Breast Path

Question 1

Acute Mastitis Cause

Answer 1

Staph Aureus** breast feedingdrain abscessesimp to treat with antibiotics and keep breastfeeding

Question 2

Fat Necrosis Cause

Answer 2

Trauma or prior surgery

Question 3

Gynecomastia

Answer 3

subareolar enlargemetnhyperestrinismelderly, pubertal = NORMALanywhere in between = liver pathology, medications, testicular neoplasmscirrhosis of liver or testicular neoplasmill-defined white or tan massproliferation of periductal CT & hyperplasia of ductal epitheliumno association with cancer

Question 4

Fibrocystic Changes

Answer 4

most common type breast pathologytoo much estrogennon-proliferative - no increased risk cancerproliferative - increased risk cancer

Question 5

Epithelial hyperplasia

Answer 5

** ducts are filledsmall duct papilloma

Question 6

Intraductal papilloma

Answer 6

most common cause of nipple bleeding (w/ small, palpable subareolar tumor)solitary large duct excision curativemay become infarcted or fibrotic

Question 7

Atypical hyperplasia

Answer 7

Cytologic atypia, mitotic featuresThis is what you worry about right before cancerDO NOT FILL ENTIRE DUCT 5x increased risk of cancer; 11x increased risk of cancer if 1st degree relative with breast cancer

Question 8

Phyllodes Tumors

Answer 8

rare, benignWomen >60Rapid growth, can be very large - causes ulcers on skinbiphasic hypercellular stromarecurs if not completely excised Low-grade = more cellular, mitotic figures, may recur High grade: even more mitotic activity, not as well-circumscribed, can invade; high recurrence rateMets hematogenous, to lung, so lymph node dissection not necessaryTx: wide local excision, mastectomy

Question 9

Fibroadenomas

Answer 9

Well-circumscribed, solitaryWomen

Question 10

Large Duct Papilloma

Answer 10

Bloody nipple discharge Soft, solitary, and smallIn main lactiferous duct Excision is curative

Question 11

Breast Ca RIsk Factors

Answer 11

Age Family history Genetics (only 5-10% of people with breast Ca are positive for genes: BRCA1, BRCA2, p53/Li-Fraumeni, PTEN/Cowden) Proliferative fibrocystic changes Carcinoma of contralateral breastIncreased estrogen exposure (early menarche, late menopause, first preg >35, fewer children or nulliparous, never breast-fed

Question 12

Paget’s of the Breast

Answer 12

Type of DCIS w/ eczema or ulceration of nipple with patches invasion of epidermis of nipple 50-60% will have invasive ductal carcinoma at presentationMore concerning of a prognosis because it is already invasive

Question 13

Lobular carcinoma in situ

Answer 13

No calcification, doesn’t show up on mammo, often found incidentally Tend to be multifocal and bilateral May be precursor to invasive carcinoma Increased risk of developing carcinoma in either breast Cells are bland, monotonous, small, low-grade

Question 14

Invasive carcinoma

Answer 14

Firm, hard, immobile mass, without well-demarcated borders - makes sense because it is invading May have nipple retraction, dimpling skin (peu d’orange) Abnormalities do NOT change with menstrual cycle – any cancer will not change with menstrual cycle

Question 15

Invasive ductal carcinoma

Answer 15

stellate appearanceinfiltrating disorganized tubules/ductulesdoesn’t look like normal breast tissue

Question 16

Invasive lobular carcinoma

Answer 16

Straight line/single file (Line = Lobular)Cells don’t form ducts, often doesn’t form a mass Small cells, relatively little nuclear pleomorphism metastasizes different from most breast ca: peritoneal surface, meninges, ovaries, GI tract

Question 17

Inflammatory carcinoma

Answer 17

Involvement of dermal lymphatics, skinPoor prognosisThis is so abnormal it must be bad

Question 18

ER Positive Breast Ca

Answer 18

Better prognosisbetter differentiationhormonal therapy

Question 19

Her-2/Neu+ Breast Ca

Answer 19

used to be very bad - higher nuclear grade and aneuploidynow not terrible prognosis if treated with trastuzumab

Question 20

Mucinous Breast Ca

Answer 20

better prognosisrareGelatinous blob; ducts floating in pools of mucin, seldom metastasize to lymph nodes Older women, slow-growing

Question 21

Medulalry Breast Ca

Answer 21

Large, do not elicit fibrous reaction Soft and squishy (like the medulla of the brain!) Grow in sheets, induce strong lymphoplasmocytic reaction High nuclear grade, prognosis good b/c produce adhesive molecules that prevent metsrarebetter prognosis

Question 22

Invasive Papillary Ca

Answer 22

better prognosisrare