breast

Question 1

myoepithelium

Answer 1

BM equivalent for invasion of CA
stains with S100
does not have ERs
oxytocin causes contraction

Question 2

inverted nipple

Answer 2

congenital- higher risk of lactiferous sinus obstruction and inflammation and difficulty breastfeeding
acquires- must R/O CA

Question 3

lactational mastitis

Answer 3

1st month postpartum
segmental acute inflammation (10% abscess)
typically S. aureus sometimes strep

Question 4

periareolar non-lactational mastitis

Answer 4

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

Question 5

peripheral non-lacational mastitis

Answer 5

usually associated with underlying condition like DM, RA, steroids, or trauma

Question 6

fat necrosis

Answer 6

secondary to trauma

necrosis of fat cells -> foreign body granulomatous response -> Bx required to confirm

Question 7

progression of ductal CA

Answer 7

hyperplasia -> atypical hyperplasia -> CIS -> IBC

Question 8

fibrocystic change (FCC)

Answer 8

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

Question 9

proliferative fibrocystic change w/o atypia

Answer 9

• usual epi hyperplasia, same as FCC, but >4cells in thickness
• radial scar -> mimics CA
• intraductal papilloma

Question 10

proliferative fibrocystic change with atypia

Answer 10

atypical ductal hyperplasia

atypical lobular hyperplasia

Question 11

atypical ductal hyperplasia

Answer 11

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

Question 12

atypical lobular hyperplasia

Answer 12

proliferation of low grade neoplastic cells in lobule
cytologically different from ductal cells and e-cadherin neg
overlap with LCIS

Question 13

hyperplasia w/o atypia increases risk of BCA by how much

Answer 13

2x

Question 14

hyperplasiaw/atypia increases risk of BCA by how much

Answer 14

3-5x

Question 15

high grade DCIS increases risk of BCA by how much

Answer 15

10x

Question 16

typical age of LCIS

Answer 16

44-47

Question 17

typical age of DCIS

Answer 17

54-58

Question 18

clinical signs of LCIS

Answer 18

none

Question 19

clinical signs of DCIS

Answer 19

mass, pain, discharge

Question 20

mammogram signs of LCIS

Answer 20

none

Question 21

mammogram signs of DCIS

Answer 21

microcalcifications

Question 22

invasive lobular carcinoma

Answer 22

must have radiation following excision

Question 23

low grade DCIS

Answer 23

mild nuclear atypia and micropapillary or cribiform architechture

Question 24

high grade LCIS

Answer 24

malignant nuclear atypia and solif architecture

Question 25

comedonecoriss

Answer 25

cental tumoral necrosis -> toothpaste finding grossly

necrotic cells are prone to dystrophic calcification

Question 26

microinvasion

Answer 26

invasion <2mm

Question 27

LCIS

Answer 27

cannot be detected grossly or with mammogram

histo- dyshesive architecture with signet-cell morphology and mucin +

Question 28

paget disease

Answer 28

eczematous/red change to nipple and areola d/t underlying DCIS +/- invasion

Question 29

pagets histo

Answer 29

infiltration of epi by malignant glandular cells
mucin+
CEA +
EMA+

Question 30

pagetoid

Answer 30

refers to microscopic finding of upward infiltration of epi by glandular neoplastic cells
also seen in melanoma and SCC

Question 31

risk factors for BCA

Answer 31

E exposure
radiation
breast density
proliferative fibrocystic changes
lifestyle (alcohol, obesity, sedentary)
familial
age

Question 32

life-time E exposure

Answer 32

menarch 35
nullparity
longer breast feeding

Question 33

GAD45

Answer 33

inhibits G1/S and GD/M allowing for DNA repairs

Question 34

Li Fraumeni

Answer 34

p53 mutation
90% chance of BCA <30
sarcomas, brain tumors, osteosarcoma, adrenocortical tumors, leukemia, and others

Question 35

inflammatory BC

Answer 35

worst outcome of all BCA

redness, skin thickening, dermal LVI

Question 36

pT1

Answer 36

tumor <2cm

Question 37

pT2

Answer 37

tumor 2-5cm

Question 38

pT3

Answer 38

tumor is >5cm

Question 39

pNO

Answer 39

no CA in regional nodes

Question 40

pN1

Answer 40

CA found in 2-3 regional nodes

Question 41

pN2

Answer 41

CA in 4-9 nodes

Question 42

pN3

Answer 42

CA spread to 10+ nodes

Question 43

Tamoxifen

Answer 43

competitive antagonist to ER on nuclear DNA

Question 44

Arimidex

Answer 44

used in post-menopausal pts to block adrenal/fat cells from conversion of androgens to estrogens

Question 45

angiosarcomas

Answer 45

usually post radiation

Question 46

lobular stroma neoplasias

Answer 46

fibroadenoma

phyllodes tumor

Question 47

interlobular stoma

Answer 47

fat necrosis
lipoma
fibrous tumor
PASH
fibromatosis
sarcoma

Question 48

fibroadenoma

Answer 48

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)

Question 49

phyllodes tumors

Answer 49

50-60
palpable masses
rubbery, can be very large
more cellular and mito active then fibroadenomas
low-high grade spectrum

Question 50

low grade phyllodes tumors

Answer 50

local recurrence, need wide surgical margins

Question 51

high grade phyllodes tumors

Answer 51

aggressive local invasion w/hematogenous mets

Question 52

lipoma

Answer 52

benign tumor of fat cells
most common soft tissue disorder of adults
round, circumscribed, soft, mobile, painless

Question 53

gynecomastia

Answer 53

associated with cirrhosis, kleinefelters, E-producing tumors

meds, exogenous E

Question 54

BCA in men

Answer 54

1% rate of women, otherwise the same