Breast – Normal Histology and Benign Disease

Question 1

The ducts are largest near the ____________.

Answer 1

areolae

Question 2

Where do the lymph nodes of the breasts drain?

Answer 2

Most (45%) drain to the axillary lymph nodes. Second-most drain to the supraclavicular lymph nodes. Some can drain to the mediastinum or below the diaphragm.

Question 3

The entire ductal system is lined by _______________.

Answer 3

a two-cell layer (any more is abnormal): inner is glandular, outer is myoepithelial

Question 4

Between the lobules is ______________.

Answer 4

intralobular stroma, which is hormone-responsive

Note: there is also interlobular stroma between different lobular units, which is fibrous.

Question 5

What is the main difference in male breasts?

Answer 5

There are ducts in males breasts, but there are no lobules.

Question 6

In a malignancy, the ___________ layer is lost.

Answer 6

myoepithelial

Question 7

Puberty prompts the formation of _____________.

Answer 7

acini

Question 8

During pregnancy, _____________ increase in number.

Answer 8

acini

Question 9

After menopause, there is ______________.

Answer 9

more stroma and fat; less glandular tissue

Question 10

In addition to increased lobules, there is _____________ during pregnancy as well.

Answer 10

epithelial vacuolization

Question 11

During pregnancy or even menstruation, breast tissue can appear in the ___________.

Answer 11

axilla

Question 12

Nipple retraction (having an innie nipple) can occur due to ______________.

Answer 12

congenital abnormality or cancer

Question 13

In gynecomastia, _____________ accounts for most of the extra mass.

Answer 13

stromal proliferation

Question 14

What causes acute mastitis?

Answer 14

Usually occurring in lactating women, acute mastitis results from cracks in the nipple that allow Staphylococci into the ducts (where they survive on milk).

This presents with redness and tenderness of the breast.

Question 15

What causes chronic mastitis?

Answer 15

Generally non-infectious causes like milk obstructions.

Most often presents in perimenopausal women.

Can mimic carcinoma because irregular fibrosis often results from healing.

Question 16

What causes recurrent subareolar mastitis?

Answer 16

Squamous metaplasia around the main nipple duct leads to recurrent inflammation due to the accumulation of keratin where it should not be.

Question 17

Recurrent subareolar mastitis most often occurs in ____________.

Answer 17

smokers

Question 18

_____________ can cause fat necoris of the breast.

Answer 18

Trauma and ischemia

Question 19

Describe how a fibroadenoma presents.

Answer 19

Firm but regular; well-encapsulated; mobile

Question 20

How do fibroadenomas appear on histologic exam?

Answer 20

There is proliferation of glands and fibrous stroma, but in general the fibrous stroma takes over and occludes the lobules.

Question 21

______________ presents as primarily a proliferation of glandular tissue.

Answer 21

Lactating adenoma

Question 22

Which masses can be benign or malignant?

Answer 22

Phyllodes tumors and papillomas

Question 23

____________ are often described as large fleshy tumors.

Answer 23

Phyllodes tumors

Question 24

Papillomas tend to occur near the ____________.

Answer 24

sub-areolar region

Question 25

Papillomas arise from ____________ and invade the ducts.

Answer 25

epithelium

Question 26

About 50% of women present with _____________ at autopsy.

Answer 26

fibrocystic change (most often asymptomatic)

Question 27

_______________ is like fibrocystic change without cysts.

Answer 27

Sclerosing adenosis

Question 28

Fibrocystic change can present as ______________ or ________________.

Answer 28

proliferative (with epithelial hyperplasia); nonproliferative (no hyperplasia)

Question 29

_______________ often leads to fibrous obliteration of the terminal lobules.

Answer 29

Sclerosing adenosis

Question 30

Apocrine metaplasia is associated with ________________.

Answer 30

fibrocystic change

Question 31

Lobular carcinoma in situ is distinct from atypical lobular hyperplasia in that ______________.

Answer 31

LCIS involves more than 50% of the lobules, while ALH involves less than

Question 32

LCIS raises risk of ____________.

Answer 32

carcinoma bilaterally

Question 33

_______________ presents with hyperplasia and discrete punched-out lesions.

Answer 33

Atypical ductal hyperplasia

Question 34

Bloody nipple discharge is associated with _____________.

Answer 34

papillomas and carcinomas

Question 35

True or false: LCIS raises risk of only lobular carcinoma.

Answer 35

False. It raises the risk of both.

Question 36

On fine-needle aspiration, malignant cells will appear as _____________, while benign cells will appear as _________________.

Answer 36

frangible cells; cohesive masses

Question 37

Describe the changes in skin types that occur from the outside of the nipple to the duct.

Answer 37

Outside: keratinizing, stratified squamous epithelium
Inside: double-layer cuboidal epithelium (myoepithelium and luminal epithelium)

Question 38

Prior to puberty, the breasts are _______________.

Answer 38

branching ducts without the terminal lobules

Question 39

At the end of pregnancy, the breast is composed almost entirely of _____________.

Answer 39

lobules

Question 40

By what cellular processes does the breast shrink after cessation of lactation?

Answer 40

Atrophy of stroma and apoptosis of epithelial cells

Question 41

Describe juvenile hypertrophy of the breasts.

Answer 41

Some girls get extensive development of the breast in the absence of hormone imbalances.

Question 42

Ductal papillomas typically present in _____________.

Answer 42

large ducts as papillary protrusions

Question 43

Both types of ______________ raise risk of carcinoma.

Answer 43

atypical hyperplasia

Question 44

Blue-domed cysts are characteristic of ______________.

Answer 44

non-proliferative FCC