breast Flashcards
what is the most common palpable nodule / mass of breast lesions? 40%
FCC (Fibrocystic changes)
presentation of FCC( fibrocystic changes)
irregular mass, cyst, calcification, nipple discharge, nodularity or thickening
pre-menopausal age
what inflammatory lesion of the breast occurs during lactation?
mastitis
non proliferative FCC histologic findings
- Cysts: with or without apocrine metaplasia
- Stromal fibrosis
- Adenosis: an increase in the number of acini per lobule
proliferative FCC disease w/o atypia
there are more acini than you’d expect to see in a normal breast,
under mammogram & histologically it mimics invasive carcinoma
what is seen in intraductal papilloma of breast
proliferative dis w/o atypia,
acini proliferate into ducts,
benign, but has malignant variants,
2 types: large and small duct growth
large duct intraductal papilloma of breast
acini proliferate into large duct found close to nipple,
**bloody discharge from nipple,
no increased risk of cancer
small intraductal papilloma of breast
acini proliferate into small ducts near periphery of breast,
mildly increased risk of cancer
which proliferative breast disease with atypia has some, but not all of DCIS features?
Atypical ductal hyperplasia (ADH) – it must be removed from the breast.
Flat epithelial atypia (FEA) of breast appears as
there isn’t as much proliferation into lumen, but you still see atypia
what is atypical lobular hyperplasia (ALH)
proliferative disease w/atypia
Proliferation of cells identical to those of LCIS.
Cells do not fill or distend more than 50% of the acini within a lobule.
breast specific biphasic tumors
stromal tumors
Fibroadenoma
Phyllodes tumor
what is the most common benign tumor
fibroadenoma
presentaiton of fibroadenoma
palpable and freely movable firm mass(young) mammographic density (old)
fibroadenoma grossly appearance
Encapsulated, usually solitary, discrete, yellow-white, rubbery, whirl-like pattern
Most <3 cm in diameter
fibroadenoma histological appearance
Biphasic tumor:
- Stromal overgrowth
- Compressed duct-like, epithelial lined spaces
phyllodes tumor most common in which age group
most common in the 50s
50s
if phyllodes tumor becomes malignant how will it appear
usually large (>5cm), leaflike pattern, hemorrhage, necrosis, infiltration
the most common non skin malignancy in women
breast carcinoma
hormonal factors that increase risk of breast cancer include:
- early menarche (1st pd)
- late menopause
- nulliparity (never having a kid)
- 1st child after 35 yrs
- postmenopausal women w obesity
- estrogen producing ovarian tumors
hormonal factors that decrease risk of breast cancer include:
- oophorectomy (removal of ovaries) before age 35
- 1st child before 20 years old
- obesity prior to age 40
T/F: black women are more likely to have ER/PR positive breast cancer
false- more likely to be ER/PR negative
Genetic factors that increase risk for breast carcinoma
- 1st degree relatives with breast cancer (mom, sis, daughter), and higher risk if relative developed at early age
- germline mutations: li fraumeni syndrome (p53 mutation), CHEK2 mutation (li fraumeni variant)
- BRCA1 & BRCA2 genes: associated w familial breast cancer at an early age
breast carcinoma is most often seen in which area of the breast
upper and outer quadrant (50%)….
after that, central/subareolar area (20%) and each other quadrant (10%)
multifocal lesions seen in ___ of breast carcinoma
1/3… they’re usually unifocal
bilateral lesions common in which type of breast cancer
lobular carcinoma
breast cancer death rates went down 34% since 1990 b/c of…
mammograms
Ductal Carcinoma in situ - important aspects:
- cancer in the duct that hasn’t spread to breast parenchyma, confined within the BM
- surrounded by myoepithelial cells
- easily removed surgically
low grade vs high grade DCIS
- low grade: lack either high grade nuclei or central necrosis; characteristic changes involve at least 2 ducts or extend over at least 2mm
- high grade has both of morphological features above, plus no size limitation
Paget’s disease is DCIS that involves
skin of nipple& areola
- extending from nipple duct
- ezcema like presentation: errythematous eruption, pruritis, ulceration, oozing
determining prognosis of pagets disease
in situ or invasive ductal carcinoma in underlying breast tissue
paget disease histologically
Large pale vacuolated tumor cells (Paget cells) within the keratinizing squamous epithelium
invasive ductal carcinoma
- Malignant ductal cells forming cords, nests, tubules and sheets
- Infiltrating dense fibrotic stroma
- Accompanying DCIS, usually with similar grades
tubular carcinoma (specialized type of invasive ductal carcinoma) – better or worse prognosis than non specified types?
has extremely good prognosis… smaller size & less nodal involvement
describe tubular carcinoma (specialized type of invasive ductal carcinoma)
- well differentiated ductal carcinoma
- open tubules w single layer of tumor cells enclosing clear lumen, distorted by cellular desmoplastic stroma
medullary carcinoma (specialized type of invasive ductal carcinoma) – better or worse prognosis than non specified types?
better
macro appearance of medullary carcinoma
large soft circumscribed mass
micro appearance of medullary carcinom
ER/PR and HER2 negative large pleomorphic tumor cells solid or syncytial pattern circumscribed tumor border w/pushing margins lymphoplasmacytic infiltrates no desmoplasia
colloid (mucinous ) carcinoma is small islands of
Small islands of well differentiated tumor cells floating in lakes of mucinin
inflammatory carcinoma presents with
breast swelling and skin thickening “orange”
skin overlying breast with prominent lymphatic spaces filled with clusters of tumor cells
lobular carcinoma in situ (LCIS) bilateral or unilateral
bilateral
LCIS high risk for
subsequent development of invasive carcinoma lobular or ductal
LCIS histo
- Proliferation of small, uniform, round and loosely cohesive cells completely filling all the acini (without luminal spaces)
- Expansion or distension of at least one-half of the acini in the lobular unit
why is LCIS of breast hard to detect
usually doesn’t form a mass or have calcifications
T/F: lobular invasive carcinoma of the breast is likely to be unifocal and bilateral
false- it’s likely to be MULTIFOCAL & BILATERAL
prognosis of lobular invasive carcinoma of the breast?
no sig difference from invasive ductal carcinoma
where does invasive lobular carcinoma of breast metastasize
to peritoneum, retroperitoneum, leptomeninges, GI tract, ovaries and uterus.
gynecomastia is
enlargement of male breast
due to estrogen excess
Staging, prognosis and treatment similar to female breast carcinoma
gynecomastia histo
- Proliferation of ducts with micropapillary hyperplasia of lining epithelium
- Proliferation of collagenous stroma
- No lobular structures
Histologically and biologically resembles infiltrating ductal carcinoma of the female breast
