Breast Flashcards
Gynecomastia features?
Drugs
Lobules but duct expansion only
Early has ducts surrounded by edema/halo effect
PASH
Epithelial hyperplasia into the lumen
Drugs: Spironolactone and antiandrogen
Mammary hamartoma’s classic imaging finding?
Myoid hamartoma has increase in?
Breast in breast apperance
See disorganization in a “mass” but only normal tissues.
Smooth muscle
Diabatic mastopathy presentation?
H and E?
Premenopausal
T1DM, Hashimotos
Can be bilateral and painful
Keloid like fibrosis, dense inflammatory infiltrate around ducts/lobules, epithelioid myofibroblasts
Granulomatous lobular mastitis population?
H and E?
Young women up to 2 years after pregnancy
Lobulocentric granulomas with some foci of necoris/microabscesses
Synovial metaplasia can be present with?
What can silicone implants cause?
Implant capsule; benign
Can also have silicone bleeds with refractile material and possible granulomas
Most common breast lymphoma?
Mesenchymal lesion?
Can Sclerosing adneosis have perineural invasion?
T-cell ALCL (Alk negative)
Fibromatosis (not APC/Gardner’s)
Yes
Radial scar can mimic?
DDx?
Tx?
Carcinoma! Look for central sclerosis and “petals”
DDx: Tubular carcinoma (lacks myoep cells);
Need to excise.; associated with carcinoma
T/F Apocine lesions can lose myoepithelial cells?
True; can still be benign.
Malignancy: Histologically based. Cannot base on myo-ep cells
Juvenile papillomatosis H and E?
DDx?
Gene in males?
Why do we care?
PALPABLE MASS vs FCC
Cysts/florid epithelial hyerplasia/apocrine metaplasia/papillomas
DDx: Fibrocystic change
50% NF1 in males
10% have lobular/secretory/ductal Ca
Nipple adenoma mimics?
H and E?
Paget’s clinically
Circumscribed lesion that looks like sclerosis papilloma
DDx: Syringomatous adenoma, and tubular Ca
Paget’s is important because?
IHC?
DDx includes?
90% have underlying Ca (DCIS HG)
CK7+, HER2+, CEA+, Mucin +, (ER, PR, AR, GCDFP, S100 sometimes +)
Toker cells (10% nipples, clear), Bowens, Melanoma
What is Squamous metaplasia of lactiferous ducts?
Associated with?
Zuska’s dx ro recurrent subareolal abcess, Painful erythematous subareolar mass
H and E: Ducts with squamous material and associated inflammation/sometimes giant cells
Smoking
Mammary duct ectasia population?
Clinical?
H and E?
Peri/post menopausal women
Large subareolar ducts with pain , nipple discharge, nipple retraction, mimics CA
H and E: Intraepithelial foamy macrophages and sometimes fibrosis and cholesteroalomas with rupture
Two patterns of fibroadenoma?
4 things that make a complex fibroadenoma?
Fibroadenoma with uniform increased stromal cellularity?
Intracanalicular pattern (elongation and comprssed dructs), and pericanalicular pattern (open ducts/pink stroma)
SA, >3mm, epithelial calcs, papillary apocrine change
Juvenile fibroadenoma
What happens to periductal stromal cells in Phyllodes?
What makes malignant?
They condense and arrange perpendicular to open space
Boarder (pushing/infiltrative), stromal cellularity, MITOSIS (>5 in benign 5-10 borderline, >10 malignant), nuclear pleomorphism, stromal overgrowth (40x lacks epithelial elements–all stroma), malignant heterologous elements (automatic malignant)
What is PASH?
IHC?
Associated with?
Maybe palpable, premenopausal
Slit like spaces lined by bland stromal cells
CD34+, Desmin/SMA +/-, PR+
A/W: FA, phyllodes, hamartoma, gynecomastia
What is fibromatosis?
Gross and H and E?
IHC?
DDx?
Locally aggressive, ill defined and stellate
Lymphoid infiltrate at periphery
Fibroblasts and myofibroblasts, bland
B-catenin is helpful
Scar and fibromatosis like metaplastic CA (CK+/P63+)
Myofibroblastoma population?
H and E?
IHC?
Common in males as well as female, painless mass
Benign circumscribed spindle cell tumor
CD34+
Angiosarcoma H and E?
Gene?
What is Stewart-Treves syndrome?
Most common sarcoma of breast!
Invasive anastamosing blood vessels
MYC amplification
Angiosarcoma secondar to chronic lymphedema in the arm
Columnar cell change stains?
Flat epithelial atypia?
No nuclear atypia; ER+, CK5/6-
More rounded with low grade atypia vs radiation atypia (single layer epithelial atypical but see non-continuous atypical cells)
UDH?
Proliferation of cells in lumen, peripheral spaces, Swirling and streaming
CK5/6, ER stianing will shows heterogenous/mosaic pattern vs ADH/DCIS (Homogenous strong pattern ER and CK5/6-)
ADH?
Low grade nuclei, <2 gland spaces or 2 mm
See roman bridges (perpendicullary arranged nuclei); punched out spaces
ER+, CK5/6-
Atypical lobular hyerplasia?
LCIS with central necrosis and pleomorphic?
>50% of gland or entire gland involved but no acini expansion; E cadherin - (but also Golgi staining)
Called florid lobular carcinoma in situ; pleomorphic have >4x nuclear differences and mitotic figures (looks like DCIS); manage these like DCIS
IHC staining in Low vs High Grade DCIS?
Low: ER+/PR+
High: Her2+ (also nuclei no longer polarized and more haphazard)
