Block 3 Breast Flashcards
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
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
Acute infection of the breast with gram +ve cocci, causing erythematous breast tissue & nipple discharge
acute mastitis
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
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
periductal mastitis
1) A subareolar mass with nipple retraction, involves metaplasia of squamous cells lining the lactiferous ducts
periductal mastitis
What is mammary duct ectasia?
Rare inflammation with dilation (ectasia) of the subareolar ducts that is seen in multiparous postmenopausal women
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
A postmenopausal woman with a brownish peri areolar mass with nipple discharge
mammary duct ectasia
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
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
Biopsy reveals:
Necrotic fat that is associated with calcification & giant cells
fat necrosis of the breast
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
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
fibrocystic change of the breast
Which types of fibrocystic changes of the breast are NOT associated with invasive carcinoma
Fibrosis, Cysts, & Apocrine metaplasia
Which types of fibrocystic changes of the breast are associated with twice the risk of developing invasive carcinoma?
Ductal hyperplasia & sclerosing adenosis
Ductal hyperplasia & sclerosing adenosis are all fibrocystic changes of the breast that are associated with what?
twice the risk of developing invasive carcinoma
Which types of fibrocystic changes of the breast are associated with five times the risk of developing invasive carcinoma?
Atypical hyperplasia
Atypical hyperplasia is a fibrocystic change of the breast that are associated with what?
five times the risk of developing invasive carcinoma
What is an Intraductal papilloma?
It is papillary growth in the large ducts.
It presents as:
1) A bloody nipple discharge in premenopausal women
It is papillary growth in the large ducts.
It presents as:
1) A bloody nipple discharge in premenopausal women
Intraductal papilloma
What is a papillary carcinoma?
It is fibrovascular projections lined with epithelial cells without any underlying myoepithelium.
It presents as:
1) bloody nipple discharge
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
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
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
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
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
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
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
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
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
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
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
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
