Breast Diseases Flashcards
Most breast lumps are?
Fibrocystic changes
Fibrocystic changes are mostly?
Cysts and fibrosis
What is the most common breast abnormality in premenopausal women?
Fibrocystic changes
What causes fibrocystic changes
Cyclic breast changes that occur normally in the menstrual cycle
Fibrosis is caused by? Cysts form by? What lines cysts?
Fibrosis is caused by the rupture of cysts
Cysts formed by the folding and unfolding of lobules
The lining is apocrine metaplasia
What is epithelial hyperplasia and what cells are involved?
Increase in the number of layers of duct epithelium to more than 2. There are ductal and myoepithelial cells
Sclerosing adenosis presents as? What cells are preserved?
Presents as mammography calcifications and myoepthileal cells are preserved and increase
Acute mastitis is related to? What organism causes it?
Related to the first month of breast feeding and S. aureus causes it by entering the ducts
What is seen histologically in acute mastitis?
The breast tissue is infiltrated by neutrophils
Duct ectasia is AKA?
Plasma cell mastitis
Patients with duct ectasia present with?
Periareolar mass that is associated with thick white nipple discharge and skin retraction
What cells are seen surrounding the ducts? Inside?
Plasma cells and lymphocytes. Inside see macrophages
What is the most common benign breast tumor and when does it occur?
Fibroadenoma, occurs in the 3rd decade
Is the fibroadenoma mobile? What is the consistency? What is the most common site for one?
Mobile and rubbery. The most common site is the upper outer quadrant
In fibroadenoma the stroma resembles? The glandular spaces are lined by what kind of cells?
Stroma resembles normal stroma. Spaces lined by ductal and myoepithelial cells.
What happens to the stroma in older women?
Becomes hyalinzed and the epithelium is atrophic
Phyllodes tumor arises from?
Intralobular stroma
Phyllodes tumor presents in?
The 6th decade, older women
What percentage of phyllodes tumors are malignant?
15%
What are the 3 types of phyllodes tumors?
Benign, low grade malignant, and high grade malignant
Higher grade phyllodes tumors are? How do they grow?
Hemmorhagic, grow in a bulbous fashion
What distinguishes phyllodes tumors from fibroadenoma?
- Stromal cellularity and mitoses
- Nuclear pleomorphism
- infiltrative borders
An intraductal papilloma grows within?
A dilated duct
When does the risk for breast cancer begin to increase?
After age 30 and especially after menopause
75% of women with breast cancer are older than?
50
Where is risk for breast cancer highest? What factors are involved?
North America and Northern Europe.
Diet, reproductive patterns, nursing habits
Ductal carcinoma in situ is associated with? What cells are present but in diminished numbers?
Calcifications
Myoepithelial cells present
Ductal carcinoma in situ can involve?
TDLU and larger ducts
How is ductal carcinoma in situ graded?
By the degree of nuclear pleomorphism
What is comedo DCIS or comedocarcinoma?
Sheets of cells with high nuclear grade and central necrosis
Microinvasions may be present
Tumor cells invading less than _ mm into stroma is seen in ___ grade DCIS?
1 mm, high grade
What is Paget disease?
Poorly differentiated DCIS that extends from the lactiferous ducts into skin of nipple. Resulting in unilateral inverted nipple
In lobular carcinoma in situ the population of cells is?
Monomorphic
How is lobular carcinoma in situ detected?
Incidental finding, not mammographically detected
How the cells appear in lobular carcinoma in situ?
Dyscohesive cells with oval or round small nuclei
What causes the discohesion in lobular carcinoma in situ?
Cell adhesion Protein E cadherin is lost
Receptors for what hormones are often expressed in lobular carcinoma in situ?
Estrogen and progesterone
Invasive lobular carcinomas tend to be lateral or bilateral?
Bilateral and multicentric
Where does invasive lobular carcinoma metastasize to?
CSF, serosa, basement membrane and solid organs
When breast cancers spread into the skin they cause?
Peau d’orange
Breast cancer often spreads to what lymph nodes?
Axillary and internal mammary nodes
When breast cancer involves dermal lymphatics it causes?
Inflammatory carcinoma
BRCA 1 is located on what chromosome?
17q21
BRCA puts people at risk of what other cancers?
Ovarian and prostate
BRCA genes code for?
Tumor suppressor proteins
BRCA 2 is located on what chromosome?
13q12.3
What cancers are associated with BRCA2?
Higher chance for breast cancer in men, slightly lower risk of ovarian cancer, stomach and melanoma, prostate, pancreas
What other genes have been associated with breast cancer?
RAS, MYC, p53, PTEN
How are estrogen and progesterone receptors detected?
Immunohistochemistry
What do these receptors mean for treatment?
Those with both receptors respond to hormone therapy 80% of the time, single respond 40%
Double negative respond to chemo, ER positive less likely to respond to chemo
What gene is sometimes over expressed in breast cancers?
HER2
HER2 over expression means?
More aggressive and less responsive to hormone therapy
HER2 tumors respond to what drug
Herceptin
What are the two types of surgical resection?
Lumpectomy for small tumors and mastectomy for lager ones
Men can only get what type of breast cancer?
Ductal carcinoma
What is a good marker for myoepithelial cells?
P63
What is the term for multiple papillomas? What does this cause?
Papillomatosis, increases the risk of breast cancer
Non-comedo ductal carcinoma in situ shows?
Low to moderate grade, no necrosis
What is the differential diagnosis for Paget Disease?
Melanoma
