ALL THINGS BREAST- FINAL Flashcards
Amastia
breast tissue, nipple and aureola are absent
Amazia
mammary gland tissue is absent but the nipple and aureola remain present
Athelia
presence of breast glandular tissue but no nipple or areola
Supernumerary nipple
more than one nipple
occurs most often along the milk line (extends from the axilla to the groin)
Supernumerary breast tissue
presence of breast tissue in an ectopic location
occurs most often along the milk line (extends from the axilla to the groin)
Can ectopic breast tissue be pathologic?
Yes. This supernumerary breast tissue can undergo the same pathologic changes as normal breast tissue (benign cystic changes, benign breast tumors, and breast cancer)
Inverted nipple
The new onset of nipple inversion is a sign that requires a work-up to rule out underlying breast cancer
Inverted nipple is usu caused by_______
fibrous bands of tissue that tether the nipple in an inverted position
Galactorrhea is__________
the spontaneous flow of milky nipple d/c that occurs in the absence of childbirth or lactation
Galactorrhea is commonly due to
hormonal dysregulation or as a side effect of several medications such as oral contraceptives
The presence of galactorrhea is the most disconcerting when____________
the d/c is unilateral, bloody or when there is an associated mass
Mastitis is___________
the non-infectious inflammation of the parenchyma of the mammary gland
If mastitis occurs in lactating women (as it most often does), then condition is called__________
puerperal mastitis
If mastitis occurs in non-lactating women or if it occurs in men it’s called_________
non-puerperal mastitis
If the cause of mastitis is infectious (less common), it is most likely due to________
Staph aureus or Strep epidermitis
Where does peri-ductal mastitis usually occur?
sub-areolar area with overlying skin erythema
What population does peri-ductal mastitis usually occur in?
smokers (90%)
The microscopic morphology of peri–ductal mastitis usually reveals_________
keratinizing squamous epithelium in the duct system of the nipple which often extends to an abnormal depth
A chronic _________ response is characteristically noted in peri-ductal mastitis?
granulomatous inflammatory
condition that is characterized by the dilatation of the sub-areolar ducts is called_____________
Mammary duct ectasia
Mammary duct ectasia is more often see in__________
multiparous women
What sequelae is seen in 30-40% of cases of mammary duct ectasia?
nipple inversion
In mammary duct ectasia, microscopically one sees_________
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
early lesion of mammary duct ectasia is characterized by
the accumulation of foamy macrophages beneath the luminal duct epithelium
Fibrocystic breast disease is a condition characterized by____
fibrous lumps and cords in the breast tissue that are non-cancerous
fibrocystic breast changes may be asx or they may cause discomfort
What disease represents the singe most common disorder of the breast?
Fibrocystic breast disease!
It accounts for more than half of all surgical operations that are performed on the female breast
Where are fibrocystic breast changes most often found?
upper outer quadrant!
Microscopic appearance of fibrocystic breast disease
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)
Fat necrosis results from____________
the rupture of adipocytes and hemorrhage from broken blood vessels into the traumatized area
calcification and hemosiderin deposition occurs within the affected area
Mammography (or US) of an area of fat necrosis often reveals
a central radiolucent area of fat with increased density and/or presence of calcifications at the fat periphery
Microscopically fat necrosis is characterized by
irregular fatty spaces which are surrounded by foamy histiocytes and multinucleated giant cells
microscopic examination of lymphocytic mastophathy reveals
a thickening and fibrosis of stromal tissue and lymphocytic infiltrates that surrounds the epithelium and blood vessels
Lymphocytic mastopathy is most commonly associated with
women with type 1 diabetes mellitus and in women with autoimmune thyroiditis (AI diseases!)
Granulomatous mastopathy is an uncommon form of mastitis that is characterized by
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
what is the most common benign tumor of the breast?
fibroadenoma
the appearance of fibroadenoma microscopically________
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
Hormonally responsive, what commonly increases in size during pregnancy?
Fibroadenomas
they often regress after menopause
Fibroadenomas are benign, but are associated with a minimally increased risk for_____________
development of carcinoma (therefore routinely removed and bx)
Microscopy of intraductal papillomas characteristically shows
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
the vast majority of breast cancer originates where?
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
Risk factors rated as high for breast cancer
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.
Protective role against breast cancer
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
The most common denominator to many of the breast cancer risk factors is__________
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.
BRCA1 and BRCA2 appear to be responsible for
30-40% of all inherited breast cancers
_________ are tumor suppressor genes
BRCA1 and BRCA2
In the general population, prevalence of BRCA1 mutation is _________, compared with _______ prevalence in the Ashkenazi Jewish population
0.1%, 20%
Another genetic risk factor for breast cancer is
HER2/neu gene (a proto-oncogene)
Peau de organge
increased dimpling of the skin of a breast with cancer
The three main types of breast cancer are
Ductal, lobular and nipple (or Paget’s disease)
of these three, ductal carcinoma is the most common
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?
Carcinoma in situ
In contrast, invasive carcinoma does not confine itself to the initial tissue compartment and invades the surrounding tissue
Infiltrating ductal carcinoma (or just ductal carcinoma) manifests as
a single hard mass with irregular borders
comprises nearly 80% of all breast cancers
The second most common histologic type after ductal carcinoma is___________
lobular carcinoma
associated with a multiple loci in the affected breast as well as increased risk for both breast to be involved
microscopic appearance of lobular carcinoma is___________
single file phenomenon (line up and look like they are in a single file line)
“signet ring” appearance
________ disease of the breast is relatively uncommon compared to ductal and lobular forms of breast cancer
Paget’s disease
Involves the nipple and areolar area, often associated with an underlying in-situ or invasive carcinoma
Histologic dx of Paget’s is confirmed by the finding of_____________
large round cells with pale cytoplasm and pleomorphic nuclei (nuclei that are varying sizes)
Inflammatory breast cancer (IBC) is a form of __________ that is distinguished by the markedly inflamed appearance of the affected breast
ductal carcinoma
inflammatory breast cancer is esp aggressive because of the lack of symptoms (often presents without a palpable lump)
