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Lifecycle Unit 2 Test > Breast: Normal Histology and Benign Diseases > Flashcards

Breast: Normal Histology and Benign Diseases Flashcards

1
Q

Breast tissue

A
  • dense fibrous tissue
  • contains smooth muscle fibers that assist with milk expression
  • the areola is more pigmented than the rest of the skin and becomes more so during pregnancy
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2
Q

Lymphatic drainage of the breast

A

-to axillary, supraclavicular, and mediastinal lymph node

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3
Q

Duct system of the breast

A
  • breast contains 6-10 major ductal systems
  • keratinizing squamous epithelium of the overlying skin dips into the orifices at the nipple and then abruptly changes to a double-layered cuboidal epithelium lining the ducts
  • branching of large ducts leads to terminal duct lobular unit (functional unit of breast)
  • terminal duct branches into a grapelike cluster of small acini (tubules) to form a lobule
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4
Q

Two cell types that line ducts and lobules

A
  1. Contractile myoepithelial cells (MEC)– assist in milk ejection

MEC layer is lost in invasive breast cancer

  1. luminal epithelial cells overlay the myoepithelial cells. Milk production.
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5
Q

Two types of breast stroma

A
  1. interlobular stroma: dense fibrous CT mixed with adipose tissue
  2. intralobular stroma envelopes the acini of the lobules and consists of breast-specific hormonally responsive fibroblast-like cells mixed with scattered lymphocytes
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6
Q

How does the male breast differ from female?

A 
no tubules (acini)
-made of ductal structures surrounded by small amount of adipose and fibrous tissue
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7
Q

Breast structure during childhood, before puberty

A

female breast is composed of branching ductal system without the lobular units.

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8
Q

Changes at puberty

A
  • estrogen and progesterone lead to proliferation of glandular tissues
  • once formed, lactiferous ducts and interlobular duct system are stable
  • TDLUs are dynamic and undergo changes with alterations of hormone levels (changes involve epithelium and intralobular stroma)
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9
Q

Changes during the menstrual cycle

A

First half: lobules = quiescent

After ovulation, under the influence of estrogen and rising progesterone levels, cell proliferation increases, as does the number of acini per lobule. The intralobular stroma also becomes markedly edematous

With menstruation, the fall in estrogen and progesterone levels induces the regression of the lobules and the disappearance of the stromal edema

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10
Q

Changes in pregnancy

A

-the breast become completely mature and functional. Lobules increase progressively in number and size. As a consequence, by the end of the pregnancy the breast is composed almost entirely of lobules separated by relatively scant stroma

After delivery:
luminal cells of the lobules produce colostrum (high in protein), which changes to milk (higher in fat and calories) over the next 10 days as progesterone levels drop.

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11
Q

Changes with cessation of lactation

A

With cessation of lactation, the breast epithelium and stroma undergo extensive remodeling. Epithelial cells undergo apoptosis, lobules regress and atrophy, and the total breast size is diminished. However, full regression does not occur, and as a result pregnancy causes a permanent increase in the size and number of lobules.

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12
Q

Changes with menopause

A

With increasing age, lobules and their specialized stroma start to involute. Lobular atrophy may be almost complete in elderly females.

The interlobular stroma also changes, since the radiodense fibrous stroma of the young female is progressively replaced by radiolucent adipose tissue.

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13
Q

Accessory breasts or nipples

A

May occur anywhere along embryonic mammary ridges. Accessory nipple may be seen just below the normal breast . Accessory or ectopic breast tissue may be seen in the lower axilla where it may raise a concern for metastatic cancer.

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14
Q

Congenital inverted nipples

A

clinically significant as similar change may be produced by underlying cancer.

