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breast > breast path > Flashcards

breast path Flashcards

1
Q

what is the path of gyenocomastia

A

high estrogen/androgen imblance

will cause an increase in subareolar, rubbery discrete mass

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2
Q

what is the morphology of gyenocomastia

A

terminal duts without lobule–because no period formation

the ducts are lined by aMULTILAYERED EPITHELIUM with small papillary tufts (epithelial hyperplasia)

*periductal hyalinization and fibrosis seen

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3
Q

what conditions also have a imbalance in androgen and estrogens leading to gynecomastia

A
  1. cirrhosis of liver
  2. klinefelter syndrome
  3. leydig cell tumor
  4. drugs- DIGOXIN, SPIRONOLACTONE, KETOCONAZOLE
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4
Q

what is the path of acute mastitis

A

when breastfeeding there is cracks in the breast and the bacteria from the babies mouth causes infection (Staph. aureus)

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5
Q

CF of acute mastitis

A

breast is erythematous and painful and fever is present

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6
Q

morphology of acute mastits

A
  • neutrophlis and necrotic material
  • heals by scarring and may look like a nipple retraction
    tx- is antibiotics
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7
Q

what are other names for periductal mastitis

A
  1. recurrent subareolar abscess
  2. SQUAMOUS METAPLASIA of the lactiferous ducts
  3. Zuska disease
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8
Q

CF of periductal mastitis

A

-painful, erythematous subareolar abscess
-FISTULA FORMATION in recurrent cases- at the edge of the areola/beneath the smooth muscle
-may have a inverted nipple

**STRONGLY ASSOCIATED WITH CIG SMOKING AND VIT A DEF.

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9
Q

morpholgy of periductal mastitis

A

*keratinising squamous metaplasia

KERATIN PLUGS—dilation and rupture of ducts

**intense chronic and granulomatous response around the spilled keratin

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10
Q

what is the path of mammary duct ectasia

A

open/dilated duct

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11
Q

CF of mammary duct ectasia

A

poorly defined and palpable periareolar mass with thick green nipple discharge

no pain or erythema

-produces a irregular palpable mass– mimics carcinoma due to calcifaction

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12
Q

morphology of mammary duct ectasia

A

lipid-laden macrophages and debris
marked- periductal chronic inflammation (plasma cells)
- FIBROSIS

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13
Q

path of FAT Necrosis

A

trauma

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14
Q

CF of fat necrosis

A
  • painless palpable mass with skin retraction
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15
Q

morphology of fat necrosis

A

initially- necrotic fat with neutrophils

later- foamy lipid-filled macrophages, giant cells and lymphocytes

finally- walled of by scar tissue and calcifation

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16
Q

what is the path of nonproliferative breast changes (FIBROCYSTIC CHANGES)

A

its a benign epithelial lesion

17
Q

describe the cyst componet of fibrocystic changes

A
  • turbid, semi-translucent fluid that produces a brown and blue color
  • lined by flattened atrophic epithelium or by metaplastic apocrine cells
  • calcifaction are very common
  • MILK of calcifation
    tx: needle aspiration
18
Q

describe the fibrosis component of FIBROCYSTIC CHANGES

A

cyst will frequently rupture, releasing secretory material into the adjacent stroma
- resulting in chronic inflammation and fibrosis causes it to be firm

19
Q

describe the adenosis of the fibrocystic changes

A
  • increase in the number of ACINI per lobule
  • acini are lined by columar cells, which may appear benign or show mild atypia
20
Q

what is the risk accociated with proliferative lesion without atypia (PLWA)

A
21
Q

what is the diffrence between proliferative without atypia and nonproliferative changes

A

non-proliferative changes include stromal fibrosis and cyst formation

while proliferative has the non-proliferative changes plus epithelial hyperplasia, sclerosing adenosis, and papillomas

22
Q

epithelial hyperplasia features

A
  • there is increase in the number of CELLS over the basement membrane in a duct or lobule
    -there is proliferation of epithelial and myoepithelial cells which distend and fill the lumen

*IRREGULAR SLIT LIKE LUMEN AT THE PERIPHERY

23
Q

features of sclerosing adenosis

A

proliferation of both acini and stroma

the lobular arrangment is maintanted

  • acini are compressed and distorted in the central and dilated at the periphery
  • there is fibrosis of stroma, apperance of solid cords or double strands of cells lying within the dense stroma – calcifaction present
24
Q

papillomas path

A

torsion of the stalk leading to blood stained nipple discharge

25
Q

clinical feature of papillomas

A
  • small palpable masses: densisites or calcifation
  • large duct papillomas are solitary, present in lactiferous sinuses
    -small duct papillomas- are multiple, present in smaller peripheral ducts and calcifactions
26
Q

morphology of the papillomas- benign PLWA

A

micro- central fibrovasucalr core extend from the wall of a duct

  • papillae arborize within the lumen and are lined by myoepithelial and luminal epithelial cells

-

27
Q

complex sclerosing (radial scar) features

A

it is actually not associated with prior trauma or surgery

  • componets include: sclerosing adenosis, papillomas, epithelial hyperplasia
28
Q

complex sclerosing radial scar morphology

A

radiograph- shows an irregular central mass with long dense projections

gross- solid and has irregular borders

micro- central nidus of small tubules entrapped in densely fibrotic stroma
numerous projections containing epithelium with cyst formation and hyperplasia

29
Q

what are the 2 types of prolieferative breast disease with atypia

A
  1. atypical ductal hyperplasia
  2. atypical lobular hyperplasia
30
Q

atypical ductal hyperplasaia features

A
  • histologically resembles ductal carcinoma insitu
    -cribriform spaces/fenestation
  • diff from insitu because this is limited to an extend and only partially fills the ducts
  • there is columnar cells at the periphery and more rounded cells within the central portion
    -some spaces are round and regular the peripheral spaces are irregular and slit like
31
Q

atypical lobular hyperplasia features

A
  • proliferation of cells similar to lobular in situ but do not fill more than 50%

-

32
Q

morpholgy of atypical lobular hyperplasia

A
  • monomorphic small, round and looselt cohesivve cells partially fulled a lobule
33
Q

what is the risk factor of cancer of hyperplasia with atypia

A

4-5 times the risk vs the nonatypia

breast (2 decks)

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