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D&T3 Exam 1 > Breast- Brown > Flashcards

Breast- Brown Flashcards

1
Q

Normal

Where does ducal system drain?

A

Through lactiferous sinus

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2
Q

Normal

What arise at distal end of ducts?

A

Menarche lobules

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3
Q

Normal

Terminal lobular unit=

A

Terminal duct and ductules

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4
Q

Normal

Divided into lobules by…

A

6-10 major ducts

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5
Q

Normal

Histology

Nipple and areola covered by

A

Stratified squamous epithelium (pigmented in areola)

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6
Q

Normal

Histology

Stratified squamous epithelium covers

A

Nipple and areola (pigmented in areola)

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7
Q

Normal

Histology

Stratified squamous epithelium changes to…

A

Double layer of cuboidal

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8
Q

Normal

Histology

Flattened layer of contractile cells

A

Myoepithelial

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9
Q

Normal

Histology

Interlobular strom

A

Fibroconnective tissue admixed with adipose

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10
Q

Normal

Histology

Fibroconnective tissue admixed with adipose

A

Interlobular stroma

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11
Q

Normal

Histology

Intralobular stroma

A

Loose, myxomatosis stroma and lymphocyte

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12
Q

Normal

Histology

Loose myomatous stroma and lymphocyte

A

Intralobular stroma

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13
Q

Normal

Histology

Under influence of…

A

Estrogen and progesterone

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14
Q

Normal

Histology

When is morphological and functional maturity achieved?

A

Pregnancy

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15
Q

Normal

Histology

Mammography can be affected by

A

Hormonal changes

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16
Q

Life cycle changes

Unique…

A

Not fully formed at birth

Cyclic change reproductive life

Involution before menopause

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17
Q

Life cycle changes

Prepubertal breast

A

Similar in males and females

Large ductal system with minimal lobule formation

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18
Q

Life cycle changes

At menarche

A

Terminal ducts give rise to lobules and increased interlobular stroma

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19
Q

Life cycle changes

When do terminal ducts give rise to lobules and increased interlobular stroma?

A

At menarche

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20
Q

Life cycle changes

Follicular phase

A

Lobules quiescent

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21
Q

Life cycle changes

When are lobules quiescent

A

Follicular phase

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22
Q

Life cycle changes

Luteal phase

A

Cell proliferation with increased acini/lobule

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23
Q

Life cycle changes

Cell proliferation with increased acini/lobule

A

Luteal phase

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24
Q

Life cycle changes

Pregnancy

A

Breast assumes complete morphological and functional maturity

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25
Q

Life cycle changes

When does breast achieve complete morphological and functional maturity

A

Pregnancy

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26
Q

Life cycle changes

Breast milk provides…

A

Complete nourishment requirements and provides protection against infection and allergies

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27
Q

Life cycle changes

When does involution occur?

A

Before menopause and after menopause breast resembles male breast

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28
Q

Developmental disorders

Persistence of epidermal thickening along milk line

A

Milk line remnants

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29
Q

Developmental disorders

Mastectomy may not remove all breast tissue

A

Accessory axillary breast tissue

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30
Q

Developmental disorders

Congenital inversion of nipple

A

Nursing difficulties and can be confused with inversion due to carcinoma or inflammation

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31
Q

Developmental disorders

Macromastia may cause…

A

Severe back pain

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32
Q

Developmental disorders

Reconstruction or augmentation complication

A

Formation of capsule with inflammatory response causing cosmetic deformity and difficulty in mammography evaluation

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33
Q

Clinical presentation of breast disease

Majority of signs and symptoms are…

A

Benign

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34
Q

Clinical presentation of breast disease

Most common symptoms

A

Pain (mastalgia, mastodynia)- MC, may be cyclical

Palpable mass (2 cm minimum)

Nipple discharge (most significant are those that are spontaneous and unilateral)

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35
Q

Clinical presentation of breast disease

Mammographic screening

Principle signs

A

Densities- most neoplasms grow as solid masses

Calcifications- ass. With malignancy are usually small, irregular, numerous and clustered or linear and branching

