Block 3 Breast Flashcards by isabelle courtney

What is acute mastitis?

Bacterial infection of the breast by S. aureus. It is associated with feeding, which causes fissures in the nipple giving bacteria a route to cause infection

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Bacterial infection of the breast by S. aureus. It is associated with feeding, which causes fissures in the nipple giving bacteria a route to cause infection

It presents as:
1) Erythematous breast with nipple discharge

Complication:
It can progress to form an abscess

Rx: Continue to drain (feedings) & antibiotics (dicloxacillin)

acute mastitis

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Acute infection of the breast with gram +ve cocci, causing erythematous breast tissue & nipple discharge

acute mastitis

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What is periductal mastitis?

It is inflammation of the subareolar ducts. It is usually seen in smokers due to them having a relative vitamin A deficiency which causes metaplasia in the lactiferous ducts resulting in blockage & inflammation

Presents with:
1) A subareolar mass with nipple retraction

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Presents with:
1) A subareolar mass with nipple retraction

periductal mastitis

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1) A subareolar mass with nipple retraction, involves metaplasia of squamous cells lining the lactiferous ducts

periductal mastitis

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What is mammary duct ectasia?

Rare inflammation with dilation (ectasia) of the subareolar ducts that is seen in multiparous postmenopausal women

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Rare inflammation with dilation (ectasia) of the subareolar ducts that is seen in multiparous postmenopausal women

It presents as a:
1) Peri areolar mass with green/brown nipple discharge

Biopsy shows:
Chronic inflammation with plasma cells

mammary duct ectasia

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A postmenopausal woman with a brownish peri areolar mass with nipple discharge

mammary duct ectasia

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What is fat necrosis of the breast?

It is usually caused by trauma (needle biopsy etc) that presents as a mass on physical exam & abnormal calcification on mammography

Biopsy reveals:
Necrotic fat that is associated with calcification & giant cells

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It is usually caused by trauma (needle biopsy etc) that presents as a mass on physical exam & abnormal calcification on mammography

Biopsy reveals:
Necrotic fat that is associated with calcification & giant cells

fat necrosis of the breast

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Biopsy reveals:
Necrotic fat that is associated with calcification & giant cells

fat necrosis of the breast

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What is fibrocystic change of the breast?

The development of fibrosis & cysts in the upper & outer quadrant of the breast that give it a lump bumpy texture. It usually occurs in premenopausal women & tends to be benign, though certain fibrotic changes are associated with invasive carcinoma

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fibrocystic change of the breast

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Which types of fibrocystic changes of the breast are NOT associated with invasive carcinoma

Fibrosis, Cysts, & Apocrine metaplasia

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Which types of fibrocystic changes of the breast are associated with twice the risk of developing invasive carcinoma?

Ductal hyperplasia & sclerosing adenosis

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Ductal hyperplasia & sclerosing adenosis are all fibrocystic changes of the breast that are associated with what?

twice the risk of developing invasive carcinoma

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Which types of fibrocystic changes of the breast are associated with five times the risk of developing invasive carcinoma?

Atypical hyperplasia

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Atypical hyperplasia is a fibrocystic change of the breast that are associated with what?

five times the risk of developing invasive carcinoma

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What is an Intraductal papilloma?

It is papillary growth in the large ducts.

It presents as:
1) A bloody nipple discharge in premenopausal women

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It is papillary growth in the large ducts.

It presents as:
1) A bloody nipple discharge in premenopausal women

Intraductal papilloma

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What is a papillary carcinoma?

It is fibrovascular projections lined with epithelial cells without any underlying myoepithelium.

It presents as:
1) bloody nipple discharge

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It is fibrovascular projections lined with epithelial cells without any underlying myoepithelium.

It presents as:
1) bloody nipple discharge

Complication:
It has a risk of progressing to papillary carcinoma

papillary carcinoma

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What is a fibroadenoma?

The most common benign breast tumor that is made of fibrous tissue & glands. It is usually seen in premenopausal as a well circumscribed mobile marble-like mass. It is estrogen sensitive so it grows during pregnancy & can be painful during menstruation

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fibroadenoma

a well circumscribed mobile marble-like mass that is benign & sensitive to estrogen

fibroadenoma

What is a phyllodes tumor?

A tumor that resembles a fibroadenoma except there is overgrowth of the fibrous component, with leaf-like projections giving it the potential to be malignant. It is usually seen in postmenopausal women.

A tumor that resembles a fibroadenoma except there is overgrowth of the fibrous component. It is usually seen in postmenopausal women. Biopsy shows: Lead-like projections Complication is that it can be malignant

phyllodes tumor

Fibrous tumor with leaf-like projections in a postmenopausal woman, it may be malignant

Phyllodes tumor

What is Ductal Carcinoma In Situ?

