ALL THINGS BREAST- FINAL

Question 1

Amastia

Answer 1

breast tissue, nipple and aureola are absent

Question 2

Amazia

Answer 2

mammary gland tissue is absent but the nipple and aureola remain present

Question 3

Athelia

Answer 3

presence of breast glandular tissue but no nipple or areola

Question 4

Supernumerary nipple

Answer 4

more than one nipple

occurs most often along the milk line (extends from the axilla to the groin)

Question 5

Supernumerary breast tissue

Answer 5

presence of breast tissue in an ectopic location

occurs most often along the milk line (extends from the axilla to the groin)

Question 6

Can ectopic breast tissue be pathologic?

Answer 6

Yes. This supernumerary breast tissue can undergo the same pathologic changes as normal breast tissue (benign cystic changes, benign breast tumors, and breast cancer)

Question 7

Inverted nipple

Answer 7

The new onset of nipple inversion is a sign that requires a work-up to rule out underlying breast cancer

Question 8

Inverted nipple is usu caused by_______

Answer 8

fibrous bands of tissue that tether the nipple in an inverted position

Question 9

Galactorrhea is__________

Answer 9

the spontaneous flow of milky nipple d/c that occurs in the absence of childbirth or lactation

Question 10

Galactorrhea is commonly due to

Answer 10

hormonal dysregulation or as a side effect of several medications such as oral contraceptives

Question 11

The presence of galactorrhea is the most disconcerting when____________

Answer 11

the d/c is unilateral, bloody or when there is an associated mass

Question 12

Mastitis is___________

Answer 12

the non-infectious inflammation of the parenchyma of the mammary gland

Question 13

If mastitis occurs in lactating women (as it most often does), then condition is called__________

Answer 13

puerperal mastitis

Question 14

If mastitis occurs in non-lactating women or if it occurs in men it’s called_________

Answer 14

non-puerperal mastitis

Question 15

If the cause of mastitis is infectious (less common), it is most likely due to________

Answer 15

Staph aureus or Strep epidermitis

Question 16

Where does peri-ductal mastitis usually occur?

Answer 16

sub-areolar area with overlying skin erythema

Question 17

What population does peri-ductal mastitis usually occur in?

Answer 17

smokers (90%)

Question 18

The microscopic morphology of peri–ductal mastitis usually reveals_________

Answer 18

keratinizing squamous epithelium in the duct system of the nipple which often extends to an abnormal depth

Question 19

A chronic _________ response is characteristically noted in peri-ductal mastitis?

Answer 19

granulomatous inflammatory

Question 20

condition that is characterized by the dilatation of the sub-areolar ducts is called_____________

Answer 20

Mammary duct ectasia

Question 21

Mammary duct ectasia is more often see in__________

Answer 21

multiparous women

Question 22

What sequelae is seen in 30-40% of cases of mammary duct ectasia?

Answer 22

nipple inversion

Question 23

In mammary duct ectasia, microscopically one sees_________

Answer 23

dilated lactiferous ducts that are filled with granular debris including lipid laden macrophages.
Peri-ductal and interductal inflammation is notable as characterized by infiltrates of lymphocytes and macrophages with an increased number of plasma cells

Question 24

early lesion of mammary duct ectasia is characterized by

Answer 24

the accumulation of foamy macrophages beneath the luminal duct epithelium

Question 25

Fibrocystic breast disease is a condition characterized by____

Answer 25

fibrous lumps and cords in the breast tissue that are non-cancerous fibrocystic breast changes may be asx or they may cause discomfort

Question 26

What disease represents the singe most common disorder of the breast?

Answer 26

Fibrocystic breast disease! | It accounts for more than half of all surgical operations that are performed on the female breast

Question 27

Where are fibrocystic breast changes most often found?

Answer 27

upper outer quadrant!

Question 28

Microscopic appearance of fibrocystic breast disease

Answer 28

multi-layering of the ductal cells or noting the in-growth of these cells towards the center of the duct (layering starts to compromise the ductal space)

Question 29

Fat necrosis results from____________

Answer 29

the rupture of adipocytes and hemorrhage from broken blood vessels into the traumatized area calcification and hemosiderin deposition occurs within the affected area

Question 30

Mammography (or US) of an area of fat necrosis often reveals

Answer 30

a central radiolucent area of fat with increased density and/or presence of calcifications at the fat periphery

Question 31

Microscopically fat necrosis is characterized by

Answer 31

irregular fatty spaces which are surrounded by foamy histiocytes and multinucleated giant cells

Question 32

microscopic examination of lymphocytic mastophathy reveals

Answer 32

a thickening and fibrosis of stromal tissue and lymphocytic infiltrates that surrounds the epithelium and blood vessels

Question 33

Lymphocytic mastopathy is most commonly associated with

Answer 33

women with type 1 diabetes mellitus and in women with autoimmune thyroiditis (AI diseases!)

