Breast Disease-Melissa Flashcards
Where can super-numerary nipples form?
IN HONDURAS.
actually anywhere from the axilla to the vulva– known as the milk line
Functional unit of the breast?
Two layers of cells?
- terminal duct, composed of lobules
- lobules have luminal cells for milk production and myoepithelial cells for contracting/ excreting milk
Breast hyperplasia during menarche/ pregnancy is driven by?
-estrogen + progesterone
…. lack thereof causes atrophy in menopause
Acute Mastitis:
- most common bug
- clinical presentation
- common population
- sequelae
- tx
- Usually staph aureus infection (unilateral)
- purulent discharge from nipple in breast feeding moms
- possible scarring and nipple retraction (mimic neoplasm)
- should continue feeding, need abx
Periductal mastitis/ subaereolar abscesses:
- most common population
- describe pathogenesis
- treatment
-common in smokers
-Pathogenesis:
LOW Vitamin A–> squamous metaplasia of lact.ducts–>
Blockage + inflammation–> Granulation tissue –> Nipple retraction
-Remove abscess + fistula surgically to prevent recurrence.
Fat necrosis:
- clinical sx
- cause
- histo (4)
- mass/calcification on mammo
- caused by trauma (seat belt, running w/o sports bra)
- necrotic fat, giant cells, calcifications, bloody pigment
Drugs causing gynecomastia in males:
Some Hormones Create Knockers
- spiro
- hormones (estrogen, prog)
- cimetidine
- ketoconazole
Fibrocystic changes:
- How does this present?
- histo?
- Cancer risk?
- lumpy breast in young woman, usually bilateral/multifocal
- Usually cysts/ metaplasia, rarely hyperplasia
- Patients usually not at risk for cx, unless hyerplastic lesions
Intraductal papilloma:
- histo
- symptoms
- papilla growing into a duct (see the NAME)
- retains underlying myoepithelial cells (THESE ARE LOST IN CANCER)
- serous or bloody discharge in young woman
Fibroadenoma:
- frequency and age group?
- treatment?
- symptoms?
- MOST COMMON BENIGN NEOPLASM ESP IN YOUNG LADIES
- small (pea/marble) mobile mass that has ^^ size with estrogen
- treatment: reassurance
Phyllodes tumors:
- age group
- histo appearance
- benign or malignant?
- Older women
- CT mass with leaf like lobulations; fibrous tissue + glands
- Usually benign; rarely become malignant
Site of most malignant breast cancers?
Most common type of malignant tumor?
Most important prognostic factor?
- Terminal duct lobular unit esp in upper outer quadrant
- Ductal carcinoma of “No specific type”– bad prog.
- Brown says “size”; FA says involvement of sentinel lymph nodes.
What does it mean to be a “triple negative” tumor?
Who commonly gets these?
-NO: E receptors, P receptors, Her-2-Neu mutations
-Aggressive tumor mostly in AA women
(AA get breast cancer less often but when they do it is aggressive)
Drug targeting Her-2-neu mutations?
E/P receptors?
Her2Neu: trastuzumab
E/P receptors: tamoxifen
Where are BRCA genes located?
- BRCA1: chromosome 17 (I had this question on Rx)
- BRCA2: chromosome 13
DCIS:
clinical presentation:
What does the comedocacinoma subtype look like on histo?
- calcification on mammography (no mass on palpation)
- comedocarcinoma = central caseous necrosis
What is Paget’s Disease of the boob?
- underlying DCIS –> nipple erythema + ulceration
- 100% related to cancer; possibly invasive
How is invasive ductal carcinoma detected?
What are four subtypes?
Which is the worst in terms of prognosis?
Which is assc with BRCA?
- palpable at 2cm + seen on mammogram at 1cm (Ca++)
- may have bloody discharge like intraductal papilloma
Subtypes: tubular, mucinous, medullary, inflammatory
- Inflammatory = worst prognosis
- ^^ medullary carcinoma in BRCA + patients
Tubular carcinoma has tubules (obviously), mucin tumors have mucin lakes (obviously).
What characterizes a medullary or inflammatory carcinoma?
- medullary: sheets of PLASMAS and lymphocytes
- inflammatory: neoplastic cells block lymph drainage –> get “peau d’ orange” (orange peel breast)
Lobular Carcinoma (separate from ductal carcinoma):
- bilateral or unilateral?
- classic histo appearance
- loss of e-cadherin –> orderly rows of cells
- often bilateral
- may have “signet ring” appearance
How big should a breast mass be for you to worry about cancer?
When should you worry about a mammogram?
More than 2 cm. This is when DC is palpable.
Smaller lesions likely fibrocystic change/fibroadenoma DENSITIES on mammogram are worrisome, calcifications may be benign or malignant.
How are has the mammographic screening influenced breast cancer treatment?
- ^ detection in situ lesions
- ^ incidence
- DECREASED mortality due to early detection
Mammary duct ectasia:
What is this and who gets it?
How does it present
Describe the histo.
Multiparous postmenopausal women
- Painless dilation (ectasia) of subareolar ducts
- Green/ brown/ cheesy nipple discharge
- Chronic inflammation w PLASMA CELLS on biopsy
YA GET OLD, YOUR BOOBS LITERALLY ROT OFF.
Lymphocytic mastoplasty:
Describe the histo
- hard palpable mass(es)
- collagenized stroma surrounding atrophic ducts + lobules
