3- Breast Flashcards
What are symptoms of a malignant breast lesion
Retracted nipples (involves main excretory duct) Puckering
What are other signs of breast cancer
calcification on X-ray
Serous bloody nipple discharge
Hard, enlarged axillary nodes
Lymphedema and thick skin (peau d’orange)
What is Invasive Ductal carcinoma
firm and gritty tumor (no sharp margins) with hallmark Desmoplastic reaction
-Puckering and nipple retraction due to dance connective tissue pulling on adjacent tissue
What are a majority of invasive breast carcinomas
Invasive Ductal
What is a desmoplastic reaction
tumor cells infiltrating tissue are surrounded by dense connective tissue made by host in response to tumor
How are invasive and non-invasive ductal carcinomas different
Non-invasive lack ability to invade through BM= no distant spread– BUT, can spread through ductal system so it’s a precursor of invasive carcinoma
Invasive ductal invade through surrounding stroma
What are Invasive Lobular carcinomas
arise form terminal ductules of acini, more bilateral than invasive ductal
rubbery, poorly circumscribed, NO desmoplasia
What are characteristics of Invasive Lobular
Strands of single file malignant cells through storm with little pleomorphism Targeted pattern (solid sheets and nests arranged in concentric rings)
Is there a cancer risk in Fibrocystic condition
ONLY if there is atypical epithelial hyperplasia. More severe hyperplasia=greater risk
Is there a cancer risk in Intraductal papillomas
Solitary papillomas are benign
Multiple are associated with increased risk of papillary carcinoma
What are the RF for breast cancer
Sex (W)
Age (rare before puberty, peak 60)
Race (Jews- rare in japs/chin)
Genetics (mom= daughters risk)
Hormones (long estrogen exposure/Nulliparous)
Other CA (other breast, ovarian, endometrial)
Premalignant fibrocystic changes/multiple intraductal papillomas
Obesity, high fat diet, moderate alcohol
What is fat necrosis of breast
solitary, local, unilateral process due to trauma, surgery, or radiation therapy
-Gross hemorrhage and central fat necrosis later forms a nodule (grey-white) with chalk white debris
What is fat necrosis often mistaken for
Cancer, if it is fibrotic
What is fibrocystic condition of the breast
Fibrosis + Cysts (blue domed) in older women Sex hormones (Est/Pro) stimulate proliferation of cells in the excretory duct
What are characteristic findings in fibrocystic condition of the breast
*Most constant feature is fibrosis
Dense connective tissue rich in collagen
Palpable lumps that fluctuate (bag of worms)
When does fibrocystic condition of the breast occur
not before puberty or after menopause (dominated by sex hormones)- many improve after menopause
How do you diagnose fibrocystic condition of breast
Biopsy!
Where are breast cancers located
45% in upper outer quadrant (fibroadenoma and ductal carcinoma)
25% central, beneath nipple
(intraductal papilloma w/in lactiferous ducts or sinuses)
What is gynecomastia
male breast enlargement associated with hormonal changes in puberty OR excess estrogen in adult hood (cirrhosis or tumor)
What is male breast cancer
100x less likely, but can occur in the DUCTS (men don’t have lobules)
What is the most common inflammatory disease of the breast
acute mastitis- staph or strep invade the breast through dilated milk ducts or skin lacerations from suckling and form an abscess (PMN)
What is chronic mastitis
Rare unknown etiology that produces small lumps that mimic cancer
What is medullary carcinoma
foci of hemorrhage and necrosis in older women (NO desmoplastic reaction)
What is Paget’s disease of breast
ductal carcinoma that forms in the nipple/areolar area causing ulcers, fissures, discharge, and edema around nipple.
