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Repro > Benign and Malignant Diseases of the Breast (Zafar) > Flashcards

Benign and Malignant Diseases of the Breast (Zafar) Flashcards

1
Q

What is the rate of false negative MRIs

Is this more likely in a younger or older woman

A

20%

younger (bc breasts are denser)

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2
Q

the breast is a modified

A

sweat gland

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3
Q

Describe the embryogenesis of the breast

A

at the end of 1st month a solid bud develops. It invaginates and gives off several secondary buds tht will develop into lactiferous ducts which will branch even further during puberty and pregnancy

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4
Q

A breast becomes fully matured in puberty or pregnancy

A

pregnancy

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5
Q

At what age does a breat reach normal size

A

16-19

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6
Q

realitive to the bones in the anterior chest, where are the breasts located

A

between ribs 2-6 the sternum and the axilla

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7
Q

What is a terminal duct lobule unit (TDLU)?

A

the basic functional and histopathological unit of the breast. The TDLU is composed of a small segment of terminal duct and a cluster of ductules, which are the effective secretory units

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8
Q

the breast is divided into 10-20 ____

A

lobes

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9
Q

the TDLUs are embedded in ____

A

stroma

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10
Q

In what strucuture is the milk produced in the breast?

A

lobule (specifically the acini)

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11
Q

What is the milk line?

A

breasts develop along it, it is also where you can find extra nipples

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12
Q

what are PET scans useful for (in terms of breast CA)

A

staging

*recall, fructose is taken up by highly metabolically active tissue

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13
Q

What is nipple inversion assc with?

A

large pendulous breasts (as in a pendulum, yikes?!) cancer, trauma, infection

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14
Q

where is ectopic breast tissue found?

A

along mammary line

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15
Q

term for excessive breast tissue

A

macromastia

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16
Q

results from the failure of any portion of the mammary ridge to involute?

A

ectopic breast tissue

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17
Q

persistant epidermal thickenings along the milk line from axilla to perineum

A

supernumerary breasts/nipples

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18
Q

painful, tender breasts assc with lactation, cracks in nipple

A

acute mastitis/abscess

*that sounds like an awfully vague presentation … here is what wiki says:
Breast tenderness or warmth to the touch
General malaise or feeling ill
Swelling of the breast
Pain or a burning sensation continuously or while breast-feeding
Skin redness, often in a wedge-shaped pattern
Fever of 101 F (38.3 C) or greater[4]
The affected breast can then start to appear lumpy and red.

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19
Q

causes synovial metaplasia to form a fibrous capsule

A

silicone implants

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20
Q

what cells are notable in the tissue surrounding a silicone implant

A

giant cells (implants cause a “foreign body reaction”)

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21
Q

hyperplasia of breast stroma + fluid filled BLUE dome

A

firbocystic disease

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22
Q

clustered microcalcifications + increased acini and interalobualr fibrosis but maintinas lobular architecture

A

sclerosing adenosis

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23
Q

how many cell layers thick is sclerosis adenosis

A

2

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24
Q

what is the term for a palpable mass caused by sclerosis adenosis

A

adenosis tumor

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25
Q

lesion with features that are suggestive but not diagnostic of DCIS

A

atypical ductal hyperplasia

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26
Q

actin immunohistochemistry + myoepithelail cells

A

sclerosis adenosis

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27
Q

how many ducts must typically be involved to call a lesion DCIS

A

2+

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28
Q

multi-layers of cells with progressive loss of nuclear polarity, enlarged nuclei, and nucleoli

A

atypical ductal hyperplasia

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29
Q

What is the most common benign breast tumor?

A

fibroadenoma

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30
Q

pathology that does not fill or distend 50% or more acini within a lobule

A

atypical lobualr hyperplasia

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31
Q

lobular lesion that is more likely to be widespread and/or bilateral

A

atypical lobular hyperplasia

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32
Q

fibroadenomas can have both neoplastic and polyclonal components. Where/in what types of tissues?

A

neoplastic stroma and polyclonal epithelal

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33
Q

focal preservation of luminal spaces

A

atypical lobular hyperplasia

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34
Q

marble that moves around in the breast

A

fibroadenoma = sharply circumscribed and freely mobile

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35
Q

loss of heterozygosity to 16q (40% clonal)

A

atypical ductal hyperplasia

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36
Q

has stromal and epithelial components

A

fibroadenoma

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37
Q

involves lactiferous sinus

A

large duct papilloma

mastitis/breast abcess

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38
Q

multifocal disease in post renal transplant pts (i.e. immunosuppressed) with EBV

A

fibroadenomatosis

39
Q

serous bloody/nipple discharge

A

large duct papilloma

40
Q

in general, the presence of what cells in a breast lesion indicates it is probably benigh

A

myoepithelial cells

*malignant lesions usually do not have these

41
Q

benign tumor that may grow in pregnancy

A

fibroadenoma bc it is hormone responsive

42
Q

pathophys of blood nipple discharge assc with large duct papilloma

A

tumor outgrows blood supply → necrosis → hemorrhage, since it is in duct the blood comes out the nipple

