinoma no special type (70-80%).

Special types: lobular carcinoma (10%), Medullary, Mucinous, Tubular, Papillary, Metaplastic Ca, etc…

37
Q

Invasive ductal carcinoma no special type

A

Nipple contraction. White tissue represents the fibrous (scirrhous) reaction.

Irregular solid groups of cells in a dense fibrous stroma, with an associated lymphocytic infiltrate.

38
Q

Infiltrating lobular carcinoma:

A

Infiltrating lobular carcinoma: Strands of single cells (Indian file) invade fibrous stroma without induction of a desmoplastic response

lack of E-cadherin

39
Q

Tubular carcinoma

A

Relatively good prognosis

40
Q

Mucinous (colloid) carcinoma

A

Tends to occur in older women (average age is 70 years)
Relatively good prognosis

41
Q

Medullary carcinoma

A

Grows as a well-circumscribed mass that can mimic fibroadenoma on mammography

Large groups of irregularly shaped high grade tumor cells in syncytial growth are surrounded by an infiltrate of lymphocytes and plasma cells.

67% there is hypermethylation of the BRCA1 promoter

Relatively good prognosis

42
Q

Invasive Paget disease

A
43
Q

Inflammatory breast cancer(carcinoma erysipeloides )

A

Presents classically as an inflamed, swollen breast with no discrete mass;

Lymphatic obstruction by tumor cells

Can be mistaken for acute mastitis

44
Q

Triple test

A

Clinical

Radiologic – Mammography(X-ray),US,CT/MRI.

Pathologic – Cytology (FNAC) and histopathologic(biopsy (core needle or open biopsy)).

45
Q

very poor prognosis in tests all tests

A

‘Triple-negative’ tumors are negative for ER, PR, and HER2/neu

46
Q

very good response

A

er pos
pr pos
her2 neg

47
Q

Based on gene expression profiling, breast cancers cluster into three main groups:

A

“luminal” (predominantly ER-positive/ HER2-negative),
“HER2-enriched” (predominantly HER2- positive), and
“basal-like” (predominantly ER-negative/ HER2-negative).

48
Q

Angiosarcoma

types

A

primary
and secondary

Patho (33 decks)

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