breast disorders Flashcards
lactaceles
milk producing cells
oxytocin
milk excretion and bonding
prolactin
milk secreting
mastalgia
breast pain that can be cyclical or non-cyclical
galactorrhea
milk discharge due to either excessive breast stimulation, prolactinoma, hypothyroid or dopamine antagonist medications
bloody nipple discharge
can be due to intraductal papilloma or breast cancer
- Arise in a lactiferous duct, usually 2-4mm and solitary
- Discharge can be bloody and/or clear
- Most commonly in women 30-50yo
- If multiple or with atypia, can be associated with underlying cancer
intraductal papilloma
DCIS (intraductal carcinoma) more commonly detected via screening rather than symptoms
yep
Paget’s
skin involvement with underlying breast cancer
Gail model
5 year risk of breast cancer assessment to help guide decision-making
Fibrocystic Breast Disease
lumpy dumpy breasts: usually a benign process but there is some tenderness and symptoms fluctuate
**reduces reliability of screening with mammogram due to visibility and thus an ultrasounds is used instead
Fibroadenomas
most common cuase of breast masses in younger women and uncommon post-menopausal
- firm, well-circumscribed, mobile and non-tender mass
Benign Cysts
- 1/3 of women age 35-50yo will have a breast cyst
- Varies in size, typically solitary or a few, well-circumscribed, mobile, +/- tenderness
- Almost always benign
Fluid accumulation within glands
Can aspirate if bothersome and/or to confirm dx
breast cancer
1 in 8 will be diagnosed
** shape is irregular and stellate
- Rare; <1% of all breast tumors
- Range from benign to malignant
- More common in younger women (40s)
- Usually single breast, large and firm
- Progress rapidly, but rarely metastasize
phyllodes tumor
mastitis
infection that is lactational almost always and it is diagnosed clinically with fever, systemic symptoms and localized erythema, warmth and pain
- treatment: dicloxacillin QID and continued breastfeeding /pumping
breast abcess
progression of a mastitis
Malignant phyllodes is a _________
sarcoma.
no increased risk for breast cancer
benign non-proliferative disease
slight increased risk for breast cancer
benign proliferative disease, without atypia
fibroadenoma
non or slight increased risk for breast cancer
benign breast lesions
fibrocystic changes that is common esp. in 25-45 yr of age
** can stimulate breast carcinoma on imaging
moderatly increased risk of breast cancer
benign proliferative disease with atypia
high risk for breast cancer
carcinoma in situ (non malignant)
usually non-palpable, associated with microcalcifications and up to 25% develop ipsilateral invasive carcinoma
in situ intraductal carcinoma
DCIS spread?
no stays within the ducts
outcome of invasive ductal carcinoma and invasive lobular carcinoma (unique pathology; tumor cells in strands and cords)
good prognosis
(Nottingham) Scarf-Bloom-Richardson
Breast Carcinoma Grading
tumor histologic grading criteria (3)
- tubule formation
- nuclear size
- mitotic count
independent varial for correlation with survival
tumor size
Breast Cancer Predictive Marker Studies:What is the Objective?
Predict response to various therapeutic agents in individual patients and Select patients with higher likelihood of response Avoiding potential toxicity in those who are unlikely to respond to a particular drug
Estrogen and progesterone receptor expression
Predicts response to hormonal therapy
- ER Modulation:
- Estrogen Synthesis Inhibition:
- ER Degradation:
- ER Modulation: Tamoxifen
- Estrogen Synthesis Inhibition: Aromatase inhibitors
- ER Degradation: Fulvestrant
HER2 oncoprotein/oncogene status
Predicts response to targeted therapy to trastuzumab
Gene expression profile analysis
- Performed on selected cases
- Predicts benefit from chemotherapy
15 - 20% of invasive breast carcinomas are ___________.
__________ tumors have a worse prognosis
Positive result predicts response to anti-_______ therapy
HER2 positive
RS an independent/dependent predictor of disease recurrence
independent
RS predictive of response to chemotherapy
- High RS:
- Low RS:
- High RS: benefit from chemotherapy
2. Low RS: greatest benefit from hormonal therapy
staging is unique to each tumor type
yep
assessment for met carcinoma
lymph node involvement where 2/10 of a milimeter is positive
Peau d’orange skin change
inflammatory breast carcinoma
inflammatory breast carcinoma is where the tumor is present in
dermal lymphatics and shows poor prognosis
** underlying mass not always palpable
flaky irritation around nipple, some oozing and biopsy shows infiltrate within the epidermis
mammary paget disease
** underlying DCIS