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36
Q

Mammary duct ectasia

Common pt

A

5th or 6th decade in multifarious woman

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37
Q

Mammary duct ectasia

Presentation

A

Poorly defined mass, skin retraction, cheesy discharge

Pain and erythema uncommon

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38
Q

Mammary duct ectasia

Morphology

A

Ductal dilation

Inspissation of secretion

Marked periductal and interstitial chronic granulomatous inflammation

Squamous metaplasia is not a feature

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39
Q

Fat Necrosis

Hx

A

Sharply localized

Hx of trauma, prior surgical intervention, radiation therapy

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40
Q

Fat necrosis

Morphology- gross

Early

A

Hemorrhage

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41
Q

Fat necrosis

Morphology-gross

Later

A

Lequifactive necrosis: ill defined nodule of firm tissue with Fock of chalky white or hemorrhage

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42
Q

Fat necrosis

Histology

Early

A

Central necrotic fat cells surround by lipid laden macrophages and intense neutrophilic infiltrate

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43
Q

Fat necrosis

Histology

Late

A

Walled off by fibroblasts

Foreign body giant cells

Calcium salts

Blood pigment

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44
Q

Benign epithelial lesions

3 groups

A

Non proliferative

Proliferative

Atypical hyperplasia

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45
Q

Benign Epithelial Lesions

Non-proliferative Breast Changes

Pathogenesis

A

Due to hormonal imbalance; inc estrogen or dec progesterone

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46
Q

Benign Epithelial Lesions

Non-proliferative Breast Changes

Incidence

A

Unusual before adolescence

Peaks around menopause

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47
Q

Proliferation

Define

A

Alterations with inc risk of cancer

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48
Q

Benign Epithelial Lesions

Non-proliferative Breast Changes

Morphology

3 patterns

A

Cyst formation of ting with apocrine metaplasia

Fibrosis

Adnosis

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49
Q

Non-proliferative Breast Changes

Cysts

Appearance

A

Unopened looks like “blue dome cyst”

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50
Q

Non-proliferative Breast Changes

Cysts

Clinically

A

Palpable mass

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51
Q

Non-proliferative Breast Changes

Cysts

Seen…

A

Usually evident grossly

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52
Q

Non-proliferative Breast Changes

Cysts

Presentation

A

Can be multifocal and bilateral

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53
Q

Non-proliferative Breast Changes

Cysts

Pathogenesis

A

Secretory products can calcify

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54
Q

Non-proliferative Breast Changes

Cysts

Lining cells have abundant eosinophilic cytoplasm resembling sweat glands

A

Apocrine metaplasia

55
Q

Non-proliferative Breast Changes

Cysts

Apocrine metaplasia

A

Lining cells have abundant eosinophilic cytoplasm resembling sweat glands

Virtually always benign

56
Q

Non-proliferative Breast Changes

Cysts

Larger cysts…

A

May have atrophic lining from pressure

57
Q

Non-proliferative Breast Changes

Fibrosis

Patogenesis

A

From rupture of cyst and release of contents resulting in inflammation

58
Q

Non-proliferative Breast Changes

Adenosis

A

Inc in number of acinar units per lobule

If lumens enlarged called blunt duct adenosis

Calcifications can be seen

59
Q

Non-proliferative Breast Changes

Lactational adenomas

A

Palpable masses in pregnant or lactating women

Exaggerated response to hormones

60
Q

Non-proliferative Breast Changes

Clinical significance

A

Without proliferative changes no inc risk

Important because form palpable masses, calcification or nipple discharge

61
Q

Proliferative Breast Disease Without Atypia

Finding

A

Rarely palpable

Usually mammographic density, calcification or incidental finding

62
Q

Proliferative Breast Disease Without Atypia

Characterized by

A

Proliferation of ductal epithelium and/or stroma without cellular abnormalities suggestive of malignancy

63
Q

Proliferative Breast Disease Without Atypia

Types

A

Epithelial hyperplasia (moderate or florid)

Sclerosing adenosis

Complex Sclerosing Lesion (Radial Scar)

