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pathology > breast > Flashcards

breast Flashcards

1
Q

what is the most common palpable nodule / mass of breast lesions? 40%

A

FCC (Fibrocystic changes)

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2
Q

presentation of FCC( fibrocystic changes)

A

irregular mass, cyst, calcification, nipple discharge, nodularity or thickening

pre-menopausal age

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3
Q

what inflammatory lesion of the breast occurs during lactation?

A

mastitis

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4
Q

non proliferative FCC histologic findings

A
  • Cysts: with or without apocrine metaplasia
  • Stromal fibrosis
  • Adenosis: an increase in the number of acini per lobule
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5
Q

proliferative FCC disease w/o atypia

A

there are more acini than you’d expect to see in a normal breast,
under mammogram & histologically it mimics invasive carcinoma

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6
Q

what is seen in intraductal papilloma of breast

A

proliferative dis w/o atypia,
acini proliferate into ducts,
benign, but has malignant variants,
2 types: large and small duct growth

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7
Q

large duct intraductal papilloma of breast

A

acini proliferate into large duct found close to nipple,
**bloody discharge from nipple,
no increased risk of cancer

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8
Q

small intraductal papilloma of breast

A

acini proliferate into small ducts near periphery of breast,
mildly increased risk of cancer

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9
Q

which proliferative breast disease with atypia has some, but not all of DCIS features?

A

Atypical ductal hyperplasia (ADH) – it must be removed from the breast.

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10
Q

Flat epithelial atypia (FEA) of breast appears as

A

there isn’t as much proliferation into lumen, but you still see atypia

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11
Q

what is atypical lobular hyperplasia (ALH)

A

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.

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12
Q

breast specific biphasic tumors

stromal tumors

A

Fibroadenoma

Phyllodes tumor

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13
Q

what is the most common benign tumor

A

fibroadenoma

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14
Q

presentaiton of fibroadenoma

A 
palpable and freely movable firm mass(young)
mammographic density (old)
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15
Q

fibroadenoma grossly appearance

A

Encapsulated, usually solitary, discrete, yellow-white, rubbery, whirl-like pattern

Most <3 cm in diameter

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16
Q

fibroadenoma histological appearance

A

Biphasic tumor:

  • Stromal overgrowth
  • Compressed duct-like, epithelial lined spaces
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17
Q

phyllodes tumor most common in which age group

most common in the 50s

A

50s

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18
Q

if phyllodes tumor becomes malignant how will it appear

A

usually large (>5cm), leaflike pattern, hemorrhage, necrosis, infiltration

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19
Q

the most common non skin malignancy in women

A

breast carcinoma

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20
Q

hormonal factors that increase risk of breast cancer include:

A
  • early menarche (1st pd)
  • late menopause
  • nulliparity (never having a kid)
  • 1st child after 35 yrs
  • postmenopausal women w obesity
  • estrogen producing ovarian tumors
21
Q

hormonal factors that decrease risk of breast cancer include:

A
  • oophorectomy (removal of ovaries) before age 35
  • 1st child before 20 years old
  • obesity prior to age 40
22
Q

T/F: black women are more likely to have ER/PR positive breast cancer

A

false- more likely to be ER/PR negative

23
Q

Genetic factors that increase risk for breast carcinoma

A
  • 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
24
Q

breast carcinoma is most often seen in which area of the breast

A

upper and outer quadrant (50%)….

after that, central/subareolar area (20%) and each other quadrant (10%)

25
Q

multifocal lesions seen in ___ of breast carcinoma

A

1/3… they’re usually unifocal

26
Q

bilateral lesions common in which type of breast cancer

A

lobular carcinoma

27
Q

breast cancer death rates went down 34% since 1990 b/c of…

A

mammograms

28
Q

Ductal Carcinoma in situ - important aspects:

A
  • cancer in the duct that hasn’t spread to breast parenchyma, confined within the BM
  • surrounded by myoepithelial cells
  • easily removed surgically
29
Q

low grade vs high grade DCIS

A
  • 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
30
Q

Paget’s disease is DCIS that involves

A

skin of nipple& areola

  • extending from nipple duct
  • ezcema like presentation: errythematous eruption, pruritis, ulceration, oozing
31
Q

determining prognosis of pagets disease

A

in situ or invasive ductal carcinoma in underlying breast tissue

32
Q

paget disease histologically

A

Large pale vacuolated tumor cells (Paget cells) within the keratinizing squamous epithelium

33
Q

invasive ductal carcinoma

A
  • Malignant ductal cells forming cords, nests, tubules and sheets
  • Infiltrating dense fibrotic stroma
  • Accompanying DCIS, usually with similar grades
34
Q

tubular carcinoma (specialized type of invasive ductal carcinoma) – better or worse prognosis than non specified types?

A

has extremely good prognosis… smaller size & less nodal involvement

35
Q

describe tubular carcinoma (specialized type of invasive ductal carcinoma)

A
  • well differentiated ductal carcinoma

- open tubules w single layer of tumor cells enclosing clear lumen, distorted by cellular desmoplastic stroma

36
Q

medullary carcinoma (specialized type of invasive ductal carcinoma) – better or worse prognosis than non specified types?

A

better

37
Q

macro appearance of medullary carcinoma

A

large soft circumscribed mass

38
Q

micro appearance of medullary carcinom

A 
ER/PR and HER2 negative
large pleomorphic tumor cells
solid or syncytial pattern
circumscribed tumor border w/pushing margins 
lymphoplasmacytic infiltrates
no desmoplasia
39
Q

colloid (mucinous ) carcinoma is small islands of

A

Small islands of well differentiated tumor cells floating in lakes of mucinin

40
Q

inflammatory carcinoma presents with

A

breast swelling and skin thickening “orange”

skin overlying breast with prominent lymphatic spaces filled with clusters of tumor cells

41
Q

lobular carcinoma in situ (LCIS) bilateral or unilateral

A

bilateral

42
Q

LCIS high risk for

A

subsequent development of invasive carcinoma lobular or ductal

43
Q

LCIS histo

A
  • 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
44
Q

why is LCIS of breast hard to detect

A

usually doesn’t form a mass or have calcifications

45
Q

T/F: lobular invasive carcinoma of the breast is likely to be unifocal and bilateral

A

false- it’s likely to be MULTIFOCAL & BILATERAL

46
Q

prognosis of lobular invasive carcinoma of the breast?

A

no sig difference from invasive ductal carcinoma

47
Q

where does invasive lobular carcinoma of breast metastasize

A

to peritoneum, retroperitoneum, leptomeninges, GI tract, ovaries and uterus.

48
Q

gynecomastia is

A

enlargement of male breast
due to estrogen excess

Staging, prognosis and treatment similar to female breast carcinoma

49
Q

gynecomastia histo

A
  • 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

pathology (8 decks)

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