Breast - FS Flashcards by Storm Wolf

most common benign tumor in young women

fibroadenoma

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describe a fibroadenoma

glandular and stromal elements, with smooth defined borders, mobile

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2 epithelial cells that can give rise to cancer in the breast

luminal cells - secretory and estrogen sensitive

myoepithelial(basal) cells

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what is a myoepithelial cell protein

S100

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which epithelial cell type will stain for estrogen receptors

luminal estrogen +

myoepithelial estrogen -

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why hard to read young women mammograms

lots of dense fibrous interlobular stroma

not much adipose tissue

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possible causes of inverted nipple

congenital - 10-20% (assd with sinus blockage and breastfeeding difficulty)
acquired - must rule out pathology(malignancy)

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what is serous and bloody nipple discharge assd with

cysts and large duct papillomas

cancer risk 7% < 60 yo 30% > 60 yo

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how is modified radical mastectomy different than radical a mastectomy

modified doesn’t take the pectoralis muscle

both take axillary lymph nodes

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lactational mastitis

1st month post partum
acute inflammmation -> 10% abcess
nipple fissure/milk stasis
staph aureus maybe strep

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periareolar mastitis(mammary duct ectasia)

obstructed lactiferous sinus
young women - smoking ->keratin plug
dilated sinus - forms MASS

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what is a ruptured periareolar mastitis

periductal mastitis - foreign body inflammation, with redness, swelling, heat, pain
may form fistula

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fat necrosis

trauma, granulomatous response w/repair fibrosis

may cause dimpling, mass, calcifications

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fat necrosis - diagnosis and treatment

biopsy(vs carcinoma w/desmoplasia(tumoral fibrosis)), usually taken out

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problems with breast implants

rupture - saline better than silicone (10% leak/ 10 years)

capsule formation - rough surface better

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fibrocystic change

1/3 women age 30-50 - stops @ menopause
presents as mass, pain, microcalcifications
cysts, adenosis, apocrine metaplasia, fibrosis
-no increase carcinoma risk
aka blue domed cysts

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usual epithelial hyperplasia

proliferative fibrocystic change w/o atypia (risk 2x)

like - fibrocystic change but thicker >4cell layers

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radial scar(complex sclerosing lesion)

proliferative fibrocysitic change w/o atypia (risk 2x)
central fibroelastic scar w/ trapped distorted glands
mimicker of carcinoma
no atypia - check for BM with S100

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intraductal papilloma

proliferative fibrocystic change w/o atypia (risk 2x)
papillary lesions w/ 2 cell types
may have bloody nipple discharge

atypical ductal hyperplasia

proliferative fibrocystic change with atypia (risk 5x)
low grade neoplastic cells from duct (BM intact)
called DCIS when duct is filled with neoplastic cells and lesion is >2cm

atypical lobular hyperplasia

proliferative fibrocystic change with atypia (risk 5x)
low grade neoplastic cells from lobule (BM intact)
E CADHERIN negative
overlap with LCIS

comedo

ductal carcinom in situ with necrosis - tumor outgrew blood supply - center dies
Microcalcifications

how do you differentiate ductal vs lobular carcinomas

lobular is E-cadherin negative

low grade DCIS

mild nuclear atypia and micropapillary or cribiform architecture

high grade DCIS and types

malignant nuclear atypia and solid architecture +/- comedonecrosis - central necrosis - calcifications +/- microinvasion - invasion focus < 2mm

how is lobular CIS findings different than DCIS

mammogram - doesn't calcify gross - no discrete mass microscopic - dyshesive architecture /w signet ring morphology

Pagets disease

DCIS that has expanded out the nipple eczematous, red change to nipple mucin + malignant glandular cells

what is pagetoid

microscopic finding of upward inflitration of epidermis by glandular neoplastic cells

What stains can be used to confirm Paget disease

IHC - breast epithelial and glandular epithelial cell markers like cytokeratin CK7

Second most common fatal malignancy of women

Lung >breast >colon

What are risk factors of invasive carninoma of breast

cumulative lifetime exposure to estrogen - menarch, meopause, pregnancy, HRT radiation, breast density, lifestyle, familial, increasing age

How does p 53 work?

upregulates cell cycle inhibitors CDKN1A (upregulates p21 kinase) or GADD45 - inhibits G1/S and G2/M for DNA repair

how does her2/neu work?

upregulates cell cycle inhibitor p27

what syndrome has mutated p53 gene

Li Fraumini - multiple early onset cancers | - p53 on short arm of ch17

When to test for gene mutations

Early onset cancers, family history(ashkenazy jews, french-canadians), high risk breast cancers

What are preventative treatments for BRCA cancers

``` propylactic mastectomy (90%) salpingo-oopherectomy (80% ovarian, 50% breast) tamoxifen (50% decrease) ```

What screening for BRCA cancers

annual mammogram and MRI at 25

Clinical presentation of invasive carcinoma

breast mass - palpable at 2 cm, mammogram at 1 cm axillary mass - lymph nodes skin dimpling - coopers ligaments involved redness/peau d'orange - inflammatory metastisis - weight loss, malaise, fracture, blood smear

invasive ductal carcinoma

85% (50% in RUQ) - good prognosis stellate mass with hard gritty surface due to dysplasia ie irregular bordered dense white mass infiltrating cells form glands/nests

invasive lobular carcinoma

15% - good prognosis diffuse infiltration hard to detect - cells in a line invading along fibrous septae e-cadherin negative spread to mesothelial surface and leptomeninges

inflammatory breast cancer

worst prognosis orange

Tamoxifen

ER antagonist 75% breast cancer is ER + 2/3 respond to Tamoxifen

Herceptin - Traztuzumab

her-2/neu receptor blocker worse prognosis if untreated better if treated

Fibroadenoma

Most common benign tumor of breast ages 20-40, may be multiple masses with sharp edges " india rubber feel" stroma and epithelial cells on micro

phyllodes tumor

from intralobular stroma 50-60 yo palpable masses - can be very large, rubbery micro - like fibroadenoma but more cellular and active low grade - local recurrance high grade - aggressive local w/ metasteses in 1/3

lipoma

benign tumor of fat cells most common soft tumor of adulthood round circumscribed, soft, mobile and painless

Breast disease in males

hyper estrinism (cirrhosis, kleinfelter, tumors, meds) 1% risk of women, same risk factors and path more common w/ BRCA2