Breast carcinoma Flashcards
3 general features of breast carcinoma
most common cause of CA in women;
rare in women under 25;
lifetime risk w/ no family Hx is 8-10%
Risk factors for breast carcinoma
40+ y/o; nulliparity; Fam Hx; early menarche; late menopause; Fibrocystic disease (other than fibrosis); obesity; high fat diet
Clinical features for breast carcinoma
50% upper outer quadrant;
90% in ductal epithelium;
slightly more common in Left breast=> bilateral 4%
self exam / routine physical discovery
What tumor suppressor genes are associated with breast carcinoma?
BRCA1 and BRCA2
What is the risk for a mutated BRCA1?
almost 100% lifetime risk for breast CA in 30-40s;
increased risk for ovarian CA
Risk associated with men in BRCA1 mutations?
yes=> increase risk for prostate CA
risk for mutated BRCA2 gene
men & women => increase breast CA;
no increase in ovarian CA in women
Where are the 4 locations for invasion in breast carcinoma?
thoracic fascia becoming fixed to chest wall;
extend into skin, causing dimpling and retraction;
obstruction of subQ lymphatics=> peau d’orange;
Cooper ligaments w/in ducts to cause nipple retraction
How and where does breast carcinoma spread?
lymphatic or hematogenous routes;
axillary, supraclavicular, internal thoeracic nodes;
contralateral breast nodes
6 types of breast carcinoma
infiltrating ductal carcinoma; Paget disease of breast; noninfiltrating intraductal carcinoma; medullary carcinoma w/ lymphoid infiltration; colloid (mucinous) carcinoma; lobular carcinoma
most common breast CA
infiltrating breast carcincoma
gross path of infiltrating breast carcinoma
rock hard, cartilaginous consistency, 2-5cm;
foci of necrosis and calcification common
Can infiltrating breast carcinoma be found on mammography?
yes
Histo path of infiltrating breast carcinoma
anaplastic duct appear in epithelial cells appear in masses that invade the stroma
pathogenesis of infiltrating breast carcinoma
fibrous reaction responsible for hard, palpable mass
Epidemiology and prognosis of Paget disease of breast
older women;
poor Px
Define Paget disease of breast
form of intraductal carcinoma involving areolar skin and nipple
Gross path of Paget disease of breast
skin of nipple and areola ulcerated and oozing
histo of Paget disease of breast
ductal carcinoma;
large, anaplastic, hyperchromatic Paget cells
What and why are noninfiltrating intraductal carcinomas referred to?
comedocarcinomas=> cheesy, necrotic tumor tissue may be expressed from ducts
Gross path of noninfiltrating intraductal carcinoma
focus of increased consistency in breast tissue
histo path of noninfiltrating intraductal carcinoma
typical duct epithelial cells proliferate and fill ducts => leading to ductal dilatation
Prognosis of medullary carcinoma w/ lymphoid infiltration
better than infiltrating ductal carcinoma
gross path of medullary carcinoma w/ lymphoid infiltration
5-10cm fleshy masses w/ little fibrous tissue;
foci of hemorrhage and necrosis is common
histo path of medullary carcinoma w/ lymphoid infiltration
sheets of large, pleomorphic cells w/ increased mitotic activity and lymphocytic infiltrate
Epidemiology and prognosis of colloid (mucinous) carcinoma
older women, slow growing;
better Px than infiltrating ductal carcinoma
gross path of colloid (mucinous) carcinoma
soft, large, gelatinous tumors
histo of colloid (mucinous) carcinoma
islands of tumor cells w/ copious mucin
Etiology of lobular carcinoma
multicentric w/ estrogen receptors arising from terminal ductules
gross path of lobular carcinoma
rubbery and ill-defined => from multicentric nature
histo path of lobular carcinoma
small tumor cells that may be arranged in rings
5 characteristics differentiated FIBROCYSTIC DISEASE from breast cancer
often bilateral; multiple nodules; menstrual variation; cyclic pain and engorgement; may regress during pregnancy
5 characteristics differentiating fibrocystic disease from BREAST CANCER
unilateral; single nodule; no menstrual variation; no cyclic pain or engorgement; does NOT regress during pregnancy
define acute mastitis
usually unilateral fissures in nipples during early nursing w/ pus in ducts;
necrosis may occur
what is acute mastitis associated with?
predisposes to bacterial infection
What are common pathogens assoc. w/ acute mastitis?
Staph aureus and Streptococcus
Tx for acute mastitis
Antibiotics and surgical drainage
Epidemiology in mammary duct ectasia (plasma cell mastitis)
occurs in 5th decade in multiparous women
How does mammary duct ectasia (plasma cell mastitis) present?
pain, redness, and induration around areola w/ thick secretions;
usually unilateral
What characteristics of mammary duct ectasia (plasma cell mastitis) make it difficult to distinguish from malignancy?
skin fixation;
nipple retraction;
axillary lymphadenopathy
Define gynecomastia
enlargement of male breasts;
often unilateral but may be bilateral
What does gynecomastia signal in a male?
high estrogen state
What diseases are associated with gynecomastia?
Klinefelter syndrome, testicular tumors; hepatic cirrhosis (liver cannot degrade estrogens)
What ages are typical of males developing gynecomastia?
puberty or old age
