Breast inflammation: mastitis, squamous metaplasia, ductal ectasia, fat necrosis, etc

Question 1

pain, erythema, subareolar mass in a female smoker. biopsy shows granulomas and hyperkeratosis of ductal cells and duct obstruction

Answer 1

squamous metaplasia of lactiferous ducts

Question 2

non-painful, non-erythematous subareolar mass with thick lactation bilaterally in multiparous female patient aged 60. biopsy shows a mass resembling invasive cancer but tumor markers are absent.

Answer 2

ductal ectasia

Question 3

mammographic screening reveals calcified mass after routine exam discovered a painless lump. CT shows hemorrhaging; biopsy identifies a central area of giant cells surrounding a liquid like material and hemosiderin

Answer 3

fat necrosis: occurs after trauma/surgery to the breast.

Question 4

type one diabetic complains of breast mass. imaging reveals multiple hard, palpable masses. what would the biopsy show?

Answer 4

Lymphocytic Mastopathy “sclerosing lymphocytic lobulitis”

atrophic ducts, basement membrane thickening, prominent lymphocytic infiltration

Question 5

pt tx’d with steroids and improves

Answer 5

granulomatous lobular mastitis

Question 6

most common breast-inflammation in immunocompromised patients

Answer 6

cystic neutrophilic granulomatous mastitis: corneybacterium, mycobacterium, or fungi

Question 7

blue dome cysts: how are they confirmed? what is normal on imaging? biopsy findings

Answer 7

1. FNA: if they disappear afterwards = confirmed
2. calcifications on imaging
3. cysts with metaplastic apocrine epithelia, flattened atrophic epithelia

Question 8

adenosis: define, imaging, biopsy, genetics, significance

Answer 8

1. adenosis = increased # of acini per/lobule
2. calcifications occasionally on imaging
3. acini lined by columnar cells
   
   1. may appear benign
   2. nuclear atypia “flat epithelial atypia”
4. deletion on chromosome 16
5. thought to be a precursor to low-grade breast cancer
6. no proven to be neoplastic
   7.

Question 9

a painless, palpable mass in a pregnant or lactating woman

Answer 9

lactational adenoma, not-neoplastic

Question 10

pt exam reveals palpable mass which show areas of calcification on imaging. biopsy reveals cord-like structures through the central aspect of the lesion.

Answer 10

sclerosing adenosis

increased number of acini compress and distort the central part of the lesion –> stromal fibrosis compresses lumen to create appearance of cords of cells

Question 11

radial sclerosing lesion, radial scar

Answer 11

complex sclerosing lesion: like a triad consisting of epithelial hyperplasia, sclerosing adenosis, and papillomas

Question 12

composed of multiple branching fibrovascular cores, epithelial hyperplasia and apocrine metaplasia often present

Answer 12

papillomas: grow within dilated ducts

Question 14

how do we expect papillomas to behave?

Answer 14

80% produce a nipple discharge, most come to attention because of a palpable mass or calcification seen on mammography