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DT4-Exam 1 > Breast Disease-Melissa > Flashcards

Breast Disease-Melissa Flashcards

1
Q

Where can super-numerary nipples form?

A

IN HONDURAS.

actually anywhere from the axilla to the vulva– known as the milk line

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2
Q

Functional unit of the breast?

Two layers of cells?

A
  • terminal duct, composed of lobules

- lobules have luminal cells for milk production and myoepithelial cells for contracting/ excreting milk

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3
Q

Breast hyperplasia during menarche/ pregnancy is driven by?

A

-estrogen + progesterone

…. lack thereof causes atrophy in menopause

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4
Q

Acute Mastitis:

  • most common bug
  • clinical presentation
  • common population
  • sequelae
  • tx
A
  • 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
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5
Q

Periductal mastitis/ subaereolar abscesses:

  • most common population
  • describe pathogenesis
  • treatment
A

-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.

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6
Q

Fat necrosis:

  • clinical sx
  • cause
  • histo (4)
A
  • mass/calcification on mammo
  • caused by trauma (seat belt, running w/o sports bra)
  • necrotic fat, giant cells, calcifications, bloody pigment
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7
Q

Drugs causing gynecomastia in males:

A

Some Hormones Create Knockers

  • spiro
  • hormones (estrogen, prog)
  • cimetidine
  • ketoconazole
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8
Q

Fibrocystic changes:

  • How does this present?
  • histo?
  • Cancer risk?
A
  • lumpy breast in young woman, usually bilateral/multifocal
  • Usually cysts/ metaplasia, rarely hyperplasia
  • Patients usually not at risk for cx, unless hyerplastic lesions
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9
Q

Intraductal papilloma:

  • histo
  • symptoms
A
  • papilla growing into a duct (see the NAME)
  • retains underlying myoepithelial cells (THESE ARE LOST IN CANCER)
  • serous or bloody discharge in young woman
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10
Q

Fibroadenoma:

  • frequency and age group?
  • treatment?
  • symptoms?
A
  • MOST COMMON BENIGN NEOPLASM ESP IN YOUNG LADIES
  • small (pea/marble) mobile mass that has ^^ size with estrogen
  • treatment: reassurance
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11
Q

Phyllodes tumors:

  • age group
  • histo appearance
  • benign or malignant?
A
  • Older women
  • CT mass with leaf like lobulations; fibrous tissue + glands
  • Usually benign; rarely become malignant
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12
Q

Site of most malignant breast cancers?
Most common type of malignant tumor?
Most important prognostic factor?

A
  • 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.
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13
Q

What does it mean to be a “triple negative” tumor?

Who commonly gets these?

A

-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)

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14
Q

Drug targeting Her-2-neu mutations?

E/P receptors?

A

Her2Neu: trastuzumab

E/P receptors: tamoxifen

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15
Q

Where are BRCA genes located?

A
  • BRCA1: chromosome 17 (I had this question on Rx)

- BRCA2: chromosome 13

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16
Q

DCIS:
clinical presentation:
What does the comedocacinoma subtype look like on histo?

A
  • calcification on mammography (no mass on palpation)

- comedocarcinoma = central caseous necrosis

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17
Q

What is Paget’s Disease of the boob?

A
  • underlying DCIS –> nipple erythema + ulceration

- 100% related to cancer; possibly invasive

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18
Q

How is invasive ductal carcinoma detected?
What are four subtypes?
Which is the worst in terms of prognosis?
Which is assc with BRCA?

A
  • 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
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19
Q

Tubular carcinoma has tubules (obviously), mucin tumors have mucin lakes (obviously).
What characterizes a medullary or inflammatory carcinoma?

A
  • medullary: sheets of PLASMAS and lymphocytes

- inflammatory: neoplastic cells block lymph drainage –> get “peau d’ orange” (orange peel breast)

20
Q

Lobular Carcinoma (separate from ductal carcinoma):

  • bilateral or unilateral?
  • classic histo appearance
A
  • loss of e-cadherin –> orderly rows of cells
  • often bilateral
  • may have “signet ring” appearance
21
Q

How big should a breast mass be for you to worry about cancer?

When should you worry about a mammogram?

A

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.

22
Q

How are has the mammographic screening influenced breast cancer treatment?

A
  • ^ detection in situ lesions
  • ^ incidence
  • DECREASED mortality due to early detection
23
Q

Mammary duct ectasia:
What is this and who gets it?
How does it present
Describe the histo.

A

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.

24
Q

Lymphocytic mastoplasty:

Describe the histo

A
  • hard palpable mass(es)

- collagenized stroma surrounding atrophic ducts + lobules

25
Q

Granulomatous mastitis:

What is it and who gets it?

