Breast carcinoma Flashcards by Hunter Garrett

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%

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Risk factors for breast carcinoma

40+ y/o; nulliparity; Fam Hx; early menarche; late menopause;
Fibrocystic disease (other than fibrosis); obesity; high fat diet

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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

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What tumor suppressor genes are associated with breast carcinoma?

BRCA1 and BRCA2

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What is the risk for a mutated BRCA1?

almost 100% lifetime risk for breast CA in 30-40s;

increased risk for ovarian CA

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Risk associated with men in BRCA1 mutations?

yes=> increase risk for prostate CA

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risk for mutated BRCA2 gene

men & women => increase breast CA;

no increase in ovarian CA in women

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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

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How and where does breast carcinoma spread?

lymphatic or hematogenous routes;
axillary, supraclavicular, internal thoeracic nodes;
contralateral breast nodes

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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

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most common breast CA

infiltrating breast carcincoma

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gross path of infiltrating breast carcinoma

rock hard, cartilaginous consistency, 2-5cm;

foci of necrosis and calcification common

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Can infiltrating breast carcinoma be found on mammography?

yes

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Histo path of infiltrating breast carcinoma

anaplastic duct appear in epithelial cells appear in masses that invade the stroma

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pathogenesis of infiltrating breast carcinoma

fibrous reaction responsible for hard, palpable mass

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Epidemiology and prognosis of Paget disease of breast

older women;

poor Px

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Define Paget disease of breast

form of intraductal carcinoma involving areolar skin and nipple

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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