Breast CA Flashcards
Acute mastitis
First month of lactation when breast vulnerable to bacterial infections through nipple cracks and fissures
- antibiotics and continued feeding
Periductal mastitis
Squamous metaplasia of nipple ducts results in keratin shedding and subsequent ductal plugging
- duct dilation and rupture then leads to intense chronic and granulomatous inflammation
- painful subareolar mass
- recurrent subareolar abscess, squamous metaplasia of lactiferous ducts, zuska disease
Smoking associated
Mammary duct ectasia
Ill defined painless eriareolar mass with viscous white nipple secretions
- occurs in multiparous women between ages 50-70
- not associated with smoking
- inspissation of secretions, duct dilation without squamous metaplasia, periductal inflammation leading to fibrosis and skin retraction
fat necrosis
painless palpable mass, skin thickening or retraction, mammographic density or calcifications
- associated with prior trauma or surgery
- progress from hemorrhage with acute inflammation and liquefactive necrosis to chronic inflammation with giant cells and hemosiderin to scar tissue
Sclerosing lymphocytic lobulitis
Single or multiple, rock hard, palpable masses
- collagenous stroma around atrophic ducts with prominent lymphocytic infiltrate
- association with type I diabetes and autoimmune thyroid disease
Granulomatous mastitis
systemic diseases, foreign bodies, granulomatous infections
- parous women, hypersensitivit to lactational epithelium
Nonproliferative breast changes (fibrocystic changes)
No malignant potential
- lumpy bumpy breasts
Morph: lobular dilation and unfolding and coalesce to form larger lesions
- lined by flattened atrophic epithelium or metaplastic apocrine cells
- fibrosis secondary to cyst rupture and inflammation
- adenosis defined as increased numbers of acini per lobule, pregnancy and can be a local finding in non-pregnant breasts
Proliferative breast disease without atypia
epithelial or stromal proliferation without cytologic or architectural atypia
Morph:
- epithelial hyperplasia defined by more than two cell layers around ducts and lobules
- sclerosing adenosis - increased numbers of acini per lobule, central distortion and compression and peripheral dilation
- complex sclerosing lesions - sclerosing adenosis, papiloomas, epithelial hyperplasia
- papillomas - epithelial growth and associated fibrovascular cores within dilated ducts
Proliferative breast diseases with atypia
Atypical ductal and atypical lobular hyperplasia
Morph: atypical ductal hyperplasia shares features with DCIS, atypical lobular hyperplasia shares features with LCIS
Breast CA
Most common non-skin malignancy in women - 1/8 chance of developing CA Risk: - gender - age - age at menarche/ menopause - age at first live birth - relatives with breast CA - atypical hyperplasia - race/ethnicity - estrogen exposure - breast density, radiation, CA of endometrium or contralateral breast - geographic influence - diet - obesity - breast feeding
hereditary - BRCA1 and BRCA2, CHEK2, p53, PTEN, LKB1/STK11
sporadic - hormone exposure, most estrogen receptor positive in postmenopausal women
Ductal carcinoma in situ
Incidence: 15-30% of all breast CA
Morph:
- comedocarcinoma - ducts and lobules dilated by sheets of high grade pleomorphic cells with zones of central necrosis
- noncomedo DCIS - monomorphic population of cells of varying nuclear grades
- paget disease: rarely, malignant cells extend from ductal DCIS into nipple skin
- microinvasion - stromal invasion
Lobular carcinoma in situ
No calcifications or stomal responses - bilateral - age premenopausal - progresses to invasive cancer Morph: discohesive cells from loss of E-cadherin, intracellular mucin forming signet ring cells
Invasive infiltrating carcinomas
Palpable masses or lesions
Sx: peau d’orange, nipple retraction
Inflammatory carcinoma
Tumors that present with swollen erythematous breast due to extensive lymphatic invasion and destruction
Invasive carcinoma, no special type
70-80% of cancers
Classifications:
- luminal A: ER pos, HER2/neu neg
–> well differentiated, postmenopausal women, slow growing, respond to hormone therapy
- luminal B: ER pos HER2/neu pos
–> nodal metastases and may respond to chemo
- Normal breast: ER pos, HER2/neu neg, well differentiated
- basal like: ER, PR, HER2/neu neg
–> express myoepithelial cell markers in BRCA1
–> high grade and proliferative and pursue aggressive course
- HER2 pos: ER neg, HER2/neu pos, poorly differentiated and aggressively metastatic
Morph: gross - irregular border and gritty sensation, firm and hard tumors
micro - well differentiated with tubule formation, small nuclei, rare mitoses
