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General Pathology > Breast > Flashcards

Breast Flashcards

1
Q

can occur anywhere along the milk lines –> two thickened bands of ectoderm which develop during 5th week of gestation, extends from axilla to groin

A

supernumerary nipples

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2
Q

another name for supernumerary nipples

A

polythelia

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3
Q

supernumerary nipples and/or breast tissue can develop in other areas along the milk line

A

 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

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4
Q

Supernumerary nipples may be associated with ______ abnormalities. Give examples.

A

renal (extra kidney, horseshoe kidney, RCC)

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5
Q

non-neoplastic enlargement of male breast due to hyperplasia of epithelium and stroma due to the imbalance in ratio of free androgen to estrogen

A

gynecomastia (males)

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6
Q

Histology: increase in ducts, fibrous stroma, adipose tissue

A

gynecomastia (males)

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7
Q

clinical presentation: +/- pain, unilateral or bilateral, localized or diffuse

A

gynecomastia (males)

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8
Q

seen in virtually all cases of gynecomastia (males)

A

ER, PR, and AR

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9
Q

arises from the terminal duct lobular unit (TDLU)

A

fibrocystic change (females)

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10
Q

cysts that contain blue/brown fluid, usually multiple

A

fibrocystic change

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11
Q

caused by material released from ruptured cysts into adjacent stroma

A

fibrosis

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12
Q

Clinical: bumpy/lumpy breast on palpation, usually bilateral

A

fibrocystic change

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13
Q

microscopic: cyst dilation, ductal hyperplasia, and fibrosis

A

fibrocystic change

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14
Q

benign neoplasm of small or large ducts

A

intraductal papilloma

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15
Q

polypoid intraluminal mass, usually < 3 cm in size

A

intraductal papilloma

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16
Q

soft and friable with areas of hemorrhage

A

intraductal papilloma

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17
Q

most common cause of bloody nipple discharge

A

intraductal papilloma

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18
Q

bacterial infection of the breast, clinically presents as breast “mass” + fever + pain,

A

acute mastitis

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19
Q

bacteria that most commonly causes acute mastitis

A

Staph. aureus

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20
Q

associated with lactation, often during the first month post-partum

A

acute mastitis

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21
Q

treatment for acute mastitis

A

antibiotics and continued lactation

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22
Q

common benign inflammatory reaction secondary to trauma (pressure necrosis, radiation treatment, post-surgery)

A

fat necrosis

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23
Q

Clinical: palpable mass and skin changes

A

fat necrosis

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24
Q

Mammogram: dystrophic calcifications, radiolucent “oil cysts”, masses

A

fat necrosis

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25
Q

Histology:
 Necrotic areas walled off by dense fibrosis “oil cysts”
 Dystrophic calcifications

A

fat necrosis

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26
Q

complications of breast implants

A

Most common: contraction –> thick surrounding fibrosis

Rupture: silicone can migrate to regional lymph node

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27
Q

rare complication of breast implant (1 in 500,000-3,000,000) that occurs about 8-10 years after surgery

A

lymphoma

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28
Q

specific type of lymphoma that occurs as a result of implants

A

anaplastic large cell lymphoma

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29
Q

breast cancer stats

A

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%)

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30
Q

Major risk factors for breast cancer:

A

hormones, genetics, personal history of proliferative breast disease

31
Q

represents < 15% of all breast cancers, and 25% of these are due to mutations in BRCA

A

familial breast cancer

32
Q

BRCA1 vs BRCA2

A

 BRCA1: higher grade breast cancers, GYN cancers, prostate cancer
 BRCA2: higher incidence of male breast cancer, GI and GYN cancers, prostate cancer

33
Q

25% of familial breast cancers are due to BRCA gene, 10% are due to what gene?

A

p53

34
Q

Characteristics associated with breast cancer:

A

 Age > 50 years
 A palpable mass
 An atypical lesion on mammography

35
Q

Mechanisms for the detection of breast cancer:

A

 Self-examination

 Radiology: mammogram or ultrasound –> sent to pathology: FNA and/or core needle biopsy

36
Q

prognostic factors of breast cancer

A
  • 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
37
Q

What is ER/PR status?

A

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

38
Q

What is Her-2/neu receptor status?

