3- Breast

Question 1

What are symptoms of a malignant breast lesion

Answer 1

Retracted nipples (involves main excretory duct) 
Puckering

Question 2

What are other signs of breast cancer

Answer 2

calcification on X-ray
Serous bloody nipple discharge
Hard, enlarged axillary nodes
Lymphedema and thick skin (peau d’orange)

Question 3

What is Invasive Ductal carcinoma

Answer 3

firm and gritty tumor (no sharp margins) with hallmark Desmoplastic reaction
-Puckering and nipple retraction due to dance connective tissue pulling on adjacent tissue

Question 4

What are a majority of invasive breast carcinomas

Answer 4

Invasive Ductal

Question 5

What is a desmoplastic reaction

Answer 5

tumor cells infiltrating tissue are surrounded by dense connective tissue made by host in response to tumor

Question 6

How are invasive and non-invasive ductal carcinomas different

Answer 6

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

Question 7

What are Invasive Lobular carcinomas

Answer 7

arise form terminal ductules of acini, more bilateral than invasive ductal
rubbery, poorly circumscribed, NO desmoplasia

Question 8

What are characteristics of Invasive Lobular

Answer 8

Strands of single file malignant cells through storm with little pleomorphism 
Targeted pattern (solid sheets and nests arranged in concentric rings)

Question 9

Is there a cancer risk in Fibrocystic condition

Answer 9

ONLY if there is atypical epithelial hyperplasia. More severe hyperplasia=greater risk

Question 10

Is there a cancer risk in Intraductal papillomas

Answer 10

Solitary papillomas are benign

Multiple are associated with increased risk of papillary carcinoma

Question 11

What are the RF for breast cancer

Answer 11

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

Question 12

What is fat necrosis of breast

Answer 12

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

Question 13

What is fat necrosis often mistaken for

Answer 13

Cancer, if it is fibrotic

Question 14

What is fibrocystic condition of the breast

Answer 14

Fibrosis + Cysts (blue domed) in older women 
Sex hormones (Est/Pro) stimulate proliferation of cells in the excretory duct

Question 15

What are characteristic findings in fibrocystic condition of the breast

Answer 15

*Most constant feature is fibrosis
Dense connective tissue rich in collagen
Palpable lumps that fluctuate (bag of worms)

Question 16

When does fibrocystic condition of the breast occur

Answer 16

not before puberty or after menopause (dominated by sex hormones)- many improve after menopause

Question 17

How do you diagnose fibrocystic condition of breast

Answer 17

Biopsy!

Question 18

Where are breast cancers located

Answer 18

45% in upper outer quadrant (fibroadenoma and ductal carcinoma)
25% central, beneath nipple
(intraductal papilloma w/in lactiferous ducts or sinuses)

Question 19

What is gynecomastia

Answer 19

male breast enlargement associated with hormonal changes in puberty OR excess estrogen in adult hood (cirrhosis or tumor)

Question 20

What is male breast cancer

Answer 20

100x less likely, but can occur in the DUCTS (men don’t have lobules)

Question 21

What is the most common inflammatory disease of the breast

Answer 21

acute mastitis- staph or strep invade the breast through dilated milk ducts or skin lacerations from suckling and form an abscess (PMN)

Question 22

What is chronic mastitis

Answer 22

Rare unknown etiology that produces small lumps that mimic cancer

Question 23

What is medullary carcinoma

Answer 23

foci of hemorrhage and necrosis in older women (NO desmoplastic reaction)

Question 24

What is Paget’s disease of breast

Answer 24

ductal carcinoma that forms in the nipple/areolar area causing ulcers, fissures, discharge, and edema around nipple.

Question 25

What are “paget” cells

Answer 25

large malignant clear staining cells due to cancer beneath the nipple

Question 26

What is colloid/mucinous carcinoma

Answer 26

slow growing tumor of older women that is soft and gelatinous
-Good prognosis, lymph mets not common

Question 27

How does breast size affect cancer

Answer 27

smaller boobs have higher cancer risks because there is less fat and cancer can jump to lymph faster

Question 28

What is distant mets common in

Answer 28

Lungs, liver, bones, brain, adrenals

Question 29

How do local Mets spread

Answer 29

mostly through axillary lymph nodes

less commonly through internal mammary nodes

Question 30

How do you preform breast biopsy

Answer 30

Start with FNA, but you can’t see BM so may need to repeat or do a surgical biopsy with general anesthesia for larger sample

Question 31

What is the prognosis of breast cancer

Answer 31

Depends on local lymph spread and stage

Must consider histologic subtype and grading, estrogen and progesterone receptors

Question 32

Briefly describe staging of breast cancer

Answer 32

Stage I is small and has good prognosis
Stage III is >5cm w/o distant spread
Stage IV is local and distant mets with very poor prognosis