breast Flashcards
intraductal papilloma presentation
buzzwords: bloody nipple discharge, premenopausal woman, myoepithelial cells still present
papillary growth w/in lactiferous ducts can bleed
where are these axillary nodes:
level I
level II
level III
rotters
level I - lateral to pec minor
level II - deep to pec minor
level III - medial to pec minor
rotter’s nodes - interpectoral
risk factors for breast cancer
- increased estrogen exposure(obesity)
- increased # of menstrual cycles
- bein older when you have ya first baby
- african american - increased risk for triple negative
- BRCA1/2
Ki-67 index
nuclear marker for proliferation in breast cancer
invasive lobular carcinoma
5-10% of all breast cancers
Presentation:
- Hard to see, even on imaging and grossly – sneaky bastard
- Usually expresses hormonal receptors so pretty easy to treat
- orderly rows of malignant cells(indian file)
- bilateral w/multiple lesions in same location
Mets to: CSF, BM, GU tract, peritoneum
loss of e-cadherin means they wont be formin no ducts! discohesive.
periductal mastitis
inflammation of subareolar ducts
SMOKERS – causes relative vitamin A deficiency; lactiferous ducts cant start to become squamous tissue due to lack of vit. A; keratin plugs up lactiferous ducts causing inflammation
buzzwords: smoker, subareolar mass, nipple retraction
difference in chemotherapy benefit for breast cancer based on age
young people benefit by a greater margin than old people who are indicated for chemo
acute mastitis
bacterial breast infection(s. aureus mostly)
breast-feeding causes fissures, allows bacteria in
presents as mother with erythematous breast w/purulent discharge – drain and give dicloxacillin!
tubular invasive ductal carcinoma presentation
well formed tubules w/low-grade nuclei
LACKS MYOEPITHELIAL CELLS
young patient
ER/PR+; good prognosis
tamoxifen
anti-estrogen; blocks estrogen binding to ER+ cells
also called selective estrogen receptor modulator(SERM)
staple treatment for premenopausal patients w/early stage disease
partial agonist @ endometrium: increased cancer risk
antagonist @ breast: anti-ER+ tumor effect
mammary duct ectasia
inflammation w/dilation of subareolar(lactiferous) duct
usually seen in multiparous, POSTmenopausal woman
buzzwords: green-brown nipple discharge, periareolar mass(can mimic breast canceR)
phyllodes tumor presentation
fibroadenoma-like tumor w/excess fibrous tissue – causes leaf-like projections; can be malignant(low-grade)
more common in post-menopausal women
fibroadenoma presentation
buzzwords: small, mobile, firm mass, well-circumscribed, young
benign tumor of fibrous tissue and glands in premenopausal women; no malignant potential; no increased risk; can be left alone
estrogen sensitive - gets bigger w/more estrogen; regress after menopause
mucinous invasive ductal carcinoma
old lady(70-80)
tumor is filled w/mucous - rather indolent
estrogen/progesterone +
adenosis
increased acinii in lobules
non-malignant causes of breast calcifications
fat necrosis – saponification
sclerosing adenosis – seen in association with fibrocystic breast changes
inflammatory subtype of invasive ductal carcinoma
invasion of dermal lymphatics by malignant cells
peau d’orange(breast skin looks like an orange)
bad prognosis – looks very similar to acute mastitis(erythematous, swollen breast)
- keep inflammatory invasive ductal carcinoma in back of mind when seeing this presenation
proliferative breast diseases and their cancer risk
- *fibrocystic changes -** enlarged, cystic glands w/hyperplasia of fibrous breast stroma
- no risk
sclerosing adenosis - excess glands that increase in fibrous tissue – can calcify!
- 2x increased risk
epithelial/ductal hyperplasia - increased # of ductal cells – more than 2 layers in duct
- 2x increased risk
atypical hyperplasia
- 5x increased risk
these risks are all bilateral increases in risk!
medullary sub-type of invasive ductal carcinoma
high grade malignant cells w/lymphocytic infiltrate
good prognosis
assn. w/BRCA mutation; ER-/PR-
invasive ductal carcinoma presentation
“rock-hard” mass; poorly defined edges
duct-like cells - cells havent lost e-cadherin like invasive lobular
worst and most invasive
most common(76% of all breast cancers)
how is DCIS often picked up on mammography?
microcalcifications in the ducts!
HER2 mutation is _____prognostic and ________predictive
poor prognostic, but positive predictive
HER 2 lets you use trastuzumab or pertuzumab so positive predictive! natural course would be worse though so poor prognostic
fibroscystic changes presentation
buzzwords: premenopausal, “lumpy” breast, blue dome cysts
hormone mediated change in breasts involving cystic ducts and increased fibrous change around them
aromatase inhibitors
prevents formation of estrogens
staple treatment for postmenopausal patients – prolly cause they dont need estrogen for periods and stuff as much as pre-meno’s
reduced risk of second primary BC
ER/PR/HER2 status for Luminal A and B molecular subtypes of breast cancer?
ER+/PR+/HER2-
name the molecular subtypes of breast cancers
Luminal A
Luminal B
HER2+
Basal-like(triple-negative)
how to differentiate intraductal papilloma vs carcinoma
both present with blood nipple discharge
papilloma: premenopausal and 2 cell layers present
carcinoma: postmenopausal and 1 cell layer(no myo)
trastuzumab(herceptin) mechanism and toxicity
Mab against HER2(TK receptor); helps kill breast cancers overexpressing HER2 proteins
toxicity: HEARTceptin – damages the heart
ER/PR/HER2 status for basal-like molecular subtype of breast cancer
triple negative for basal-like
how are diagnostic mammograms different than the screening ones?
- specialized views(spot compression, spot magnification, rolled)
- real-time interpretation by radiologist w/results at time of exam
- US can be performed on-site if indicated
comedocarcinoma
DCIS with caseous necrosis in center
cells grow into center of duct, further from blood supply, start to die
paget disease of breast
DCIS creeps up to nipple
eczematous patches on nipple
histo: paget cells are large cells in epidermis w/clear halo
can also be seen in vulva, but is NOT suggestive of DCIS there…
