Breast Flashcards
can occur anywhere along the milk lines –> two thickened bands of ectoderm which develop during 5th week of gestation, extends from axilla to groin
supernumerary nipples
another name for supernumerary nipples
polythelia
supernumerary nipples and/or breast tissue can develop in other areas along the milk line
Often smaller and less developed than normal nipple (can be mistaken for a nevus/mole)
May give rise to the same benign and/or malignant lesions seen in breast
Supernumerary nipples may be associated with ______ abnormalities. Give examples.
renal (extra kidney, horseshoe kidney, RCC)
non-neoplastic enlargement of male breast due to hyperplasia of epithelium and stroma due to the imbalance in ratio of free androgen to estrogen
gynecomastia (males)
Histology: increase in ducts, fibrous stroma, adipose tissue
gynecomastia (males)
clinical presentation: +/- pain, unilateral or bilateral, localized or diffuse
gynecomastia (males)
seen in virtually all cases of gynecomastia (males)
ER, PR, and AR
arises from the terminal duct lobular unit (TDLU)
fibrocystic change (females)
cysts that contain blue/brown fluid, usually multiple
fibrocystic change
caused by material released from ruptured cysts into adjacent stroma
fibrosis
Clinical: bumpy/lumpy breast on palpation, usually bilateral
fibrocystic change
microscopic: cyst dilation, ductal hyperplasia, and fibrosis
fibrocystic change
benign neoplasm of small or large ducts
intraductal papilloma
polypoid intraluminal mass, usually < 3 cm in size
intraductal papilloma
soft and friable with areas of hemorrhage
intraductal papilloma
most common cause of bloody nipple discharge
intraductal papilloma
bacterial infection of the breast, clinically presents as breast “mass” + fever + pain,
acute mastitis
bacteria that most commonly causes acute mastitis
Staph. aureus
associated with lactation, often during the first month post-partum
acute mastitis
treatment for acute mastitis
antibiotics and continued lactation
common benign inflammatory reaction secondary to trauma (pressure necrosis, radiation treatment, post-surgery)
fat necrosis
Clinical: palpable mass and skin changes
fat necrosis
Mammogram: dystrophic calcifications, radiolucent “oil cysts”, masses
fat necrosis
Histology:
Necrotic areas walled off by dense fibrosis “oil cysts”
Dystrophic calcifications
fat necrosis
complications of breast implants
Most common: contraction –> thick surrounding fibrosis
Rupture: silicone can migrate to regional lymph node
rare complication of breast implant (1 in 500,000-3,000,000) that occurs about 8-10 years after surgery
lymphoma
specific type of lymphoma that occurs as a result of implants
anaplastic large cell lymphoma
breast cancer stats
o #1 non-skin malignancy in women
o 2nd most common cancer-related cause of death in women (#1 = lung)
o 1 in 8 chance of developing by age 80 (11% lifetime risk)
o Upper outer quadrant is most common location (50%)
Major risk factors for breast cancer:
hormones, genetics, personal history of proliferative breast disease
represents < 15% of all breast cancers, and 25% of these are due to mutations in BRCA
familial breast cancer
BRCA1 vs BRCA2
BRCA1: higher grade breast cancers, GYN cancers, prostate cancer
BRCA2: higher incidence of male breast cancer, GI and GYN cancers, prostate cancer
25% of familial breast cancers are due to BRCA gene, 10% are due to what gene?
p53
Characteristics associated with breast cancer:
Age > 50 years
A palpable mass
An atypical lesion on mammography
Mechanisms for the detection of breast cancer:
Self-examination
Radiology: mammogram or ultrasound –> sent to pathology: FNA and/or core needle biopsy
prognostic factors of breast cancer
- grade and stage of tumor (tumor size, spread to axillary lymph nodes?, distant metastases?)