Papillomas

Fibroadenomas

64
Q

Proliferative Breast Disease Without Atypia

Epithelial hyperplasia

A

More than 2 cell layers is hyperplasia

More than 4 is moderate or florid

Forms irregular lumens

65
Q

Proliferative Breast Disease Without Atypia

Sclerosing adenosis

A

Number of acini inc x 2

Normal lobular arrangement

Compressed in central region and dilated at periphery

Prominent myoepithelial cells

Mimic carcinoma

Frequent calcifications

66
Q

Proliferative Breast Disease Without Atypia

Complex Sclerosing Lesion

A

Stellate with central nidus of entrapped glands

Can mimic carcinoma grossly and mammographically

67
Q

Proliferative Breast Disease Without Atypia

Papillomas

A

Multiple branching fibrovascular cores lined by ductal and myoepithelial cells

Large duct papillomas are usually single and situated in lactiferous sinus

Small duct papillomas are deeper within ductal system (more clearly ass. With inc risk of carcinoma)

68
Q

Proliferative Breast Disease With Atypia

Atypical hyperplasia resembles…

A

Carcinoma in situ but lacks features for diagnosis

69
Q

Proliferative Breast Disease With Atypia

Atypical ductal hyperplasia

A

Characteristically limited in extent

Cells not completely monomorphic and fail to completely fill ductal space

70
Q

Proliferative Breast Disease With Atypia

Atypical lobular hyperplasia

A

Do not fill or distend mor than 50% of acini

71
Q

Proliferative Breast Disease With Atypia

Types

A

Atypical hyperplasia

Atypical ductal hyperplasia

Atypical lobular hyperplasia

72
Q

Proliferative Breast Disease With Atypia

Clinical significance

Risk of cancer

A

Non-proliferative- no inc risk

Proliferative- mild inc

Proliferative with atypia- mod inc risk

All modified by menopausal status, family hx and time since biopsy

73
Q

MC malignancy of breast

A

Carcinoma of the Breast

Epithelial=carcinoma

74
Q

MC non-skin malignancy in women

A

Carcinoma of the Breast

75
Q

Carcinoma of the Breast

Risk factors

A

Age

Age at menarche- younger than 11 inc risk

1st live birth-under 20 less risk than no kids of >35

1st degree relative with breast cancer

Breast biopsies

Race-lower in African-American

76
Q

Carcinoma of the Breast

Additional risk

A

Estrogen: not oral contraceptives

Radiation

Carcinoma of contralateral breast

Geographic: US and Europe higher

Diet:dec with B carotene, alcohol inc

Obesity: dec in obese <40, inc post menopause obesity

Exercise: dec

Breast feeding: longer, greater reduction

77
Q

True or false

Tobacco is ass. With breast cancer

A

FALSE

78
Q

Carcinoma of the Breast

Tx of women at high risk

A

Bilateral prophylactic mastectomy

Chemoprevention- tamoxifen

79
Q

Carcinoma of the Breast

Pathogenesis

Sporadic

A

Risk related to hormone exposure, gender, age at menarche and menopause, reproductive history, breast feeding and exogenous hormones

80
Q

Carcinoma of the Breast

Pathogenesis

Genetic

A

Family hx of breast cancer in 1st degree relative

81
Q

Carcinoma of the Breast

High penetrating AD genes

A

BRCA1 and BRCA2

82
Q

BRCA1 and BRCA2

A

Highly penetrating AD genes that are ass. With breast cancer

83
Q

Carcinoma of the Breast

Mechanisms of carinogenesis

A

Accumulation of 7 new capabilities inc genetic instability

Heredity can help (i.e. HER-2/neu for self-sufficient growth)

84
Q

Carcinoma of the Breast

Classification

2 divisions

A

In situ and invasive carcinomas

85
Q

Carcinoma of the Breast

Classification

In situ

A

Limited by BM to ducts or lobules but may extend to overlying skin as Paget’s disease

