Breast-- Benign Disorders

Question 1

Most common symptoms of Breast Disease?

Answer 1

Pain (mastalgia)

Palpable Mass

Nipple Discharge

Question 2

Why is nipple discharge an important diagnostic factor?

Answer 2

If there is blood in the discharge it may indicate serious disease (like malignancy)

Question 3

Commonest site for breast cancer?

Answer 3

Upper outer quadrant of breast tissue, spreads via axillary LN

Question 4

First thing lost in invasive breast cancer?

Answer 4

Myoepithelial layer of cells–

This is why pathologists would stain for myoepithelium (stain for actin, etc…), to see if the cancer is invasive or not.

Question 5

What is going on in this picture?

(section taken from lobular aspect of breast)

Answer 5

Patient is lactating–this is lactacting breast tissue.

Question 6

What are the congenital anomalies of breasts

Answer 6

Polymastia/polythelia (irregular/extra breast tissue)

inversion of nipple

hemihypertrophy and hemiatrophy

juvenile hypertrophy (bilateral)

Question 7

First question to ask when pt. has inverted nipple?

Answer 7

Has your nipple always been like this?

Acquired vs. Congenital

Question 8

Inflammation of breast is due to what?

Answer 8

Acute Mastitis

Usually caused by Staph. Aureus, related to nursing or skin infection. May produce an abcess. Can become chronic**. **

Scar and skin retraction that happens as a result may be mistake for carcinoma.

Strep infection produces diffuse mastitis

Chronic Mastitis

MCC: Tuberculosis and Syphilis

Question 9

Neutrophils present in the duct on histo examination is evidence of what?

Answer 9

ACUTE MASTITIS

Question 10

What is peridcutal Mastitis

Answer 10

When there is squamous metaplasia of lactiferous duct

Squamous cells block duct since they’re thicker and as a result secretions get blocked and backed up and this form an abcess

Sometimes a fistula forms so that the backed up fluid and get out.

Higher incidence in smokers

Question 11

Mammary duct ectasia

Answer 11

cystic dilation of lactiferous ducts+periductal plasma cell inflammation

firm mass may resemble cancer

Question 12

Cause of fat necrosis

Answer 12

Trauma

Question 13

Two types of fibrocystic change of breast

Answer 13

Proliferative and non proliferative

B/L and typical in women on child bearing age.

Question 14

Simple Fibrocystic Change (Non-Proliferative)

Answer 14

Multiple bilateral masses d/2:

• fibrous stromal overgrowth and scars (often an inflammatory reaction to ruptured cysts)
• cyst formation
• adenosis and epithelial changes including mild hyperplasia and APOCRINE metaplasia

Will see microcalcifications

NO increased risk of carcinoma

Question 15

Proliferative Fibrocystic Changes vs non proliferative?

Answer 15

The difference from non proliferative is the extent and degree of epithelial hyperplasia

Question 16

Answer 16

Apocrine metaplasia – also commonly associated with fibrocystic change. This is a benign change.

Question 17

Proliferative Fibrocystic Changes?

Answer 17

Hyperplastic epithelial changes - > 4 layers of cells

Full spectrum to florid hyperplasia, atypical (dark nuclei, etc…) hyperplasia , and CIS

Sclerosing adenosis

Large and small duct papillomas

Note: Often no associated breast mass

Question 18

Answer 18

Proliferative Fibrocystic Changes

Severe (florid) epithelial hyperplasia – note the lumen of the duct is almost occluded.

Question 19

In assesing the significance of fibrocystic change the pathologist is most concerned with what?

Answer 19

EPITHELIAL CHANGES!

Question 20

Benign epithelial tumor of the breast?

Answer 20

Lactiferous duct papilloma

Question 21

benign stromal tumor of the breast?

Answer 21

fibroadenoma

Question 22

Answer 22

Fibroadenoma-benign, solitary, discrete, freely movable, rubbery to soft lump

Question 23

Answer 23

Phyllodes tumor : distinguish from fibroadenoma; also called “cystosarcoma phyllodes” but is commonly benign-

Also differentiate from fibroadenoma with size

Question 24

Common cause of bleeding from the nipple?

Answer 24

Intraductal papilloma

Look for bloody nipple discharge-

probably not Palpable-

benign but needs to be completely excised

SAID WE SHOULD REMEMBER THIS–POSSIBLE QUESTION

Question 25

Answer 25

Intraductal Papilloma in lactiferous duct

Question 26

Risk factors for Breast Carcinoma

Answer 26

THINK EXCESSIVE ESTROGEN

1- positive family history of breast cancer,

2- early menarche and late menopause,

3- nulliparity,

4- obesity,

5- Atypical FCC of the breast,

6- hyperestrogenemia and exogenous estrogen administration,

7- Carcinoma of contralateral breast, endometrial or ovarian cancer.

8- Geographic location (?related to fat intake )

9- Increasing age

Question 27

Pathogenesis of Breast Cancer

Answer 27

Question 28

Two forms of ductal carcinoma

Two forms of lobular carcinoma

Answer 28

In situ

Invasive/infiltratative

Question 29

In situ (intraductal) carcinoma

Answer 29

1- Poorly differentiated

2- Well Differentiated.

Carcinoma cells plugging the ducts, but remain confined within the basement membrane of the duct.

Question 30

Answer 30

Intraductal carcinoma

same as ductal carcinoma in situ –DCIS. Look for distended ducts filled with malignant epithelial cells which show central necrosis like a comedone or pustule – hence the name comedo carcinoma

Question 31

Lobular Carcinoma In Situ

Answer 31

Small uniform cells that fill at least 50% of the ductules & acinar units of a single lobule & may extend into the larger ducts.

**Often bilateral & multicentric. **

Question 32

Answer 32

Lobules are large, completely filled with uniform small cells (arrow). This is typical lobular carcinoma in situ (LCIS)