- tumor predictors (ER/PR status, HER2/neu proto-oncogene status)
- histologic type
What is ER/PR status?
o Receptors are located on ductal epithelial cells
o Detected by antibody/IHC as a nuclear stain
o Expression = better prognosis
o About 2 or 3 breast cancers have at least one receptor, can be treated with hormone therapy drugs
What is Her-2/neu receptor status?
o Proto-oncogene overexpressed in 15% of breast tumors—human epidermal growth factor receptor 2 (HER2)
o Detection—antibody/IHC as a membranous stain and/or FISH (fluorescent in situ hybridization)
o Worse prognosis if overexpressed, BUT better outcomes due to targeted therapeutic intervention –> Herceptin (trastuzumab)
o Her-2/neu immunohistochemistry reveals strong positivity as evidenced by membranous staining in most cells
breast cancer treatment depends on…
stage and type
Modalities of breast cancer treatment may include:
Lumpectomy Mastectomy Removal of axillary lymph nodes Radiation Chemotherapy Hormone therapy Targeted drug therapy (Herceptin) Immunotherapy (Keytruda)
Name the breast carcinoma: pre-invasive (limited by basement membrane) but still considered cancer
carcinoma in situ (CIS)
Two forms of carcinoma in situ:
Ductal CIS (DCIS)—ducts are filled with pleomorphic cells
Lobular CIS (LCIS)—lobules are filled with pleomorphic cells
Name the breast carcinoma: accounts for 70-80% of all breast cancers
invasive ductal carcinoma
Name the breast carcinoma: most common type of breast cancer in both males and females
invasive ductal carcinoma
Name the breast carcinoma: classified into subtypes based on ER, PR, and HER2/neu status, 10-20% are “triple negative” (more aggressive and difficult to treat)
invasive ductal carcinoma
Invasive ductal carcinoma in women under vs over 40
o For women under 40, 85% detected as palpable mass and 15% by screening
o For women over 40, 60% detected by screening and 40% as a palpable mass
Name the breast carcinoma: invasive carcinomas characterized by loss of normal cell adhesion
invasive lobular carcinoma
Name the breast carcinoma: diffuse pattern of infiltration
invasive lobular carcinoma
Name the breast carcinoma: most common type of breast cancer to present with distant metastases and occult primary
invasive lobular carcinoma
Name the breast carcinoma: 1/3 not detected on mammogram, calcifications are uncommon
invasive lobular carcinoma
Name the breast carcinoma: classic histology: linear arrangement of single cells between collagen fascicles
invasive lobular carcinoma
Name the breast carcinoma: uncommon (1-7% of invasive breast cancers), favorable prognosis (10-year survival rate > 80%)
mucinous carcinoma
Name the breast carcinoma: clinical presentation is a palpable SOFT mass in older women (60s)
mucinous carcinoma
Name the breast carcinoma:
Histology: abundant extracellular mucin production, clusters of detached tumor cells float in pools of mucin
mucinous carcinoma
Mucinous carcinoma: ER? HER2?
~95% positive for estrogen receptor
< 5% overexpress HER2
Name the breast carcinoma: a unique type of triple-negative breast carcinoma
medullary carcinoma
Name the breast carcinoma:
Most common type of carcinoma in patients with BRCA1 germline mutations (30-60%)
Rare with BRCA2 mutations
medullary carcinoma
Name the breast carcinoma:
Clinical: palpable, often rapidly growing circumscribed mass, 45-52 yo patients
medullary carcinoma
Name the breast carcinoma:
Histology:
High grade
Prominent inflammatory infiltrate
medullary carcinoma
most common genetic mutation in medullary carcinoma
p53
Name the breast carcinoma: defined by clinical presentation of edema and erythema of > 1/3 of breast skin
inflammatory breast cancer
Name the breast carcinoma: peau d’orange appearance (skin of orange/orange peel)
inflammatory breast cancer
Name the breast carcinoma:
Histology: lymph-vascular invasion that obstructs lymphatic outflow
inflammatory breast cancer
Name the breast carcinoma: HER2 amplification and TP53 mutations are common
inflammatory breast cancer
Name the breast carcinoma: poor prognosis –> 5-year survival rate: 30%
inflammatory breast cancer
Name the breast carcinoma: clinical presentation of breast cancer as scaling crust of skin due to DCIS involving nipple epidermis
Paget’s disease of the breast
Name the breast carcinoma: ~50% of cases are associated with invasive carcinoma deeper in breast
Paget’s disease of the breast
Name the breast carcinoma: often mistaken for skin inflammatory disease or infection
Paget’s disease of the breast
Name the breast carcinoma:
Histology: cancer cells present within the epidermis
Paget’s disease of the breast
benign neoplasm of intralobular STROMA of the breast
fibroadenoma
most common benign, solid breast neoplasm (20-35 yo)
fibroadenoma
hormone-sensitive, size increases with pregnancy, regresses with age
fibroadenoma
Gross: painless and palpable
Spherical mobile nodule, sharply circumscribed
Rubbery
fibroadenoma
Histology: glands compressed into slit-like spaces
fibroadenoma