86
Q

Carcinoma of the Breast

Classification

Carcinomas

A

Arise from terminal duct lobular unit

87
Q

Carcinoma of the Breast

Carcinoma in situ

Ductal Carcinoma in situ

A

Malignant cells limited by BM

Myoepithelial cells can be present but decreased

88
Q

Carcinoma of the Breast

Ductal Carcinoma in situ

Architectural subtypes

A

Comedocarcinoma

Non-comedocarcinoma

89
Q

Carcinoma of the Breast

Carcinoma in situ

Comedocarcinoma

A

Solid sheets of pleomorphic cells

90
Q

Carcinoma of the Breast

Carcinoma in situ

Non-comedocarcinoma

A

Nuclear grades from low to high

91
Q

Carcinoma of the Breast

Carcinoma in situ

Non-comedocarcinoma

Types

A

Cribiform- cookie cutter spaces

Solid

Papillary- fibrovascular cores

Micropapillary- bulbous protrusions

92
Q

Carcinoma of the Breast

Carcinoma in situ

Paget’s Disease

A

Unilateral erythematous eruption with scale crust

Pruritis

Extension of DCIS into surface epithelium

Can have underlying invasive carcinoma

93
Q

Extension of DCIS into surface epithelium

A

Paget’s disease

94
Q

Carcinoma of the Breast

Ductal Carcinoma in situ

Clinical

A

Seen grossly

Can progress to invasive

Mastectomy curative

Breast conservation possible

Tamoxifen reduces recurrence

95
Q

Carcinoma of the Breast

Lobular Carcinoma in situ

Found…

A

Always incidental as no calcifications and does not form density

96
Q

Carcinoma of the Breast

Lobular Carcinoma in situ

Common pt

A

Before menopause

20-40% bilateral

97
Q

Carcinoma of the Breast

Lobular Carcinoma in situ

Cancer risk

A

Multicentric and bilateral and subsequent neoplasms can occur in both breasts

98
Q

Carcinoma of the Breast

Lobular Carcinoma in situ

Pathogenesis

A

Both LCIS and invasive lobular carcinoma

Lack 3-cadherin (cell adhesion: reason invasive lobular occurs frequently as single cells

99
Q

Carcinoma of the Breast

Lobular Carcinoma in situ

Histology

A

Small cells with oval or round nuclei with small nucleoli

Signet ring cells with mucin seen

100
Q

Carcinoma of the Breast

Lobular Carcinoma in situ

Receptors and markers

A

Express hormone receptors and are negative for over-expression of HER-2/neu

101
Q

Carcinoma of the Breast

Lobular Carcinoma in situ

Clinical

A

Women with LCIS develop invasive lesions at a frequency similar to DCIS

Ipsilateral breast at more risk

102
Q

Carcinoma of the Breast

Lobular Carcinoma in situ

Tx

A

Bilateral prophylactic mastectomy

Tamoxifen

103
Q

Invasive Carcinoma

Presentation

A

If no mammographic screening can present as palpable mass and can already have LN metastasis

104
Q

Invasive Carcinoma

Signs

A

Can be fixed to chest wall causing dimpling (peau d’orange)

Nipple inversion (central involvement)

105
Q

Invasive Carcinoma

Define “inflammatory” carcinoma

A

Clinical presentation of carcinoma extensively involving dermal lymphatics (enlarged erythematous breast)

106
Q

Invasive Carcinoma, No Special Type (NST;Invasive Ductal Carcinoma)

Gross

A

Firm with irregular border

Retracts from cut surface due to fibrosis

Firm to cut

107
Q

MC carcinoma

A

Invasive Carcinoma, no special type

108
Q

Invasive Carcinoma, No Special Type (NST;Invasive Ductal Carcinoma)

Morphology

2 types

A

Well differentiated

Poorly differentiated

109
Q

Invasive Carcinoma, No Special Type (NST;Invasive Ductal Carcinoma)

Well differentiated

A

Maintain tubular glands lined by mildly atypical cells

Express hormone receptors and neg for over-expression of HER2/neu

110
Q

Invasive Carcinoma, No Special Type (NST;Invasive Ductal Carcinoma)