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15
Q

Juvenile hypertroph

A
  • rare
  • adolescent girls
  • breasts (one or both) markedly enlarge due to hormonal stim
  • no endocrine abnormality
  • embarrassment, pain, discomfort
  • reduction mammoplasty improves QoL
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16
Q

Gynecomastia

A

Enlargement of one or both breasts in a male. Many cases are idiopathic. Some may be caused by excessive estrogen stimulation. Predisposing factors include:
•hormonal imbalance, as may occur in puberty or old age
•exogenous hormones
•drugs, including dilantin, digitalis, marijuana
•Klinefelter’s syndrome (testicular feminization)
•testicular tumors
•liver disease

Microscopic features of gynecomastia are ductal epithelial hyperplasia, stromal edema, and loose fibrosis around ducts.

17
Q

Acute mastitis and breast abscesses

A

Acute inflammation of the breast, often with abscess formation, occurs commonly at the onset of lactation (puerperal mastitis)

  • cracks in nipple and milk stasis predispose to infection
  • Staph aureus most common
  • redness, swelling, pain, and tenderness in the affected area of the breast.
  • Abscess formation is common and requires drainage of pus.

Differential diagnosis includes inflammatory breast carcinoma

18
Q

Chronic mastitis

A
  • rarer
  • perimenopausal women (due to obstruction of the lactiferous ducts by inspissated luminal secretions)
  • Obstruction leads to dilatation of the ducts (mammary duct ectasia) and periductal chronic inflammation
  • usually plasma cells (plasma cell mastitis)
  • rarely includes foamy histiocytes and fibrosis (granulomatous mastitis)
  • both types produce irregular masses with induration that mimic breast carcinoma
19
Q

periductal mastitis

A

-F and M (rare)
-painful erythematous subareolar mass that clinically appears to be an infectious process
-90% are smokers
-In recurrent cases, a fistula tract often tunnels under the smooth muscle of the nipple and opens onto the skin at the edge of the areola
-many women have inverted nipple
-Why with smoking?
Possibly: Vit A deficiency or toxic substances alter the differentiation of the ductal epithelium

20
Q

Fat necrosis

A

uncommon disease of unknown cause

  • possible ischemia from stretching and narrowing of arteries in pendulous breasts
  • early phase: collection of neutrophils and histiocytes around necrotic fat cells
  • later: fibrosis, calcification

*clinical importance is that this may present as a hard mass that can be suspicious for carcinoma on physical examination

21
Q

Fibroadenoma

A
  • Benign neoplasm found often in young women but may occur at any age
  • solitary, discrete, mobile mass composed of proliferating ducts (“adenoma”) in proliferating fibroblastic stroma (“fibro”).
  • risk for development of breast cancer relates to presence/absence of complex features
  • tx: surgical excision
22
Q

Lactating adenoma

A
  • palpable mass in pregnant or lactating women.
  • It is formed by normal-appearing breast tissue with physiologic adenosis and lactational changes
  • may be assoc w/ rapid increase in size during pregnancy, raising suspicion of carcinoma

likely not true neoplasms, but exaggerated response to hormonal influences

23
Q

Intraductal papilloma

A

benign neoplasms

  • commonly originating in a major lactiferous duct near the nipple.
  • present with a bloody nipple discharge.
  • Most = about 1 cm in diameter.
  • The large tumors are palpable as a subareolar mass.
  • Grossly, the tumor appears as a papillary mass projecting into the lumen of a large duct.
  • Histologically, there are numerous delicate papillae composed of a fibrovascular core, covered by a layer of epithelial and myoepithelial cells.
  • In complex papillomas, distinction from papillary carcinoma may be difficult.
24
Q

Phyllodes tumor

A
  • Rare tumors composed of intralobular stroma and ductal epithelium
  • benign (most) to malignant
  • cured by excision
  • low grade can recur after excision
  • high grade malignant can metastasize
  • most grow to massive size
  • cut section: leaf-like clefts and slits
  • micro: benign epithelium overlying a stromal over growth. Benign ones have no cytologic atypia or mitoses
25
Q

Fibrocystic change (FCC)

A

encompasses a group of morphologic changes that often produce palpable lumps and which are characterized by various combinations of cysts, fibrous overgrowth, and epithelial proliferation.

