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Pathology > Breast > Flashcards

Breast Flashcards

1
Q

Most common type of fibrocystic lesions

A

Nonproliferative changes

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2
Q 
Brown to blue dome cysts  filled with watery turbid fluid
May calcify
Apocrine metaplasia (polygonal abundant granular eosinophilic cytoplasm and small round deeply chromatic nuclei)
A

Fibrocystic changes

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3
Q

Presence of more than normal 2 cell layers of the ducts and lobules of breast (ie luminal overlying myoepithelial cell)

A

Epithelial hyperplasia

Proliferative fibrocystic change

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4
Q 
Small gland fenestrations
Ductal papillomatosis (small papillary excrescences into duct lumen)
Micrpcalcifications 
Atypical ductal hyperplasia occasionally
Atypical lobular hyperplasia
A

Epithelial hyperplasia

Proliferative fibrocystic change

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5
Q

Mimics carcinoma
Hard😟, rubbery
Proliferation of luminal space (adenosis) lined by epithelial cells and myoepithelial cells small glands within fibrous stroma
Stromal fibrosis compresses epithelium and lumen of ducts
Double layered epithelium

A

Sclerosing adenosis

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6
Q

Fibrosis, cystic change, apocrine metaplasia, mild hyperplasia

A

Minimal or no inc risk of breast carcinoma

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7
Q

Moderate to florid hyperplasia without atypia
Ductal papillomatosis
Sclerosing adenosis

A

Slightly inc risk 1.5-2 fold

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8
Q

Atypical hyperplasia whether ductular or lobular

A

Significantly inc risk 5 fold

Prolif fibrocystic change are bilateral multifocal asoc with inc risk of carcinoma

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9
Q

Nonbacterial chronic inflammation of breast assoc with inspissation of breast secretions in main excretory ducts

A

Mammary duct ectasia

Plasma cell mastitis

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10
Q

Most distinguishing feature of breast inflammatory change is

A

lymphoplasmacytic infiltrate and granulomas in periductal stroma

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11
Q

inoccuous lesion with central focus of necrotic fat surrounded by neutrophil and lipid laden mac with giant cells

A

Fat necrosis

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12
Q

Most common benign neoplasm of breast
Premenopausal women in 20s and 30s
Biphasic with fibroblastic stroma and epithelium lined glands the former of which is neoplastic

Well circumscribed, mobile, marble-like mass

Related to inc

A

Fibroadenoma

estrogen

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13
Q

Fibroadenoma-like tumor with overgrowth of fibrous component
Biphasic
Stromal element forming epithelium leaflike projections
Cleft like spaces with spindle stroma
Arises de novo
Leaf-like projections
Most commonly seen in postmenopausal women
Benign, localized but may be malignant

A

Phyllodes tumor
Cystosarcoma phyllodes

Tx: wide excision or mastectomy

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14
Q

Benign neoplastic papillary growth in lactiferous ducts
Fibrovascular core lined with eithelial and myoepithelial cells
Serous bloody nipple discharge
Small subareolar tumor
Nipple retraction
Delicate branching growths within dilated duct
Multiple papillae with a double layrred core covered by epithelial cell and outer luminal of myoepithelial cell

A

Intraductal papilloma

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15
Q

Most common location of breast tumors

A

Upper outer quadrant 50%

Central portion 20%

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16
Q

high grade nuclei with extensive necrosis extruding from transected
ducts on application of gentle pressure
dystrophic calcification inside cells

A

Comedo DCIS

other types:
cribriform
solid
micropapillary
papillary
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17
Q

Frequently assoc with DCIS

A

Calcification

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18
Q

Extension of DCIS up lactiferous ducts into contiguous skin of nipple unilateral crusting exudate over the nipple and areolar skin

A

Paget disease of nipple

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19
Q

Malignant proliferation of cells in lobules
Monomorphic bland, round nuclei occuring loosely in cohesive clusters within lobules
No invasion of BM
Mucin vacuoles forming signet rings
Dyscohesive cells lacking e-cadherin
Multifocal and bilateral (20-40%)
Premenopausal (80-90)
Subsequent invasive carcinomas arise in either breast
A marker of inc risk of carcinoma in both invasive ductal and lobular breasts and direct precursor of some cancers

A

LCIS

Tx: Tamoxifen and close follow up

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20
Q

Rf for Breast CA

A

Estrogen exposure
Long menarche and menopause
Atypical proliferative lesions
Family hx of breast cancer in a first degree

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21
Q

10% of all breast CA are inherited mutations in

A

BRCA1

BRCA2

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22
Q

Estrogen receptor expressing tumors respond to

A

Tamoxifen

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23
Q

HER2/NEU overexpressing tumors respond to

A

Trastuzumab/Herceptin

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24
Q

Clinically enlarged swollen erythematous breast without palpable mass
Poorly differentiated and infiltrative
Involves dermal lymphatic spaces with blockage of channels leading to edema
Minimal to absent inflammation