Poorly differentiated

A

Loss of glands

Anastomosing cords

Pleomorphic atypical cells

Neg for hormone receptors and over-expression of HER2/neu

111
Q

Invasive Lobular Carcinoma

Presentation

A

Palpable mass or density

Many have diffuse pattern of invasion without prominent desmoplasia (very subtle on mammography)

112
Q

Invasive Lobular Carcinoma

Gross

A

Firm with irregular margins

113
Q

Invasive Lobular Carcinoma

Morphology

A

Single infiltrating tumor cells often one cell in width

Desmoplasia not as prominent

Signet ring cells

Concentric rings around normal ducts

114
Q

Invasive Carcinoma, NST

Histology

A

Induce fibrotic reaction (desmoplasia)

Usually see varying amounts of DCIS

115
Q

Invasive Lobular Carcinoma

Clinical

A

Same prognosis as invasive ductal

Metastasizes in different pattern than other breast carcinomas

Metastasis: peritoneum, retroperitoneum, leptomeninges, GI tract, ovaries and uterus

116
Q

Mutinous (Colloid) Carcinoma

A

Well circumscribed

Slow growth

Older women

117
Q

Mutinous (Colloid) Carcinoma

Gross

A

Soft, gelatinous

118
Q

Mutinous (Colloid) Carcinoma

Morphology

A

Tumor cells seen as clusters of cells in lakes of mucin

119
Q

Mutinous (Colloid) Carcinoma

Clinical

A

Diploid

Express hormone receptors

Prognosis better than invasive ductal

120
Q

Invasive Papillary Carcinoma

A

Rare

Papillary architecture

Prognosis better than invasive ductal

121
Q

Prognostic and Predictive Fators

Major Prognostic factors

A

Invasive or in situ
Distant metastasis
LN metastasis (sentinel node)
Tumor size
Locally advanced disease (inc skin or muscle)
Inflammatory carcinoma: 3 yr survival 3-10%

Used for staging

122
Q

Prognostic and Predictive Fators

Minor prognostic factors (help determine therapy)

A 
Histologic subtype
Tumor grade
Estrogen/progesterone receptors
HER2/neu
Lymphvascular invasion
Proliferative rate
DNA content (diploid=DNA index of 1
123
Q

Prognostic and Predictive Fators

Therapy

A

Local and regional control (surgery)

Postoperative radiation

Systemic control (hormonal/chemo)

Inhibition of growth factors, stromal pro teases, and angiogenesis

124
Q

Stromal Tumors

2 types

A

Intralobular

Interlobular

125
Q

Stromal Tumors

Intralobular gives rise to…

A

Breast: specific biphasic tumors fibroadenoma and phylloides

126
Q

Stromal Tumors

Interlobular gives rise to…

A

Same types of tumors found in CT in other sites (lipomas, angiosarcomas etc.)

127
Q

Stromal Tumors

Fibroadenoma

Composition

A

Composed of fibrous and glandular tissue

128
Q

Stromal Tumors

MC benign tumor

A

Fibroadenoma

129
Q

Stromal Tumors

Fibroadenoma

Morphology

A

Sharply circumscribed nodule, freely moving

Upper outer quadrant

Grayish white with slot like spaces

130
Q

Stromal Tumors

Fibroadenoma

Histology

A

Delicate fibroblastic stroma enclosing glandular and cystic spaces lined by epithelium

Epithelial spaces may be distorted by stroma

131
Q

Stromal Tumors

Fibroadenoma

Responsive?

A

Hormonal responsive:
Enlarges late menstrual cycle

Enlargement during pregnancy may lead to infarction

Regresses postmenopausal and may calcify

132
Q

Stromal Tumors

Phylloides Tumor

Presentation

A

6th decade

Low grade, local

Rare mets

133
Q

Stromal Tumors

Phylloides Tumor

Morphology

A

Varying size

Leaf-like protrusions

Resemble fibroadenoma but increased cellularity and mitosis

High grade lesions may have Fock of heterozygous mesenchymal differentiation (e.g. Rhabdomyosarcoma)

134
Q

Ass. With seatbelt injury or surgery

MC lesion

A

Fat necrosis

D&T3 Exam 1 (19 decks)

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