Breast Path Flashcards
Acute Mastitis Cause
Staph Aureus** breast feedingdrain abscessesimp to treat with antibiotics and keep breastfeeding
Fat Necrosis Cause
Trauma or prior surgery
Gynecomastia
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
Fibrocystic Changes
most common type breast pathologytoo much estrogennon-proliferative - no increased risk cancerproliferative - increased risk cancer
Epithelial hyperplasia
** ducts are filledsmall duct papilloma
Intraductal papilloma
most common cause of nipple bleeding (w/ small, palpable subareolar tumor)solitary large duct excision curativemay become infarcted or fibrotic
Atypical hyperplasia
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
Phyllodes Tumors
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
Fibroadenomas
Well-circumscribed, solitaryWomen
Large Duct Papilloma
Bloody nipple discharge Soft, solitary, and smallIn main lactiferous duct Excision is curative
Breast Ca RIsk Factors
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
Paget’s of the Breast
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
Lobular carcinoma in situ
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
Invasive carcinoma
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
Invasive ductal carcinoma
stellate appearanceinfiltrating disorganized tubules/ductulesdoesn’t look like normal breast tissue
Invasive lobular carcinoma
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
Inflammatory carcinoma
Involvement of dermal lymphatics, skinPoor prognosisThis is so abnormal it must be bad
ER Positive Breast Ca
Better prognosisbetter differentiationhormonal therapy
Her-2/Neu+ Breast Ca
used to be very bad - higher nuclear grade and aneuploidynow not terrible prognosis if treated with trastuzumab
Mucinous Breast Ca
better prognosisrareGelatinous blob; ducts floating in pools of mucin, seldom metastasize to lymph nodes Older women, slow-growing
Medulalry Breast Ca
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
Invasive Papillary Ca
better prognosisrare
