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urogenital pathology > Breast > Flashcards

Breast Flashcards

1
Q

Describe gross appearance of fibrocystic changes

A

Usually multifocal & bilateral
Ill-defined, diffusely inc density & discrete nodularities
The cysts vary from smaller than 1 cm to 5 cm in diameter. They are brown to blue (blue dome cysts) & and are filled with watery turbid fluid

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2
Q

Describe mic pic & variants of fibrocytic changes

A
  1. Cysts lined by cuboidal to columnar epithelial cells that may be flattened in large cysts
  2. Epithelial hyperplasia of the lining cells may result in stratification (epitheliosis) may be papillomatosis, degree of hyperplasia is judged in part by number of layers of intraductal epithelial proliferation, can be mild, moderate or severe. May be graded into atypical hyperplasia or without atypia
  3. Apocrine metaplasia
  4. Stroma is formed of compressed fibrous tissue with lymphocytic infiltrate
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3
Q

CP of fibrocystic changes

A

Fibrocystic changes produce palpable lumps
Nipple discharge (serous or serosanguineous)

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4
Q

Describe morphology of sclerosing adenosis

A

G: hard, rubbery masses similar to br can
M: marked stromal fibrosis, which may compress & distort the lumina of proliferating acini & ducts so they appear as solid cords of cells

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5
Q

List fibrocystic changes with:
1. Minimal
2. Slightly inc
3. Significant inc
(risk of carcinoma)

A
  1. Fibrosis, cystic changes, apocrine metaplasia, mild hyperplasia
  2. Moderate to florid hyperplasia, ductal papillomatosis, sclerosing adenosis
  3. Atypical hyperplasia (ductular or lobular)
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6
Q

Mention causes of gynecomastia

A

In response to relative/absolute estrogen excess as in
1. Liver cirrhosis
2. Estrogen-secreting tumors, estrogen/digitalis therapy, Kleinfelter syndrome
3. Physiological gynecostia occur at puberty & in old age

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7
Q

Describe morphology of gynecomastia

A

G: button-like, subareolar swelling develops, usually bilateral may be unilateral
M: the duct show prominent epithelial hyperplasia surrounded by hylainized stroma

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8
Q

Mammary duct ectasia is associated with……occurs at age….

A

Inspissated breast secretion in main excretory ducts
45-60 yrs

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9
Q

Describe mic pic of mammary duct ectasia

A
  1. Ducts are filled by granular debris, sometimes containing leukocytes and lipid-laden macrophages
  2. The lining epithelium is usually destroyed
  3. The most distinguishing features are the prominent lymphoplasmacytic infiltrate and occasional granulomas in periductal stroma
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10
Q

What is the clinical importance of mammary duct ectasia

A

Because the duct dilatation and rupture lead to reactive changes surrounding the breast tissie that may represent a poorly demarcated periareolar mass with nipple retraction similar to changes caused by some carcinomas

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11
Q

Describe mic pic of traumatic fat necrosis

A

Early it consists of central zone of necrotic fat cells surrounded by neutrophils, lipid-laden macrophages with giant cells
Later it becomes surrounded by fibrous tissue amd mononuclear lymphocytes
Eventually the focus is replaced by scar tissue and calcifications may develop.

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12
Q

Define each of the following:
1. Congenital infection
2. Perinatal infection
3. Neonatal infection

A
  1. Infection of fetus acquired in utero across placenta
  2. Infection acquired during passage down an infected birth canal
  3. Infection acquired from birth till 28 complete days (early if birth till 7th day, late if after 7 complete days from birth
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13
Q

Mention causative agents of ophalmia neonatorum and diagnostic sepcimen for each

A

N.gonorrhea (conjuctival swab)
C.trachomatis (scrapings of epithelial cells from the eyes)

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14
Q

Describe ttt of ophthalmia neonatorum

A

Azithromycin or cephalosporins systemic therapy. Topical therapy with erythromycin also recommended and may speed resolution

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15
Q

The most common benign neoplasm of breast is….

A

Fibroadenoma

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16
Q

Describe mic pic of fibroadenoma

A

Biphasic:
1. Loose fibroblastic stroma
2. Duct like, epithelium-lined spaces of various forms and sizes:
They are lined by regular luminal and myoepithelial cells with well-defined intact BM
Although in some lesions ductal spaces are open round to oval and regular (pericanalicular fibroadenoma) others are compressed by extensive proliferation of stroma so they appear as slits or irregular structures (intracnalicular fibroadenoma). Most cases are of mixed patterns

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17
Q

Describe CP of fibroadenomas

A

Present as solitary, discrete freely movable masses
They may enlarge late in menstrual cycle and during pregnancy after menopause they may regress and calcify

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18
Q

Peak age for fibroadenoma is…..while for Phyllodes tumor is…..

A

Third decade of life
45 yrs of age

19
Q

Describe mic pic for Phyllodes tumor

A

Benign epithelial component covering abundant hypercellular stroma
It is chct by leaf-like processes protruding into cystic spaces
Malignant changes are observed as inc stromal cellularity with anaplasia, high mitotic activity, rapid inc in size and infiltrative margins

20
Q

Describe biological behaviour og Phyllodes tumor

A

-Most of these tumors remain loaclised and are cured by excision
Malignant lesions may recur, but also tend to remian localisrd
Only 2% of cases metas.

