Breast, Final W2015

Question 1

What term refers to a condition where breast tissue, nipple and areola are absent?

Answer 1

Amastia

Question 2

What term refers to a condition where the mammary gland tissue is absent but the nipple and areola remain present?

Answer 2

Amazia

Question 3

What term refers to the presence of breast glandular tissue but no nipple or areola?

Answer 3

Athelia

Question 4

What is a supernumerary nipple and where does it arise?

Answer 4

It’s an additional nipple that may occur along the milk line.

Question 5

What is polymastia?

Answer 5

Supernumerary breast tissue or ectopic breast tissue, usually on the milk line.

Question 6

What usually causes an inverted nipple?

Answer 6

Fibrous bands of tissue that tether the nipple in an inverted position. 90% are bilateral.

Question 7

When is galactorrhea most disconcerting?

Answer 7

D/c is unilateral, bloody or associated with breast mass. It may indicate malignancy.

Question 8

Inflammation of the parenchyma of the mammary gland during lactation is often termed what?

Answer 8

Puerperal mastitis

Question 9

What is a common myth about mastitis?

Answer 9

The it is an acute infection. It is rarely associated with an infection (although this is possible if the nipple is cracked in which cased it is usually caused by staph aureus or strep epidermidis)

Question 10

What condition is characterized by keratinizing squamous epithelium in the duct system of the nipple causing pain in the sub-areolar area?

Answer 10

Peri-ductal mastitis (90% of pts are smokers)

Question 11

What condition is characterized by dilatations of the sub-areolar ducts and usually occurs in 5th or 6th decade of life to multiparous women?

Answer 11

Mammary duct ectasia

Question 12

What is the single most common disorder of the breast and accounts for more than half of all surgical operations that are performed on the female breast?

Answer 12

Fibrocystic breast disease

Question 13

How is fibrocystic breast disease diagnosed?

Answer 13

It’s too dense for mammography.
Usually, clinical diagnosis from history and sxs
Definitive diagnosis is by biopsy or aspiration

Question 14

What are the microscopic findings of fibrocystic breast disease?

Answer 14

Fibrosis
Sclerosing ductal epithelium proliferation
Adenosis
Apocrine metaplasia
Multi-layering of the ductal cells or ingrowth of the cells towards the center of the duct

Question 15

What does fat necrosis of breast tissue look like microscopically?

Answer 15

Irregular fatty spaces that are surrounded by foamy histiocytes and multinucleated giant cells

Question 16

What condition is characterized by a single hard mass or multiple hard masses that are made up of collagenized stroma surrounding atrophic ducts and lobules?

Answer 16

Lymphocytic mastopathy

Question 17

What are the microscopic findings in lymphocytic mastopathy?

Answer 17

A thickening and fibrosis of stromal tissue and lymphocytic infiltrates that surrounds the epithelium and blood vessels

Question 18

Who typically gets lymphocytic mastopathy?

Answer 18

Women with type 1 diabetes mellitus or autoimmune thyroiditis

Question 19

What is the difference between Adenosis and Adenoma?

Answer 19

Adenosis is an increased number of glandular components

Adenoma is a benign lesion with more glandular tissue involved and is more organized

Question 20

What is the most common benign tumor of the breast?

Answer 20

Fibroadenoma

Question 21

What tumor is characteristically a well circumscribed mass with a prominent fibrotic capsule?

Answer 21

Fibroadenoma

Question 22

How do fibroadenomas respond to hormones?

Answer 22

They are responsive to hormones:
Increase in size during pregnancy and late luteal phase of menses
Regress after menopause

Question 23

What is a lactating adenoma

Answer 23

A fibroadenoma. A localized focus of hyperplastic cells seen in breast tissue during pregnancy.
Marked cytoplasmic vacuolization seen in the hyperplastic lobules.

Question 24

What are the two types of intraductal papillomas and how are they different?

Answer 24

Solitary - originates in the large ducts and is located centrally beneath the nipple
Multiple - located in the terminal ducts at the periphery of the breast

Question 25

Microscopically what condition is characterized by the presence of myoepithelial cells and multilayer ductal cells becoming flattened with a heterochromatic nucleus next to the luminal surface?

Answer 25

Intraductal papilloma

Question 26

Where do most breast cancers originate and how are they classified?

Answer 26

Glandular tissues

Adenocarcinomas

Question 27

What type of receptors are overexpressed in 70% of breast cancer patients?

Answer 27

Estrogen, which stimulates proliferation of mammary cells which increases cell division and DNA replication > greater chance of mutations

Question 28

What gene mutations account for 30-40% of inherited breast cancers?

Answer 28

BRCA1 and BRCA2 which are tumor suppressor genes

Question 29

What other gene is a proto-oncogene found over-expressed in breast cancer?

Answer 29

HER2/neu gene

Question 30

What are the three main types of breast cancer?

Answer 30

Ductual (intraductual)
Lobular
Nipple (Paget’s disease of breast/nipple)

Question 31

What is the most common type of breast cancer?

Answer 31

Ductal carcinoma (infiltrating)

Question 32

Infiltrating ductal carcinoma has a central white area that is hard and gritty because the neoplasm is producing a desmoplastic reaction with lots of collagen. What is this called?

Answer 32

Scirrhous appearance

Question 33

What is the second most common histologic type of breast cancer?

Answer 33

Lobular carcinoma

Question 34

What characterizes the histologic appearance of lobular carcinoma?

Answer 34

The presence of small homogenous cells that invade the stroma often seen in a “single file pattern”. “Signet ring” appearance has a worse prognosis.

Question 35

What condition is characterized by eczematous changes overlying the nipple and areola, or in worse conditions, ulceration/destruction?

Answer 35

Paget’s disease (less common than ductal or lobular)

Question 36

What are Paget cells?

Answer 36

They are derived from glandular epithelium. They are large round cells with pale cytoplasm and pleomorphic nuclei and are seen within the epidermis

Question 37

What is notable about inflammatory breast cancer?

Answer 37

It often presents without a palpable lump on breast exam. It is especially aggressive.