  • asymptomatic masses
  • can cause pain which may be cyclical
  • some = innocuous, others associated with increased risk of carcinoma
  • cause unknown
  • MOST COMMON disorder of breast
  • dx decreases after menopause
26
Q

Cysts

A

arise in TDLU

  • clusters of small cysts may be palable
  • large cysts often contain brown fluid which gives a blue color to intact cyst: BLUE-DOMED CYST
  • Histology: cysts may be lined by flattened epithelium, columnar epi with features of apocrine cells or may lack epi lining.

Part of FCC

27
Q

Apocrine metaplasia

A

-histologic alteration of the epithelium of TDLUs in which the cells resemble apocrine sweat gland epithelium (embryologically breasts arise from same anlage as apocrine glands)

  • seen most frequently in epithelial lining of cysts
  • cuboidal to tall columnar cells, fine granular eosinophilic cytoplasm
  • round, uniform, basal nuclei w/ small central nucleoli
  • snouts or blebs protrude from apical surface into glandular lumen

Part of FCC

28
Q

Sclerosing adenosis

A
  • often incidental microscopic finding
  • may also be palpable mass and mistaken for cancer
  • almost always associated with other forms of FCC
  • diffuse microcalcifications
  • mimics carcinoma on mammography
  • proliferation of ductular structures and stroma with distortion of TDLU
  • multiple altered lobules
  • proliferated ductules may be compressed and deformed producing whorls and cords that may mimic infiltrating carcinoma, particularly in the center of the lesion
29
Q

Epithelial hyperplasia

A
  • an increase in the cellularity of the epithelium of the TDLU
  • microscopic finding
  • may coexist with other features of fibrocystic change
  • may involve terminal duct epithelium (ductal hyperplasia) or the acinar epithelium (lobular hyperplasia)
30
Q

2 types of lobular hyperplasia

A

(an increased number of cells within the lobules)

Atypical lobular hyperplasia(ALH): less than 50% of the lobules are filled with epithelial cell proliferation

  • Lobular carcinoma in situ (LCIS): more than 50% of the lobules are filled and distended by epithelial proliferation.
31
Q

Ductal hyperplasia of the usual type

A

usual hyperplasia–> atypical hyperplasia –> carcinoma-in-situ

Ductal hyperplasia of the usual type: There is increase in epithelial layer lining, ( more than 2 cell layers) which distends the terminal ducts

  • papillary tufts projecting into the lumen ( mild hyperplasia)
  • epithelial cells may proliferate to bridge and create arcades (moderate hyperplasia)
  • form solid masses which fill and distend the lumen and may have irregular fenestrations ( florid hyperplasia). Syncytial appearance (inconspicuous cell borders)
32
Q

Atypical ductal hyperplasia

A

some of the architectural and cytologic features of carcinoma in situ but lack the complete criteria for that diagnosis

33
Q

Ductal carcinoma in situ

A

malignant cells confined within basement membranes of ducts without invasion of surrounding stroma.

34
Q

Risk of breast cancer in benign and pre-malignant epithelial proliferation:
Minimal increased risk

A

RR: 1

  • Cyst, apocrine metaplasia, fibrosis
  • Duct ectasia
  • mild hyperplasia (more than 2 but less than 4 cells thick)
  • Fibroadenoma without complex features
35
Q

Slightly increased risk

A

RR: 1.5-2x

  • Hyperplasia- moderate or florid, (refers to extensive degrees of epithelial proliferation)
  • Papilloma
  • sclerosing adenosis
  • Fibroadenoma with complex features
36
Q

moderately increased risk

A

RR: 4-5x

Atypical ductal hyperplasia (ADH)

Atypical lobular hyperplasia ( ALH)

37
Q

Markedly increased risk

A

RR: 8-10x
DCIS
LCIS: marker for increased risk of developing invasive carcinoma ; risk is equal for both breasts and subsequent carcinoma may be either ductal or lobular

Lifecycle Unit 2 Test (19 decks)

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