A
  • Rare granulomatous inflammation caused by systemic disease

- parous women ONLY

26
Q
  • cysts
  • fibrosis
  • adenosis
  • lactational adenoma

What do these have in common?

A

All cystic/benign changes of the breast. Not malignant.

27
Q

Describe how fibrous cysts appear histologically (3)–how do they become “fibrous”?

A
  • domed appearance
  • ~ calcificaiton
  • ~ apocrine metaplasia
    Get fibrosis if cysts ruptures –> heals
28
Q

What is adenosis?
Describe the histo.
When might you see this?

A
  • Type of nonproliferative fibrocystic change
  • ^ acini/ lobules
  • common in preggos/breast feeding (lactational adenoma)
29
Q
  • Epithelial hyperplasia
  • Sclerosing adenosis
  • Complex Sclerosing Lesion (Radial Scar)
  • Intraductal papilloma
  • Fibroadenoma

What do these have in common?

A

Common Characteristics:

  • Proliferation of ductal epi or stroma w/o atypia suggestive of malignancy
  • rarely form palpable mass
  • mammographic denisty or calcificaiton
30
Q

Complex Sclerosing Lesion (Radial Scar):

Describe histo; from what must it be distinguished?

A
  • stellate w central nidus of entrapped glands

- can mimic ca. grossly/ mammographically

31
Q

Sclerosing adenosis/ Ductal hyperplasia:

Describe histo + risk

A
  • Double # acini/ lobule + fibrosis/ calcification

- Doubles risk of invasive ca in either breast

32
Q

Two types of proliferative disease with atypia; how are they different from malignancy in situ?

A
  • Atypical ductal hyperplasia (not completely monomorphic; don’t fill ductal space)
  • Atypical lobular hyperplasia (less than 50% acini)

(They have the word atypical in them. Just know that.)

33
Q

Risk factors for breast cancer used in statistical model:

don’t think you have to memorize this, just review

A
  • Age
  • Age of menarche before 11 yoa ^risk
  • First live birth before 20yoa decrease risk 50%
  • First degree relative (mom, sister, daugher)
  • Prior biopsy with atypia
  • Race (AA = lower, present at higher stage)
34
Q

Risk factors for breast cancer not accounted for in statistical model:
(Don’t think you have to memorize this, just review)

A
  • ^ Estrogen + progesterone exposure (not OCPs)
  • Radiation therapy
  • Endometrial or contralateral breast Ca.
  • ^ incidence in developed countries
  • ^ risk ETOH consumption
  • Obesity (protective before menopause, risky after)
  • Exercise is good for you
  • Breast feeding is good for you
  • Some pesticides have estrogenic effects (^ risk)
35
Q

How does tobacco use influence risk of breast cancer?

A

It doesnt!

RX QUESTION.

36
Q

How does obesity influence risk of breast cancer?

A
  • Protective before 40 yoa

- ^ risk after menopause (adipose makes estrogen)

37
Q

Two etiologies of breast cancer pathogenesis:

A
  • sporadic (hormonal)

- genetic (first degree relative, 25% genetic= BRACA1/2)

38
Q

Fundamental difference between ca in situ and invasive ca:

A

ca in situ DOES NOT penetrate the BM!

39
Q

How is comedocarcinoma treated?

Lobular ductal carcinoma?

A

-Tx with Tamoxifen (ER (+))

40
Q

Possible sequelae of invasive ductal cell ca

A

dimpling of skin or nipple retraction

41
Q

Hormone status of invasive ductal ca; which is the exception?

A

ER (+). PR (+), HER2-neu (-)

Medullary Ca has poor hormone receptor status due to ^ expression of adhesion molecules

42
Q

Invasive lobular ca:

Describe the histo

A
  • Cells missing E cadherin–> grow in single file pattern (cant make ducts)
  • Signet ring cells
43
Q

Invasive papillary ca:

Frequency, prognosis?

A
  • rare
  • papillary architecture (duh)
  • prognosis better than invasive ductal
44
Q

Describe metaplastic ca of the breast:

A

mixture of subtypes of cancer i.e. adenocarcinoma + chondroid stroma, etc

45
Q

Stage 0-4 breast cancer appearance

A

0: DCIS or LCIS
1: less than 2 cm; invasive
2: 2-5 cm; up to 3+ lymph nodes; invasive
3: between stages 2-4; possible local invasion
4: has mets.

46
Q

5 year survival for each ductal carcinoma stage

MAYBE KNOW STAGE 0 vs 4 BUT DONT MEMORIZE! KNOW EARLY DETECTION IS IMPORTANT!

A

0: 92%
1: 87%
2: 75%
3: 46%
4: less than 13%

DT4-Exam 1 (17 decks)

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