breast factoids, inflammatory breast disease, benign change

Question 1

what chromosomes are the BRCA1 and BRCA2 mutations found on?

Answer 1

BRCA1: chromosome 17. associated with ovarian cancer
BRCA2: chromosome 13. associated with male breast cancer
(mutation found in neurofibromatosis 1 is also on chromosome 17)

Question 2

What hormones are released in the posterior pituitary? Where are the made? How do they get there?

Answer 2

ADH and oxytocin
ADH is made by the supraoptic nucleus and is transported by neurophysin II
oxytocin is made in the paraventricular nucleus and is transported by neurophysin I

Question 3

Describe the embryology of the breast.

Answer 3

embryoligically, it is a modified sweat gland derived from skin.
not that breast tissue and patholgy can develop anywhere along the milk line (milk line runs from the axilla to the vulva)

Question 4

what is the functional unit of the breast? basic histology?

Answer 4

terminal duct-lobular unit. lobules make milk that drains via ducts to the nipple. lobules and ducts are lined by TWO layers of epithelium: luminal cell layer, which is the inner cell layer lining the ducts and lobules. it is responsible for milk production in the lobules (it is protective in the ducts). myoepithelial cell layer is the outer cell layer lining ducts and lobules. contractile function propels milk toward the nipple.

Question 5

What are some causes of galactorrhea?

Answer 5

nipple stimulation, prolactinoma of anterior pituitary, and many drugs (sprionolactone, marijuana, digitalis, estrogen, cimetidine, alcohol, heroin, dopamine D2 antagonists, ketoconazole)

Question 6

acute mastitis: what is it? causes? associations? complications? presentation? tx?

Answer 6

bacterial infection of the breast, usually du to S. aureus. associated with breast feeding; fissures develop in the nipple that provide a route of entry for microbes. presents as an erythematous breast with purulent nipple discharge that may progress to abscess formation. Tx is drainage (feeding) and abx (dicloxacillin).

Question 7

periductal mastitis: what is it, pathology, presentation

Answer 7

inflammation of the subareolar ducts. usually seen in smokers. a relative vitamin A deficiency results in squamous metaplasia of lactiferous ducts (normally have a specialized epithelium). the squamous metaplasia makes some keritin, which blocks the duct producing a duct blockage and inflammation.
presents as a subareolar mass with nipple retraction (fibrosis and granulation tissue).

Question 8

what is mammary duct ectasia? presentation? who gets it? histology?

Answer 8

inflammation with dilation of the subareolar ducts. it is rare and classically arises in multiparous postmenopausal women.
presents as a periareolar mass with green-brown nipple discharge (inflammatory debris). on biopsy, chronic inflammation with plasma cells are seen.

Question 9

What is fibrocystic change? how does it present? pathologic findings?

Answer 9

development of fibrosis and cysts in the breast that presents as a vague irregularity in breast tissue (“lumpy breast”). most common change in premenopausal women and usually seen in upper outer quadrant. cysts have a blue-dome appearance on gross exam
(cysts: lobules get bigger; there is fibrosis between that).

Question 10

what are the implications of fibrocystic change in terms of breast cancer risk?

Answer 10

fibrocystic change is benign, but can be associated with an increased frisk of invasive carcinoma.  risk applies to both breasts.  fibrosis, cyss, and apocrine metaplasia have no increased risk (this is special- it is an example of metaplasia without risk of cancer). 
 ductal hyperplasia (more than 2 cells lining the ducts) and sclerosing adenosis (too many glands in the lobule with sclerosis; often calcified) have a 2X increased risk. 
atypical hyperplasia has a 5X increased risk.

Question 11

intraductal paiplloma

Answer 11

papillary growth, usually into a large duct. characterized by fibrovascular projections lined by epithelial (luminal) and myoepithelial cells with blood vessel in the core. classically presents as bloody nipple discharge in a premenopausal woman, and must be distinguished from papillary carcinoma, which also presents as bloody nipple discharge.
mild increased risk of breast cancer in first aid.

Question 12

how can you distinguish between intraductal papilloma and papillary carcinoma?

Answer 12

papillary carcinoma is characterized by fibrovascular prjoections lined by epithelial cells withOUT underlying myoepithelial cells. risk of papillary carcinoma increases with age. thus, it is more commonly seen in postmenopausal women.

Question 13

fibroadenoma: definition, presentation, prognosis

Answer 13

tumor of fibrous tissue and glands. most common bening neoplasm of the breast. usually seen in premenopausal women. presents as a well-circumscrbed, mobile marble-like mas. it is estrogen-sensitive and grows during pregnancy; may be painful during menstrual cycle. benign with no increased risk of carcinoma.

Question 14

phylloides tumor

Answer 14

fibroadenoma-like tumor with OVERGROWTH OF FIBROUS COMPONENT. characteristic leaf-like projections on biopsy. often seen in post-menopausal women. can be malignant in some cases.