Breast

Question 1

Gynecomastia features?

Drugs

Answer 1

Lobules but duct expansion only

Early has ducts surrounded by edema/halo effect

PASH

Epithelial hyperplasia into the lumen

Drugs: Spironolactone and antiandrogen

Question 2

Mammary hamartoma’s classic imaging finding?

Myoid hamartoma has increase in?

Answer 2

Breast in breast apperance

See disorganization in a “mass” but only normal tissues.

Smooth muscle

Question 3

Diabatic mastopathy presentation?

H and E?

Answer 3

Premenopausal

T1DM, Hashimotos

Can be bilateral and painful

Keloid like fibrosis, dense inflammatory infiltrate around ducts/lobules, epithelioid myofibroblasts

Question 4

Granulomatous lobular mastitis population?

H and E?

Answer 4

Young women up to 2 years after pregnancy

Lobulocentric granulomas with some foci of necoris/microabscesses

Question 5

Synovial metaplasia can be present with?

What can silicone implants cause?

Answer 5

Implant capsule; benign

Can also have silicone bleeds with refractile material and possible granulomas

Question 6

Most common breast lymphoma?

Mesenchymal lesion?

Can Sclerosing adneosis have perineural invasion?

Answer 6

T-cell ALCL (Alk negative)

Fibromatosis (not APC/Gardner’s)

Yes

Question 7

Radial scar can mimic?

DDx?

Tx?

Answer 7

Carcinoma! Look for central sclerosis and “petals”
DDx: Tubular carcinoma (lacks myoep cells);

Need to excise.; associated with carcinoma

Question 8

T/F Apocine lesions can lose myoepithelial cells?

Answer 8

True; can still be benign.

Malignancy: Histologically based. Cannot base on myo-ep cells

Question 9

Juvenile papillomatosis H and E?

DDx?

Gene in males?

Why do we care?

Answer 9

PALPABLE MASS vs FCC
Cysts/florid epithelial hyerplasia/apocrine metaplasia/papillomas

DDx: Fibrocystic change

50% NF1 in males

10% have lobular/secretory/ductal Ca

Question 10

Nipple adenoma mimics?

H and E?

Answer 10

Paget’s clinically

Circumscribed lesion that looks like sclerosis papilloma

DDx: Syringomatous adenoma, and tubular Ca

Question 11

Paget’s is important because?

IHC?

DDx includes?

Answer 11

90% have underlying Ca (DCIS HG)

CK7+, HER2+, CEA+, Mucin +, (ER, PR, AR, GCDFP, S100 sometimes +)

Toker cells (10% nipples, clear), Bowens, Melanoma

Question 12

What is Squamous metaplasia of lactiferous ducts?

Associated with?

Answer 12

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

Question 13

Mammary duct ectasia population?
Clinical?
H and E?

Answer 13

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

Question 14

Two patterns of fibroadenoma?

4 things that make a complex fibroadenoma?

Fibroadenoma with uniform increased stromal cellularity?

Answer 14

Intracanalicular pattern (elongation and comprssed dructs), and pericanalicular pattern (open ducts/pink stroma)

SA, >3mm, epithelial calcs, papillary apocrine change

Juvenile fibroadenoma

Question 15

What happens to periductal stromal cells in Phyllodes?

What makes malignant?

Answer 15

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)

Question 16

What is PASH?

IHC?

Associated with?

Answer 16

Maybe palpable, premenopausal

Slit like spaces lined by bland stromal cells

CD34+, Desmin/SMA +/-, PR+

A/W: FA, phyllodes, hamartoma, gynecomastia

Question 17

What is fibromatosis?

Gross and H and E?

IHC?

DDx?

Answer 17

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+)

Question 18

Myofibroblastoma population?

H and E?

IHC?

Answer 18

Common in males as well as female, painless mass

Benign circumscribed spindle cell tumor

CD34+

Question 19

Angiosarcoma H and E?

Gene?

What is Stewart-Treves syndrome?

Answer 19

Most common sarcoma of breast!

Invasive anastamosing blood vessels

MYC amplification

Angiosarcoma secondar to chronic lymphedema in the arm

Question 20

Columnar cell change stains?

Flat epithelial atypia?

Answer 20

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)

Question 21

UDH?

Answer 21

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-)

Question 22

ADH?

Answer 22

Low grade nuclei, <2 gland spaces or 2 mm

See roman bridges (perpendicullary arranged nuclei); punched out spaces

ER+, CK5/6-

Question 23

Atypical lobular hyerplasia?

LCIS with central necrosis and pleomorphic?

Answer 23

>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

Question 24

IHC staining in Low vs High Grade DCIS?

Answer 24

Low: ER+/PR+

High: Her2+ (also nuclei no longer polarized and more haphazard)

Question 25

Collagenous spherulosis mimics?

Most common cause of cancer death in women?

Answer 25

Cribiform DCIS; basement membrane material present (p63+ at peripheral edges)

Lung then breast

Question 26

T/F Ductal carcinoma is more likely to be bilateral?

Tubular carcinoma?

Answer 26

F: Lobular is more likely to be bilateral

Small tubules with angular apperence and apical snouts; ER/PR+; good prognosis; associated with ALH and CCC

Question 27

Micropapillary prognosis?

Metaplastic age group and some findings?

Answer 27

Bad; high LN mets

Older; see adenosquamous, heterogenous elements (malignant bone and cartilge common)

Question 28

Microglandular adenosis mimics?

H and E?

Stain?

ER/PR status?

Answer 28

Low grade carcinoma!
Single layer (no myoep layer) but have basement membrane; round glands with eosinophilic material

Laminin for basement membrane (should have it)

Negative

25% invasieve carcinoma present

Question 29

Syringomatous adenoma location?
H and E?

Answer 29

Firm nipple areolar mass

Benign eccrine like ductal structrues; 2 layers; Bland comma shaped, p63+ squamous nests, PERINURAL INVASION CAN BE PRESENT

Question 30

Some genes to know for breast cancer?

Answer 30

BRACA1/2

PTEN (Cowden)

P53 (Li Fraumeni)

ATM

CDH1 (hereditary diffuse gastric cancer; invasive lobular

STK11 (Peutz-Jegher)

Question 32

BRCA1 gene/cancer?

BRCA2 gene/cancer?

Answer 32

Ch17; Breast: 55-65% have cancer by 70; triple negative

Also ovarian, pancreas

BRCA2: Ch13; Breast: 45% by 70; ER+; ovarian, pancreas, stomach, gallbladder, bile duct, melanoma, Males

Question 33

Is LCIS staged?

Ductal staging based on?

Micromets (for node staging) defined as?

Mets go to?

Answer 33

No; not even pleomorphic is staged

Size p1-3; T4 is from extension to chest wall or skin; Pec major doesn’t count, skin needs to go to ulcerate

200 cells in one cross section or >0.2 mm but <2mm

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