43
Q

breast mass in 20-35 yo is most likely

A

fibroadenoma

44
Q

assc with sports activity, pregnancy, lactation

A

fat necrosis

*forms due to trauma

45
Q

adolescent with bilateral (often) very large tumor with very cellular stroma and glands

A

juvenille/giant cell variant fibroadenoma

46
Q

puckering of skin + painless lump

A

fat necrosis

47
Q

stroma is not very cellular and may have other components such as cartilage and muscle

A

fibroadenoma

also phyllodes tumor, according to fist aid

48
Q

enlargement of male breasts

A

gynocomastia

49
Q

etiology of gynocomastia

A

hyperestrogenism (cirrhosis, testicular tumor, puberty, old age)
Klinefelter’s syndrome
drugs

50
Q

What drugs are known to cause gynocomastia

A 
Some Drugs Create Awkward Knockers :
spironolactone
digitalis
cimetidine
alcohol
ketoconazole
51
Q

What benign breast lesions are assc with an increased risk of developing cancer

A

sclerosis adenosis (1.5-2x higher)
atypical ductal hyperplasia (2-5x higher)
atypical lobular hyperplasia (4-5x higher)
intraductal papilloma
Phyllodes tumor

52
Q

What benign breast pathologies are NOT assc with an increased risk of developing cancer

A

fibrocystic disease

fibroademona

53
Q

button or disc-like stromal enlargement without any lobules present

A

gynocomastia **only see ducts in the stroma

54
Q

breast cancer with germline p53 mutation

A

Li-Fraumeni syndrome

55
Q

multiple hemartoma syndrome

A

Cowden disease

56
Q

heterozygous carriers of ____ are at an increased risk for breast cancer

A

ataxia-telangiectasia

57
Q

what are the hormonal risk factors for the development of breast cancer

A 
early menarche
late menopause 
having 1st child after 30
HRT (in post menopausal women)
recent OCP use
58
Q

__% of clinical;y negative nodes will actually have tumor in it

A

40%

59
Q

mammography detect…

A

1-2 mm tumors via micro-calcifications

60
Q

breast cancer spreads locally to

A

skin, nipple, chest wall

61
Q

nodal mets to

A

axilla, supraclavicular, internal mammary

62
Q

lobular cancer mets favor

A

abdominal cavity/viscera

63
Q

overexpression of ___ via ____ are aggressive breast tumors

A

Her2 via gene amplification

64
Q

favorable types of breast cancer histo

A

tubular, cribiform medullary

65
Q

worse types of breast cancer histo

A

signet ring and inflammatory

66
Q

most important prognostic factor for breast cancer

A

axillary LN involvement

67
Q

what does in situ mean when we refer to breast cancer

A

stromal invasion not seen

**BM intact

68
Q

tumor confined to glandular component of brest

A

ductal carcinoma in situ

69
Q

breast cancer that in 50-70% of cases is bilateral adn 75% are multicentric

A

lobular carcinoma in situ

70
Q

treatment diff between DCIS and LCIS

A

DCIS: surgery + radiation
LCIS: watch and wait or mastectomy

71
Q

cytological/histo diff btween DCIS and LCIS

A 
DCIS = more cellular variabtion
LCIS = all cells look the same
72
Q

high grade cells with central necrosis

A

comedo carcinoma

73
Q

genetic markers assc with comeodo carcinoma

A

Her2 +, p53 +, ER/PR -

74
Q

large cells with clear cytoplasm and abundant mucin (PAS +) in excretory ducts of breast and extends to the kin of the nipple/areola

A

pagets disease of the breast

75
Q

what does the skin involvement of pagets disease of the breast look like

A

eczema

76
Q

what malignancy is pagets’ disease of the breast assc with?

A

DCIS/invasive

77
Q

tubule formation + penetrative + calcification + tumor fixed to chest wall

A

ductal carcinoma NOS

78
Q

enlarged edematous breasts with peau d-orange

A

inflammatory carcinoma with lymphatic occlusion

79
Q

indian filing

A

lobualar carcinoma

80
Q

cleft cells

A

ductal carcinoma

81
Q

usually seen in younger women or older women with history of radiation

A

angiosarcoma

82
Q

spicualted mass

A

ductal carcinoma NOS

83
Q

large lakes of mucin

A

colloid carcinoma

84
Q

well differentiated tumor

A

tubular carcinoma

85
Q

forms tubules

A

tubular carcinoma *good prognosi

ductal carcinoma NOS *less tubules formed?

86
Q

slow growing tumor in older women

A

colloid carcinoma

87
Q

painless subareolar mass

A

carcinoma in males

88
Q

many vascular channels lined by atypical cells

A

angiosarcoma

89
Q

hog nailing

A

lymphatic vessel with tumor occluding it (inflammatory carcinoma)

90
Q

grossly is leaf like

A

phyllodes tumor

91
Q

from what part of the breast tissue does a phyllodes tumor arise?

A

stroma

92
Q

what does a phyllodes tumor resemble

A

fibroadenoma

93
Q

t or f: phyllodes tumors are always malignant

A

F they can be both–based on histo

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