breast Flashcards
myoepithelium
BM equivalent for invasion of CA
stains with S100
does not have ERs
oxytocin causes contraction
inverted nipple
congenital- higher risk of lactiferous sinus obstruction and inflammation and difficulty breastfeeding
acquires- must R/O CA
lactational mastitis
1st month postpartum
segmental acute inflammation (10% abscess)
typically S. aureus sometimes strep
periareolar non-lactational mastitis
mammary duct ectasia
2ndary to obstructed lactiferous sinus at nipple
associated with inverted nipple, and smoking
dilated sinuses -> can rupture -> acute foreign body inflammation -> fistula
peripheral non-lacational mastitis
usually associated with underlying condition like DM, RA, steroids, or trauma
fat necrosis
secondary to trauma
necrosis of fat cells -> foreign body granulomatous response -> Bx required to confirm
progression of ductal CA
hyperplasia -> atypical hyperplasia -> CIS -> IBC
fibrocystic change (FCC)
considered an exaggerated physiologic response
1/3 of women 30-50, stops at menopause
presents as mass, pain, or microcalcifications
cysts, adenosis, apocrine metaplasia and fibroiss
NO increased risk of CA
proliferative fibrocystic change w/o atypia
- usual epi hyperplasia, same as FCC, but >4cells in thickness
- radial scar -> mimics CA
- intraductal papilloma
proliferative fibrocystic change with atypia
atypical ductal hyperplasia
atypical lobular hyperplasia
atypical ductal hyperplasia
low grade neoplastic cells (identified by nucelar cytology)
overlap with DCIS
Is DCIS when duct is completely filled with neoplastic cells and entire lesion is >2mm
atypical lobular hyperplasia
proliferation of low grade neoplastic cells in lobule
cytologically different from ductal cells and e-cadherin neg
overlap with LCIS
hyperplasia w/o atypia increases risk of BCA by how much
2x
hyperplasiaw/atypia increases risk of BCA by how much
3-5x
high grade DCIS increases risk of BCA by how much
10x
typical age of LCIS
44-47
typical age of DCIS
54-58
clinical signs of LCIS
none
clinical signs of DCIS
mass, pain, discharge
mammogram signs of LCIS
none
mammogram signs of DCIS
microcalcifications
invasive lobular carcinoma
must have radiation following excision
low grade DCIS
mild nuclear atypia and micropapillary or cribiform architechture
high grade LCIS
malignant nuclear atypia and solif architecture
comedonecoriss
cental tumoral necrosis -> toothpaste finding grossly
necrotic cells are prone to dystrophic calcification
microinvasion
invasion <2mm
LCIS
cannot be detected grossly or with mammogram
histo- dyshesive architecture with signet-cell morphology and mucin +
paget disease
eczematous/red change to nipple and areola d/t underlying DCIS +/- invasion
pagets histo
infiltration of epi by malignant glandular cells
mucin+
CEA +
EMA+
pagetoid
refers to microscopic finding of upward infiltration of epi by glandular neoplastic cells
also seen in melanoma and SCC
risk factors for BCA
E exposure radiation breast density proliferative fibrocystic changes lifestyle (alcohol, obesity, sedentary) familial age
life-time E exposure
menarch 35
nullparity
longer breast feeding
GAD45
inhibits G1/S and GD/M allowing for DNA repairs
Li Fraumeni
p53 mutation
90% chance of BCA <30
sarcomas, brain tumors, osteosarcoma, adrenocortical tumors, leukemia, and others
inflammatory BC
worst outcome of all BCA
redness, skin thickening, dermal LVI
pT1
tumor <2cm
pT2
tumor 2-5cm
pT3
tumor is >5cm
pNO
no CA in regional nodes
pN1
CA found in 2-3 regional nodes
pN2
CA in 4-9 nodes
pN3
CA spread to 10+ nodes
Tamoxifen
competitive antagonist to ER on nuclear DNA
Arimidex
used in post-menopausal pts to block adrenal/fat cells from conversion of androgens to estrogens
angiosarcomas
usually post radiation
lobular stroma neoplasias
fibroadenoma
phyllodes tumor
interlobular stoma
fat necrosis lipoma fibrous tumor PASH fibromatosis sarcoma
fibroadenoma
most common benign tumor of breast typically 20-40 masses w/ or w/o calcification gross discrete india-rubber balls with lobular cut surface biphasic (stoma and epi cells)
phyllodes tumors
50-60 palpable masses rubbery, can be very large more cellular and mito active then fibroadenomas low-high grade spectrum
low grade phyllodes tumors
local recurrence, need wide surgical margins
high grade phyllodes tumors
aggressive local invasion w/hematogenous mets
lipoma
benign tumor of fat cells
most common soft tissue disorder of adults
round, circumscribed, soft, mobile, painless
gynecomastia
associated with cirrhosis, kleinefelters, E-producing tumors
meds, exogenous E
BCA in men
1% rate of women, otherwise the same