A

Inflammatory carcinoma

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25
Q

Rare carcinoma 1%
Sheets of large anaplastic cells with pushing borders
Pronounced lymphoplasmacytic infiltrate
Inc frequency in BRCA1 mutation
Lack estrogen and progesterone receptors, do not express HER2/Neu
Triple negative

A

Medullary carcinoma

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26
Q

Rare subtype
Producing abundant quantities of extracellular mucin dissecting into surrounding stroma
Soft gelatinous
Express hormone receptors

A

Colloid mucinous carcinoma

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27
Q

Palpable masses with well formed tubules low grade nuclei
Prognosis is excellent
Express hormone receptor and do not show HER2/Neu

A

Tubular carcinoma

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28
Q

Enlargement of male breast from
Excess estrogen
Due to cirrhosis and inability of liver to metabolize estrogen
Klinefelter’s, anabolic, pharma agent

Inc CT and epithelial hyperplasia of ducts
Lobules formation rare
Button like subareolar swelling develops in both breasts

A

Gynecomastia

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29
Q 
Rare in men 
Subareolar mass under nipple 
Nipple discharge
Invasive ductal 
Diagnosed at advance age
Tumor infiltrates skin and thoracic wall rapidly
Resemble invasive carcinomas
BRCA2 and Klinefelter Syndrome
A

Male breast Carcinoma

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30
Q

Highest density of ductal system in males

in females

A

Subareolar area

Upper outer quadrant

Each ductal system occupies more than one quadrant

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31
Q

Mammograms in young women are typically

A

radiodense or white in appearance

mass forming lesions or calcifications (radiodense) detection is difficult

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32
Q

Density of a young woman’s breast stems from predominance of

A

fibrous interlobular stroma

paucity of adipose

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33
Q

Drugs that cause galactorrhea

A 
Digitalis
Anti-psychotics
Anti-depressants
TCAs
Estrogen/birth control pills
D2 antagonist 
Reserpine 
Methyldopa
34
Q

Reserpine SE

A

Psychosis

35
Q

Squamous metaplasia of lactiferous ducts
Recurrent Subareolar mass with nipple retraction

Inflammation of subareolar ducts
Associated with smokers 90% and Vit A deficiency

A

Zuska disease

Periductal mastitis/abscess

36
Q

Periductal mastitis/abscess

Key feature:

A

Keratinizing squamous metaplasia of nipple ducts

Intense chronic inflammation with granulation tissue and fibrosis

Tx: enbloc removal

Complication: fistula

37
Q

Squamous metaplasia is produced because of these 2 risk factors

A

Lack of vitamin A for highly specialized epithelium

Smoking (dec Vit A)

38
Q

Inflammation and dilation of subareolar ducts
Clasically arises from multiparous postmenopausal women
Lacks squamous metaplasia of nipple ducts
End of spectrum:
Fibrosis = skin and nipple retraction

A

Mammary duct ectasia

39
Q

Gross appearance of fibrocystic change

A

Bluedome appearance

40
Q 
Proliferative disease without atypia 
Moderate or florid hyperplasia
Sclerosing adenosis
Papilloma
Complex sclerosing
Lesion radial scar
Fibroadenoma with simple features
A

5-7% risk

Mild increase

41
Q

Proliferative change with atypia

A

Moderate inc risk

42
Q

Risk reduction of breast ca may be done by

A

Prophylactic mastectomy

Giving of estrogen antagonist like tamoxifen

43
Q

Tamoxifen inc risk for

A

Endometrial ca

44
Q

Modified apocrine sweat glands
Embryologically derived from skin
6-10 major duct system (12-20 lobules)

A

Breast

45
Q

Order of duct branching

A

Lactiferous sinus -> ducts branch -> terminal duct -> cluster of acini/lobules

46
Q

Functional unit of breast

A

Terminal ductal lobular unit

47
Q

2 cell types lining ducts and lobules

2 types of stroma

Histology

A 
Myoepithelial cells (contractile)
Luminal epithelial cells

Interlobular stroma
Interlobulat stroma: hormonally responsive

Keratinizing stratified squamous epithelium (skin) changing to double layered cuboidal epithelium lining ducts and lobules (TDLU)

48
Q

Covered by stratified squamous epithelium

Pigmented and supported by smooth muscle

A

NAC

49
Q 
function in nipple lubrication
becoming prominent during pregnancy
A

Areolar glands of Montgomery

50
Q

Other conditions that promote calcification on mammography

A

fat necrosis

sclerosing adenosis

51
Q

Swollen
Erythrma
Pea d orange
Frequently mistaken for mastitis

A

Inflammatory breast cancer

52
Q

Invasive lobular carcinoma

histological landmark due to loss of e cadherin

A

Indian file pattern

53
Q

Her2 /neu

A

ERB

CD340

54
Q

Milk production outside of lactation
Not a symptom of breast cancer

Causes:
Nipple stimulation
Prolactinoma of anterior pituitary (most common)
Drugs

