Breast Histology/Benign Disease

Question 1

What composes the breast stroma?

Answer 1

Adipose tissue

Fibrous tissue

Question 2

What are the 2 main components of the breast?

Answer 2

Epithelial (glandular) component

Stromal component

Question 3

What is the lymphatic drainage of the breast?

Answer 3

Axillary nodes
Supraclavicular nodes
Mediastinal nodes

Question 4

What is the most common lymphatic site breast cancer spreads to?

Answer 4

Axillary nodes

Question 5

What comprises a terminal duct lobular unit?

Answer 5

Acini

Terminal duct

Question 6

Describe the lining of the breast ductual system.

Answer 6

2 cell layer epithelium
Epithelial cell layer- produces milk
Myoepithelial cell layer- outer layer that expells milk

Question 7

What is a breast lobule?

What is a breast lobe?

Answer 7

Lobule- collection of terminal duct lobular units

Lobe- collection of lobules (women have ~15-20 lobes)

Question 8

How does the male breast differ from female breast?

Answer 8

It lacks lobules

Question 9

What hormonal/physiologic changes take place in the breast tissue at the time of puberty?

Answer 9

Stimulation by E/P

Formation of lobules

Question 10

What physiologic changes take place in the breast tissue during the menstrual cycle?

Answer 10

Increased size/nodularity of lobules

Question 11

What physiologic changes take place in the breast tissue during pregnancy/lactation?

Answer 11

Epithelial vaculoization

Secretion into lumen

Question 12

What pysiologic changes take place in the breast tissue during menopause?

Answer 12

Loss of terminal duct lobular units

Increased fatty tissue

Question 13

What is the most common site of ectopic breast tissue?

Answer 13

Axilla

Question 14

A congenital nipple retraction must be distinguished from what condition?

Answer 14

Advanced breast cancer

Cancer can be associated with fibrosis that pulls on the nipple/skin leading to involution

Question 15

When is gynecomastia normal in men?

Answer 15

Newborn
Puberty
Elderly men

Question 16

Why can gynecomastia occur in patients with liver disease?

Answer 16

Liver is site of estrogen metabolism

Liver disease leads to decreased estrogen metabolism

Question 17

Acute mastitis presents similarly to what malignant condition?

Answer 17

Inflammatory carcinoma

Question 18

How do you distinguish acute mastitis from inflammatory carcinoma?

Answer 18

Give antibiotics

If it does not clear with antibiotics, biopsy

Question 19

What is the cellular lining of the nipple?

Answer 19

Stratified squamous epithelium

Question 20

Recurrent subareolar abscess is commonly associated with what environmental health factor?

Answer 20

Smoking

Question 21

Detail the changes that occur in recurrent subareolar abscess.

Answer 21

Squamous epithelial metaplasia
Abscess
Fistula opening at edge of areola

Question 22

What patients can be effected by recurrent subareolar abscess and what is the treatment?

Answer 22

Men/women

Surgery

Question 23

What is the most common cause of nipple discharge?

Answer 23

Intraductual papilloma

Question 24

What 3 benign lesions have malignant potential?

Answer 24

Intraductual papilloma
Phyllodes tumor
Sclerosing adenosis

Question 25

Contrast nonproliferative fibrocystic change with proliferative fibrocystic change.

Answer 25

Nonproliferative FCC: epithelial hyperplasia absent | Proliferative FCC: epithelial hyperplasia present

Question 26

How can sclerosing adenosis be differentiated from carcinoma?

Answer 26

Stain for myoepithelial cells

Question 27

A pathology report for a patient states that she has lobular carcinoma in situ. What side of the breast is at risk for malignancy?

Answer 27

Both

Question 28

FCC can be proliferative or nonproliferative. If it is proliferative, epithelial cell hyperplasia is present. How can epithelial cell hyperplasia progress to cancer?

Answer 28

Hyperplasia (ductal or lobular) Atypical hyperplasia D/L-CIS Invasive carcinoma

Question 29

What distinguishes lobular atypical hyperplasia from lobular CIS?

Answer 29

Less than 50% duct involvement is atypical hyperplasia | More than 50% duct involvement is LCIS

Question 30

Is lobular carcinoma in situ associated with increased risk for invasive lobular or ductal carcinoma?

Answer 30

Both (IDC is actually more common, does not have to originate from the site of CIS)