Benign and Malignant Diseases of the Breast (Zafar) Flashcards
What is the rate of false negative MRIs
Is this more likely in a younger or older woman
20%
younger (bc breasts are denser)
the breast is a modified
sweat gland
Describe the embryogenesis of the breast
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
A breast becomes fully matured in puberty or pregnancy
pregnancy
At what age does a breat reach normal size
16-19
realitive to the bones in the anterior chest, where are the breasts located
between ribs 2-6 the sternum and the axilla
What is a terminal duct lobule unit (TDLU)?
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
the breast is divided into 10-20 ____
lobes
the TDLUs are embedded in ____
stroma
In what strucuture is the milk produced in the breast?
lobule (specifically the acini)
What is the milk line?
breasts develop along it, it is also where you can find extra nipples
what are PET scans useful for (in terms of breast CA)
staging
*recall, fructose is taken up by highly metabolically active tissue
What is nipple inversion assc with?
large pendulous breasts (as in a pendulum, yikes?!) cancer, trauma, infection
where is ectopic breast tissue found?
along mammary line
term for excessive breast tissue
macromastia
results from the failure of any portion of the mammary ridge to involute?
ectopic breast tissue
persistant epidermal thickenings along the milk line from axilla to perineum
supernumerary breasts/nipples
painful, tender breasts assc with lactation, cracks in nipple
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.
causes synovial metaplasia to form a fibrous capsule
silicone implants
what cells are notable in the tissue surrounding a silicone implant
giant cells (implants cause a “foreign body reaction”)
hyperplasia of breast stroma + fluid filled BLUE dome
firbocystic disease
clustered microcalcifications + increased acini and interalobualr fibrosis but maintinas lobular architecture
sclerosing adenosis
how many cell layers thick is sclerosis adenosis
2
what is the term for a palpable mass caused by sclerosis adenosis
adenosis tumor
lesion with features that are suggestive but not diagnostic of DCIS
atypical ductal hyperplasia
actin immunohistochemistry + myoepithelail cells
sclerosis adenosis
how many ducts must typically be involved to call a lesion DCIS
2+
multi-layers of cells with progressive loss of nuclear polarity, enlarged nuclei, and nucleoli
atypical ductal hyperplasia
What is the most common benign breast tumor?
fibroadenoma
pathology that does not fill or distend 50% or more acini within a lobule
atypical lobualr hyperplasia
lobular lesion that is more likely to be widespread and/or bilateral
atypical lobular hyperplasia
fibroadenomas can have both neoplastic and polyclonal components. Where/in what types of tissues?
neoplastic stroma and polyclonal epithelal
focal preservation of luminal spaces
atypical lobular hyperplasia
marble that moves around in the breast
fibroadenoma = sharply circumscribed and freely mobile
loss of heterozygosity to 16q (40% clonal)
atypical ductal hyperplasia
has stromal and epithelial components
fibroadenoma
involves lactiferous sinus
large duct papilloma
mastitis/breast abcess
multifocal disease in post renal transplant pts (i.e. immunosuppressed) with EBV
fibroadenomatosis
serous bloody/nipple discharge
large duct papilloma
in general, the presence of what cells in a breast lesion indicates it is probably benigh
myoepithelial cells
*malignant lesions usually do not have these
benign tumor that may grow in pregnancy
fibroadenoma bc it is hormone responsive
pathophys of blood nipple discharge assc with large duct papilloma
tumor outgrows blood supply → necrosis → hemorrhage, since it is in duct the blood comes out the nipple
breast mass in 20-35 yo is most likely
fibroadenoma
assc with sports activity, pregnancy, lactation
fat necrosis
*forms due to trauma
adolescent with bilateral (often) very large tumor with very cellular stroma and glands
juvenille/giant cell variant fibroadenoma
puckering of skin + painless lump
fat necrosis
stroma is not very cellular and may have other components such as cartilage and muscle
fibroadenoma
also phyllodes tumor, according to fist aid
enlargement of male breasts
gynocomastia
etiology of gynocomastia
hyperestrogenism (cirrhosis, testicular tumor, puberty, old age)
Klinefelter’s syndrome
drugs
What drugs are known to cause gynocomastia
Some Drugs Create Awkward Knockers : spironolactone digitalis cimetidine alcohol ketoconazole
What benign breast lesions are assc with an increased risk of developing cancer
sclerosis adenosis (1.5-2x higher)
atypical ductal hyperplasia (2-5x higher)
atypical lobular hyperplasia (4-5x higher)
intraductal papilloma
Phyllodes tumor
What benign breast pathologies are NOT assc with an increased risk of developing cancer
fibrocystic disease
fibroademona
button or disc-like stromal enlargement without any lobules present
gynocomastia **only see ducts in the stroma
breast cancer with germline p53 mutation
Li-Fraumeni syndrome
multiple hemartoma syndrome
Cowden disease
heterozygous carriers of ____ are at an increased risk for breast cancer
ataxia-telangiectasia
what are the hormonal risk factors for the development of breast cancer
early menarche late menopause having 1st child after 30 HRT (in post menopausal women) recent OCP use
__% of clinical;y negative nodes will actually have tumor in it
40%
mammography detect…
1-2 mm tumors via micro-calcifications
breast cancer spreads locally to
skin, nipple, chest wall
nodal mets to
axilla, supraclavicular, internal mammary
lobular cancer mets favor
abdominal cavity/viscera
overexpression of ___ via ____ are aggressive breast tumors
Her2 via gene amplification
favorable types of breast cancer histo
tubular, cribiform medullary
worse types of breast cancer histo
signet ring and inflammatory
most important prognostic factor for breast cancer
axillary LN involvement
what does in situ mean when we refer to breast cancer
stromal invasion not seen
**BM intact
tumor confined to glandular component of brest
ductal carcinoma in situ
breast cancer that in 50-70% of cases is bilateral adn 75% are multicentric
lobular carcinoma in situ
treatment diff between DCIS and LCIS
DCIS: surgery + radiation
LCIS: watch and wait or mastectomy
cytological/histo diff btween DCIS and LCIS
DCIS = more cellular variabtion LCIS = all cells look the same
high grade cells with central necrosis
comedo carcinoma
genetic markers assc with comeodo carcinoma
Her2 +, p53 +, ER/PR -
large cells with clear cytoplasm and abundant mucin (PAS +) in excretory ducts of breast and extends to the kin of the nipple/areola
pagets disease of the breast
what does the skin involvement of pagets disease of the breast look like
eczema
what malignancy is pagets’ disease of the breast assc with?
DCIS/invasive
tubule formation + penetrative + calcification + tumor fixed to chest wall
ductal carcinoma NOS
enlarged edematous breasts with peau d-orange
inflammatory carcinoma with lymphatic occlusion
indian filing
lobualar carcinoma
cleft cells
ductal carcinoma
usually seen in younger women or older women with history of radiation
angiosarcoma
spicualted mass
ductal carcinoma NOS
large lakes of mucin
colloid carcinoma
well differentiated tumor
tubular carcinoma
forms tubules
tubular carcinoma *good prognosi
ductal carcinoma NOS *less tubules formed?
slow growing tumor in older women
colloid carcinoma
painless subareolar mass
carcinoma in males
many vascular channels lined by atypical cells
angiosarcoma
hog nailing
lymphatic vessel with tumor occluding it (inflammatory carcinoma)
grossly is leaf like
phyllodes tumor
from what part of the breast tissue does a phyllodes tumor arise?
stroma
what does a phyllodes tumor resemble
fibroadenoma
t or f: phyllodes tumors are always malignant
F they can be both–based on histo
