Breast Flashcards by Alexa Breaux

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

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another name for supernumerary nipples

polythelia

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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

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

renal (extra kidney, horseshoe kidney, RCC)

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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)

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Histology: increase in ducts, fibrous stroma, adipose tissue

gynecomastia (males)

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

gynecomastia (males)

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seen in virtually all cases of gynecomastia (males)

ER, PR, and AR

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arises from the terminal duct lobular unit (TDLU)

fibrocystic change (females)

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cysts that contain blue/brown fluid, usually multiple

fibrocystic change

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caused by material released from ruptured cysts into adjacent stroma

fibrosis

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Clinical: bumpy/lumpy breast on palpation, usually bilateral

fibrocystic change

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microscopic: cyst dilation, ductal hyperplasia, and fibrosis

fibrocystic change

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benign neoplasm of small or large ducts

intraductal papilloma

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polypoid intraluminal mass, usually < 3 cm in size

intraductal papilloma

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soft and friable with areas of hemorrhage

intraductal papilloma

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most common cause of bloody nipple discharge

intraductal papilloma

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

acute mastitis

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bacteria that most commonly causes acute mastitis

Staph. aureus

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

acute mastitis

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treatment for acute mastitis

antibiotics and continued lactation

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

fat necrosis

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Clinical: palpable mass and skin changes

fat necrosis

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

fat necrosis

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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