Question 34

Granulomatous mastopathy is an uncommon form of mastitis that is characterized by

Answer 34

the presence of granulomas (formed by epithelioid cells and giant cells) thought to be due to conditions such as tuberculosis, sarcoidosis, and Wegener's granulomatosis

Question 35

what is the most common benign tumor of the breast?

Answer 35

fibroadenoma

Question 36

the appearance of fibroadenoma microscopically________

Answer 36

hyperplasia of intraductal epithelial cells These hyperplastic cells have no abnormalities in nuclear size and in the normal nucleus to cytoplasm ration. called lactating adenoma if occurs during pregnancy

Question 37

Hormonally responsive, what commonly increases in size during pregnancy?

Answer 37

Fibroadenomas | they often regress after menopause

Question 38

Fibroadenomas are benign, but are associated with a minimally increased risk for_____________

Answer 38

development of carcinoma (therefore routinely removed and bx)

Question 39

Microscopy of intraductal papillomas characteristically shows

Answer 39

myoepithelial cells and multilayered ductal cells. These multi-layered ductal cells become flattened and the nuclei of the cells usually appear next to the luminal surface

Question 40

the vast majority of breast cancer originates where?

Answer 40

in the glandular tissues of the breast and are classified as adenocarcinomas both the lobular tissues (which produce milk) and the ductal tissue (which are involved in the transfer of milk to the nipple) are considered glandular

Question 41

Risk factors rated as high for breast cancer

Answer 41

Female /advancing age Prior personal history of cancer in one breast. Family history of both mother and a sister with breast cancer. Daily ETOH intake > 2 glasses. High premenopausal blood insulin-like growth factor (IGF)–1 levels. High post-menopausal blood estrogen levels.

Question 42

Protective role against breast cancer

Answer 42

``` Age at first period older than 15 years Breastfeeding for longer than 1 year Physical activity Minimal ETOH consumption No tobacco use Monounsaturated fat–rich diet ```

Question 43

The most common denominator to many of the breast cancer risk factors is__________

Answer 43

the level and duration of exposure to endogenous estrogenic stimulation Estrogens, by their cell proliferating effect on the breast epithelium, increase the chance of DNA replication errors leading to greater chance for mutations.

Question 44

BRCA1 and BRCA2 appear to be responsible for

Answer 44

30-40% of all inherited breast cancers

Question 45

_________ are tumor suppressor genes

Answer 45

BRCA1 and BRCA2

Question 46

In the general population, prevalence of BRCA1 mutation is _________, compared with _______ prevalence in the Ashkenazi Jewish population

Answer 46

0.1%, 20%

Question 47

Another genetic risk factor for breast cancer is

Answer 47

HER2/neu gene (a proto-oncogene)

Question 48

Peau de organge

Answer 48

increased dimpling of the skin of a breast with cancer

Question 49

The three main types of breast cancer are

Answer 49

Ductal, lobular and nipple (or Paget's disease) | of these three, ductal carcinoma is the most common

Question 50

what is the term used to describe low grade cancerous or precancerous cells in a particular tissue area such as the mammary duct, in the absence of invasion of the surrounding tissue?

Answer 50

Carcinoma in situ In contrast, invasive carcinoma does not confine itself to the initial tissue compartment and invades the surrounding tissue

Question 51

Infiltrating ductal carcinoma (or just ductal carcinoma) manifests as

Answer 51

a single hard mass with irregular borders | comprises nearly 80% of all breast cancers

Question 52

The second most common histologic type after ductal carcinoma is___________

Answer 52

lobular carcinoma | associated with a multiple loci in the affected breast as well as increased risk for both breast to be involved

Question 53

microscopic appearance of lobular carcinoma is___________

Answer 53

single file phenomenon (line up and look like they are in a single file line) "signet ring" appearance

Question 54

________ disease of the breast is relatively uncommon compared to ductal and lobular forms of breast cancer

Answer 54

Paget's disease | Involves the nipple and areolar area, often associated with an underlying in-situ or invasive carcinoma

Question 55

Histologic dx of Paget's is confirmed by the finding of_____________

Answer 55

large round cells with pale cytoplasm and pleomorphic nuclei (nuclei that are varying sizes)

Question 56

Inflammatory breast cancer (IBC) is a form of __________ that is distinguished by the markedly inflamed appearance of the affected breast

Answer 56

ductal carcinoma | inflammatory breast cancer is esp aggressive because of the lack of symptoms (often presents without a palpable lump)