Breast Flashcards
Describe gross appearance of fibrocystic changes
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
Describe mic pic & variants of fibrocytic changes
- Cysts lined by cuboidal to columnar epithelial cells that may be flattened in large cysts
- 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
- Apocrine metaplasia
- Stroma is formed of compressed fibrous tissue with lymphocytic infiltrate
CP of fibrocystic changes
Fibrocystic changes produce palpable lumps
Nipple discharge (serous or serosanguineous)
Describe morphology of sclerosing adenosis
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
List fibrocystic changes with:
1. Minimal
2. Slightly inc
3. Significant inc
(risk of carcinoma)
- Fibrosis, cystic changes, apocrine metaplasia, mild hyperplasia
- Moderate to florid hyperplasia, ductal papillomatosis, sclerosing adenosis
- Atypical hyperplasia (ductular or lobular)
Mention causes of gynecomastia
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
Describe morphology of gynecomastia
G: button-like, subareolar swelling develops, usually bilateral may be unilateral
M: the duct show prominent epithelial hyperplasia surrounded by hylainized stroma
Mammary duct ectasia is associated with……occurs at age….
Inspissated breast secretion in main excretory ducts
45-60 yrs
Describe mic pic of mammary duct ectasia
- Ducts are filled by granular debris, sometimes containing leukocytes and lipid-laden macrophages
- The lining epithelium is usually destroyed
- The most distinguishing features are the prominent lymphoplasmacytic infiltrate and occasional granulomas in periductal stroma
What is the clinical importance of mammary duct ectasia
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
Describe mic pic of traumatic fat necrosis
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.
Define each of the following:
1. Congenital infection
2. Perinatal infection
3. Neonatal infection
- Infection of fetus acquired in utero across placenta
- Infection acquired during passage down an infected birth canal
- Infection acquired from birth till 28 complete days (early if birth till 7th day, late if after 7 complete days from birth
Mention causative agents of ophalmia neonatorum and diagnostic sepcimen for each
N.gonorrhea (conjuctival swab)
C.trachomatis (scrapings of epithelial cells from the eyes)
Describe ttt of ophthalmia neonatorum
Azithromycin or cephalosporins systemic therapy. Topical therapy with erythromycin also recommended and may speed resolution
The most common benign neoplasm of breast is….
Fibroadenoma
Describe mic pic of fibroadenoma
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
Describe CP of fibroadenomas
Present as solitary, discrete freely movable masses
They may enlarge late in menstrual cycle and during pregnancy after menopause they may regress and calcify
Peak age for fibroadenoma is…..while for Phyllodes tumor is…..
Third decade of life
45 yrs of age
Describe mic pic for Phyllodes tumor
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
Describe biological behaviour og Phyllodes tumor
-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.
Describe mic pic of intraductal papilloma
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
Describe CP of intraductal papilloma
- Serous or bloody nipple discharge
- Small subareolar mass a few mm in diameter
- Rarely nipple retraction
The most common tumor in females worldwide is….
Breast carcinoma
List risk factors of breast carcinoma
- Geographical factors: more in NA and EU
- Age more than 50 yrs
- Family history inc risk 1.2-3 times if 1st degree relative
- Menstrual hiatory menarche before 12 menopause after 55
- Nulliparity and late childbirth
- Benign breast disease: proliferative lesion without atypia 1.6 inc risk, witha typia more than 2-fold risk inc
- Ionizing radiation to chest
- Other less established factors: exogenous estrogen, OCP, obesity, high fat diet, alcohol consumption and cigarette smoking
