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Repro Exam I > Breast - FS > Flashcards

Breast - FS Flashcards

1
Q

most common benign tumor in young women

A

fibroadenoma

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2
Q

describe a fibroadenoma

A

glandular and stromal elements, with smooth defined borders, mobile

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3
Q

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

A

luminal cells - secretory and estrogen sensitive

myoepithelial(basal) cells

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4
Q

what is a myoepithelial cell protein

A

S100

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5
Q

which epithelial cell type will stain for estrogen receptors

A

luminal estrogen +

myoepithelial estrogen -

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6
Q

why hard to read young women mammograms

A

lots of dense fibrous interlobular stroma

not much adipose tissue

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7
Q

possible causes of inverted nipple

A

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

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8
Q

what is serous and bloody nipple discharge assd with

A

cysts and large duct papillomas

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

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9
Q

how is modified radical mastectomy different than radical a mastectomy

A

modified doesn’t take the pectoralis muscle

both take axillary lymph nodes

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10
Q

lactational mastitis

A

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

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11
Q

periareolar mastitis(mammary duct ectasia)

A

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

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12
Q

what is a ruptured periareolar mastitis

A

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

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13
Q

fat necrosis

A

trauma, granulomatous response w/repair fibrosis

may cause dimpling, mass, calcifications

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14
Q

fat necrosis - diagnosis and treatment

A

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

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15
Q

problems with breast implants

A

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

capsule formation - rough surface better

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16
Q

fibrocystic change

A

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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17
Q

usual epithelial hyperplasia

A

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

like - fibrocystic change but thicker >4cell layers

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18
Q

radial scar(complex sclerosing lesion)

A

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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19
Q

intraductal papilloma

A

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

20
Q

atypical ductal hyperplasia

A

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

21
Q

atypical lobular hyperplasia

A

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

22
Q

comedo

A

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

23
Q

how do you differentiate ductal vs lobular carcinomas

A

lobular is E-cadherin negative

24
Q

low grade DCIS

A

mild nuclear atypia and micropapillary or cribiform architecture

25
Q

high grade DCIS and types

A

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

26
Q

how is lobular CIS findings different than DCIS

A

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

27
Q

Pagets disease

A

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

28
Q

what is pagetoid

A

microscopic finding of upward inflitration of epidermis by glandular neoplastic cells

29
Q

What stains can be used to confirm Paget disease

A

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

30
Q

Second most common fatal malignancy of women

A

Lung >breast >colon

31
Q

What are risk factors of invasive carninoma of breast

A

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

32
Q

How does p 53 work?

A

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

33
Q

how does her2/neu work?

A

upregulates cell cycle inhibitor p27

34
Q

what syndrome has mutated p53 gene

A

Li Fraumini - multiple early onset cancers

- p53 on short arm of ch17

35
Q

When to test for gene mutations

A

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

36
Q

What are preventative treatments for BRCA cancers

A 
propylactic mastectomy (90%)
salpingo-oopherectomy (80% ovarian, 50% breast)
tamoxifen (50% decrease)
37
Q

What screening for BRCA cancers

A

annual mammogram and MRI at 25

38
Q

Clinical presentation of invasive carcinoma

A

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

39
Q

invasive ductal carcinoma

A

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

40
Q

invasive lobular carcinoma

A

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

41
Q

inflammatory breast cancer

A

worst prognosis orange

42
Q

Tamoxifen

A

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

43
Q

Herceptin - Traztuzumab

A

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

44
Q

Fibroadenoma

A

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

45
Q

phyllodes tumor

A

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

46
Q

lipoma

A

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

47
Q

Breast disease in males

A

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

Repro Exam I (7 decks)

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