A

Galactorrhea

55
Q

Congenital nipple inversion may be corrected

A

with pregnancy

56
Q

Acute mastitis most common etiologic agents

A

Staph aureus

Streptococcus (diffuse)

57
Q

Usually related to trauma or prior surgery

Mass on PE
Calcifications on mammography

A

Fat necrosis

58
Q

Fat necrosis biopsy:

A

Necrotic fat with associated calcifications and giant cells

Saponification
Ill defined nodules with hemorrhage

59
Q

Development of fibrosis and cyst
Most common change in premenopausal women (25-40)
Unopposed estrogen stimulation

Clinically a lumpy breast on the upper outer quadrant

Decreased risk by:

A

Fibrocystic change

OCP use

60
Q

Cysts with apocrine metaplasia (no inc risk)
Fibrosis: rupture of cyst leading to secretory material released into stroma -> inflammation and fibrosis (no increased risk)
Sclerosing adenosis 2x
Inc number of acini per lobule
Often are calcified
Ductal hyperplasia 2x
Atypical hyperplasia 5x

A

Fibrocystic change -> benign

61
Q

Hallmark of intraductal papilloma

A

Bloody nipple discharge in a premenopausal

62
Q

Intraductal papilloma must be differentiated from papillary carcinoma by checking presence of

A 
Myoepithelial cells (intraductal)
Postmenopausal women (papillary)
63
Q

Characterized by proliferation of ductal epithelium and or stroma without cytologic or architectural features suggestive of carcinoma

A

Proliferative breast disease without atypia

Morphology:
epithelial hyperplasia: >2 layers
sclerosing adenosis: inc lobules with fibrosis
complex sclerosing adenosis: with epithelial hyperplasia sclerosing adenosis
papilloma: within dilated duct, fibrovascular core

64
Q 
Most common carcinoma by indicdence
2nd most common by mortality
Risk factors most commonly related to estrogen exposure:
female
age
early menarche/late menopause
obesity
atypical hyoerplasia prior biopsy 5x
1st degree relative with breast cancer
A

Breast cancer

65
Q

Means to detect small, nonpalpable, asymptomatic breast carcinomas
Sensitivity and specificity increases with age (radiodense fibrous tissue gradually replaced with radioluscent fatty tissue)

A

Mammographic screening

66
Q

Routine screening not recommended

10% chance of mammographic lesion being malignant

A

Age 40-49

67
Q

Screened every 2-3 years

25% chance of mammographic lesion being malignant

A

Age 50-74

68
Q

Mammographic signs of CA

A

densities and calcifications

69
Q

Neoplastic proliferation that is limited to ducts and lobules by an intact basement membrane

A

CA in situ

70
Q

Tumor cells penetrate through basement membrane and invade the stroma have potential to invade vasculature and metastasize

A

Invasive or infiltrative CA

71
Q

95% of breast carcinomas are?

A

adenocarcinoma

72
Q

Malignant proliferation of cells in ducts
No invasion of the basement membrane
Detected as calcification on mammography

A

DCIS

Tx: Mastectomy 95%

73
Q

Clasically forms duct like structures
Most common type of invasive carcinoma
Presents as palpable mass by physical exam and as calcifications on mammography
Advance tumors may result to skin dimpling and nipple retractions

Biopsy:

A

Invasive ductal carcinoma

Duct like structures in desmoplastic stroma

Special subtypes
Tubular
Mucinous
Medullary
Papillary
Metaplastic
Inflammatory
74
Q

Most important prognostic factor

A

Metastasis

75
Q

Most useful factor

A

Spread to axillary lymph nodes

76
Q

Used to assess biopsy

A

Sentinal lymph node biopsy

77
Q

Most important predictive factors

A

ER
PR
HER-2-NEU Amplification

78
Q

Predict response to antiestrogenic agents (Tamoxifen)

A

ER

PR

79
Q

Associated with response to trastuzumab
Cell surface growth factor receptor
Poorer survival

Poor prognosis?

A

Her-2-Neu Amplification

Triple negative

80
Q

10% of breast cancer

Multipel first degree relatives with breast cancer
Tumors at premenopausal age
Multiple tumors

BRCA1 and BRCA2
BRCA 1:
BRCA 2:

A

Hereditary breast cancer

Breast and ovarian
Breast cancer in males

Tx: if with genetic propensity, prophylactic mastectomy

Pathology (24 decks)

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