21
Q

Describe mic pic of intraductal papilloma

A

Delicate, branching growths within a dilated duct or cyst
These are composed of multiple papillae, each having a CT core covered by double layered epithelial cells, with an outer luminal epithelial layer overlying a myoepithelial layer

22
Q

Describe CP of intraductal papilloma

A
  1. Serous or bloody nipple discharge
  2. Small subareolar mass a few mm in diameter
  3. Rarely nipple retraction
23
Q

The most common tumor in females worldwide is….

A

Breast carcinoma

24
Q

List risk factors of breast carcinoma

A
  1. Geographical factors: more in NA and EU
  2. Age more than 50 yrs
  3. Family history inc risk 1.2-3 times if 1st degree relative
  4. Menstrual hiatory menarche before 12 menopause after 55
  5. Nulliparity and late childbirth
  6. Benign breast disease: proliferative lesion without atypia 1.6 inc risk, witha typia more than 2-fold risk inc
  7. Ionizing radiation to chest
  8. Other less established factors: exogenous estrogen, OCP, obesity, high fat diet, alcohol consumption and cigarette smoking
25
Q

Describe pathogenesis of breast carcinoma

A

Remains unknown but following factors seem to be imp:
1. Genetic changes: overexpression of HER2/NEU proto-ocogene–> poor prognosis, BRCA1 (5-10% of bc) less common BRCA2
2. Hormonal influences: endogenous estrogen excess/ hormonal imbalance
3. Environmental variables

26
Q

Describe mic pic of ductal carcinoma in situ

A

Often mixed:
Comedo, cribriform, solid, micropapillary, papillary, clinging types. Comedo is distinctive chct by cells with high grade nuclei distending spaces with extensive central necrosis
Calcifications are frequently associated with DCIS

27
Q

Describe prognosis of DCIS

A

Excellent 97% survival after simple mastectomy
But at least 1/3 of women develop invasive carcinoma

28
Q

Paget disease of nipple is caused by….., clinically mainfested as…..

A

DCIS that extends into lactoferous ducts and into contiguous skin of the nipple
Unilateral crusting exudate over the nipple and areolar skin, about half of cases there ia underlying invasive carcinoma

29
Q

Describe mic pic and prognosis of Paget’s disease of nipple

A

-Large clear cells with atypical nuclei seen within epidermis usually along the basal layer but also permeating malpighian layer
-Based on underlying carcinoma not worsened by presence of Paget

30
Q

Describe mic pic of lobular car in situ

A

They are monomorphic with bland, round nuclei and occur in loosely cohesive clusters in lobules
Intracellular mucin vacuoles are common
Calcifications and necrosis are rare

31
Q

Describe prognosis of LCIS

A

1/3 of women with it develop invasive carcinoma also there is inc risk of developing BC in contralateral breast

32
Q

Microscopic pictire and immunophenotype of invasive duct carcinoma

A

-It is quite heterogenous ranging from tumors with well-developed tubule formation and low grade nuclei tp tumors consisting of anaplastic cell sheets
-2/3 express estrogen and progesterone receptors, 1/3 express HER2/NEU

33
Q

Microscopic pictire and immunophenotype of invasive lobular carcinoma

A

Cells morphologically identical to LCIS, 2/3 associated with LCIS. Cells invade individually into stroma and are often aligned in strands or chains. Bull’s eye or targetoid patten (surround normal appearing acini
-Almost all express hormone receptors but HER2NEU overexpression is very rare or absent

34
Q

Peau d’orange occurs in…..due to…..

A

Inflammatory carcinoma
Lymphatic involvement by tumor emboli that skin drainage is blocked causing lymphedema and skin thickening.

35
Q

Medullary carcinoma occurs in women have…mutation

A

BRACA1

36
Q

Describe immunophenotype for:
1. Colloid carcinoma
2. Tubular carcinoma

A

Both mostly express hormone receptors and rarely overexpress HER2/NEU

37
Q

Mention clinical features of breast carcinoma

A
  1. Usually present as painless palpable masses or mammographic densities but some may be clinically occult
  2. Advanced cancers may cause dimpling of skin, retraction of nipple or fixation to chest wall
  3. Localized lymphedema
38
Q

Mention LNs affected and common distant metastasis sites for breast cancer

A

-Axillary LNs in outer quadrant tumors, internal mammary nodes in medial quadrant tumors
-Lung, skeleton, liver, adrenals

39
Q

List prognostic factors for breast cancer

A
  1. Invasion and tumor size
  2. Lymph node involvement
  3. Distant metastasis
  4. Histologic grade
  5. Histologic type of carcinoma
  6. Proloferative rate of cancer
  7. Presence or absence of estrogen or progesterone receptors
  8. Overexpression of HER2/NEU
40
Q

Describe prognosis of BC according to histologic type

A

All specialized types have better prognosis than those with no special type. Inflammatory carcinoma has poor prognosis

41
Q

…..is used to measire proliferative rate

A

Ki-67

42
Q

Describe importance of HER2/NEU overexpression

A

Associated with aggressive tumors
Importance is to predict tumor response to Herceptin therapy

43
Q

Classify breast cancer according to the molecular classification

A
  1. Luminal A: lower grade ER/PR-+ve, HER2 -ve
  2. Lumimal B: higher grade both are +ve
  3. HER2-enriched, express the latter but not ER & PR
  4. Basal like: remeble basally located myoepithelial cells (Tripple negative). Carry worst prognosis

urogenital pathology (9 decks)

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