A malignant proliferation of ductal cells that does NOT invade the basement membrane. It can be seen as calcification on mammography (not a mass) & it can be a Comedo type or Paget's disease associated with DCIS

A malignant proliferation of ductal cells that does NOT invade the basement membrane. It can be seen as calcification on mammography (not a mass). Subtypes: 1) Comedo type Has high-grade cells with necrosis & dystrophic calcification in the center of ducts 2) Paget's ass The cancer extends upwards into the ducts & involves the nipple skin, presenting as nipple erythema & ulceration

Ductal Carcinoma In Situ

What is Paget's disease that is associated with Ductal Cell In Situ?

The DCIS extends upwards into the ducts & involves the nipple skin, presenting as nipple erythema & ulceration.

What is Comedo subtype of Ductal Cell In Situ?

A cancer of the breast with high-grade cells with necrosis & dystrophic calcification in the center of ducts

What is Invasive Ductal Carcinoma?

The most common type of invasive breast cancer. It classically forms duct-like structure in the breast

The most common type of invasive breast cancer. It classically forms duct-like structure in the breast It presents as: 1) A mass 2/+cm on clinical exam 2) A mass 1/+cm on mammography 3) Skin dimpling & Nipple retraction in advanced stages Biopsy shows: Duct-like structures in desmoplastic stroma Sub types include: 1) Tubular carcinoma 2) Mucinous carcinoma 3) Medullary carcinoma 4) Inflammatory carcinoma

Invasive Ductal Carcinoma

What is Tubular carcinoma?

A subtype of invasive breast carcinoma that presents as well differentiated tubules that lack myoepithelial cells It has a good prognosis

Tubular carcinoma

What is Mucinous carcinoma?

A subtype of invasive breast carcinoma that presents as an abundance of extracellular mucin "tumor in a pool of mucus app" It is usually seen in older women (~70yrs) It has a good prognosis

Mucinous carcinoma

What is a Medullary carcinoma?

A subtype of invasive breast carcinoma that presents as large high-grade cells that grow in sheets. It is associated with lymphocytes & plasma cells & people who carry the BRCA1 gene are at higher risk Biopsy shows: A well circumscribed mass that can mimic an fibroadenoma on mammography It has a good prognosis

Medullary carcinoma

What is an inflammatory carcinoma?

A carcinoma in the dermal lymphatics that causes blockages. This causes it to classically present as an inflamed & swollen breast with NO discrete mass It has a poor prognosis

inflammatory carcinoma

What is Lobular Carcinoma In Situ (LCIS)?

Malignant proliferation of cells in the lobules that do NOT invade the basement membrane. There is NO mass or calcification, instead it is multifocal & bilateral & can be identifies via biopsy

Malignant proliferation of cells in the lobules that do NOT invade the basement membrane. There is NO mass or calcification, instead it is multifocal & bilateral & can be identifies via biopsy Biopsy shows: 1) Dyscohesive cells that LACK E-cadherin adhesion proteins Rx. Tamoxifen & follow up Complication a low risk of progressing to invasive carcinoma

Lobular Carcinoma In Situ (LCIS)

Biopsy shows: 1) Dyscohesive cells that LACK E-cadherin adhesion proteins

Lobular Carcinoma In Situ (LCIS)

What are the biopsy findings you would expect to seen in a patient with Lobular Carcinoma In Situ (LCIS)?

Biopsy shows: 1) Dyscohesive cells that LACK E-cadherin adhesion protein

What is Invasive Lobular Carcinoma of the breast?

An invasive carcinoma that grows in a single-file pattern. It's cells exhibit signet ring morphology & it CANNOT form ducts because it's cells lack E-Cadherin

Invasive Lobular Carcinoma of the breast

For TNM staging of breast cancer spread to which LN is most useful as a prognostic factor & how do you assess it?

Axillary LN is best to determine the prognosis of breast cancer, to assess it you need to biopsy the sentinel LN

Estrogen & progesterone receptor +ve breast cancers response to which type of therapy?

Antiestrogen agents (nucleus) like Tamoxifen

HER2/neu receptor +ve breast cancers response to which type of therapy?

Antibodies against HER2 receptors (cell surface) like Trastuzumab (Herceptin)

What does having a triple -ve mean & who is most at risk?

-ve for ER, PR, & HER2/neu receptors it's associated with a very poor prognosis & it is more common in African American women

What is Hereditary Breast cancer?

It is associated with a family history of breast cancer. The patient usually has: 1) Multiple first-degree relatives with breast cancer 2) A tumor in the early stage (premenopausal) 3) Multiple tumors in a single patient Highest risk: BRCA1 female ovarian & breast cancers BRCA2 male breast cancer

Hereditary Breast cancer

BRCA1

female ovarian & breast cancers

BRCA2

male breast cancer

Hereditary Breast cancer

What is male breast cancer?

A rare cancer that is associated with BRCA2 or Klinefelter syndrome. It presents in older men as a subareolar mass that may have nipple discharge

A rare cancer that is associated with BRCA2 or Klinefelter syndrome. It presents in older men as a subareolar mass that may have nipple discharge The most common subtype is Invasive ductal carcinoma

male breast cancer

What is the most common subtype of male breast cancer?

The most common subtype is Invasive ductal carcinoma

What are the conditions associated with male breast cancer?

BRCA2 or Klinefelter syndrome