A

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

39
Q

breast cancer treatment depends on…

A

stage and type

40
Q

Modalities of breast cancer treatment may include:

A 
 Lumpectomy 
 Mastectomy 
 Removal of axillary lymph nodes 
 Radiation 
 Chemotherapy 
 Hormone therapy 
 Targeted drug therapy (Herceptin) 
 Immunotherapy (Keytruda)
41
Q

Name the breast carcinoma: pre-invasive (limited by basement membrane) but still considered cancer

A

carcinoma in situ (CIS)

42
Q

Two forms of carcinoma in situ:

A

 Ductal CIS (DCIS)—ducts are filled with pleomorphic cells

 Lobular CIS (LCIS)—lobules are filled with pleomorphic cells

43
Q

Name the breast carcinoma: accounts for 70-80% of all breast cancers

A

invasive ductal carcinoma

44
Q

Name the breast carcinoma: most common type of breast cancer in both males and females

A

invasive ductal carcinoma

45
Q

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)

A

invasive ductal carcinoma

46
Q

Invasive ductal carcinoma in women under vs over 40

A

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

47
Q

Name the breast carcinoma: invasive carcinomas characterized by loss of normal cell adhesion

A

invasive lobular carcinoma

48
Q

Name the breast carcinoma: diffuse pattern of infiltration

A

invasive lobular carcinoma

49
Q

Name the breast carcinoma: most common type of breast cancer to present with distant metastases and occult primary

A

invasive lobular carcinoma

50
Q

Name the breast carcinoma: 1/3 not detected on mammogram, calcifications are uncommon

A

invasive lobular carcinoma

51
Q

Name the breast carcinoma: classic histology: linear arrangement of single cells between collagen fascicles

A

invasive lobular carcinoma

52
Q

Name the breast carcinoma: uncommon (1-7% of invasive breast cancers), favorable prognosis (10-year survival rate > 80%)

A

mucinous carcinoma

53
Q

Name the breast carcinoma: clinical presentation is a palpable SOFT mass in older women (60s)

A

mucinous carcinoma

54
Q

Name the breast carcinoma:

Histology: abundant extracellular mucin production, clusters of detached tumor cells float in pools of mucin

A

mucinous carcinoma

55
Q

Mucinous carcinoma: ER? HER2?

A

 ~95% positive for estrogen receptor

 < 5% overexpress HER2

56
Q

Name the breast carcinoma: a unique type of triple-negative breast carcinoma

A

medullary carcinoma

57
Q

Name the breast carcinoma:

 Most common type of carcinoma in patients with BRCA1 germline mutations (30-60%)
 Rare with BRCA2 mutations

A

medullary carcinoma

58
Q

Name the breast carcinoma:

Clinical: palpable, often rapidly growing circumscribed mass, 45-52 yo patients

A

medullary carcinoma

59
Q

Name the breast carcinoma:

Histology:
 High grade
 Prominent inflammatory infiltrate

A

medullary carcinoma

60
Q

most common genetic mutation in medullary carcinoma

A

p53

61
Q

Name the breast carcinoma: defined by clinical presentation of edema and erythema of > 1/3 of breast skin

A

inflammatory breast cancer

62
Q

Name the breast carcinoma: peau d’orange appearance (skin of orange/orange peel)

A

inflammatory breast cancer

63
Q

Name the breast carcinoma:

Histology: lymph-vascular invasion that obstructs lymphatic outflow

A

inflammatory breast cancer

64
Q

Name the breast carcinoma: HER2 amplification and TP53 mutations are common

A

inflammatory breast cancer

65
Q

Name the breast carcinoma: poor prognosis –> 5-year survival rate: 30%

A

inflammatory breast cancer

66
Q

Name the breast carcinoma: clinical presentation of breast cancer as scaling crust of skin due to DCIS involving nipple epidermis

A

Paget’s disease of the breast

67
Q

Name the breast carcinoma: ~50% of cases are associated with invasive carcinoma deeper in breast

A

Paget’s disease of the breast

68
Q

Name the breast carcinoma: often mistaken for skin inflammatory disease or infection

A

Paget’s disease of the breast

69
Q

Name the breast carcinoma:

Histology: cancer cells present within the epidermis

A

Paget’s disease of the breast

70
Q

benign neoplasm of intralobular STROMA of the breast

A

fibroadenoma

71
Q

most common benign, solid breast neoplasm (20-35 yo)

A

fibroadenoma

72
Q

hormone-sensitive, size increases with pregnancy, regresses with age

A

fibroadenoma

73
Q

Gross: painless and palpable
 Spherical mobile nodule, sharply circumscribed
 Rubbery

A

fibroadenoma

74
Q

Histology: glands compressed into slit-like spaces

A

fibroadenoma

General Pathology (11 decks)

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