Breast Path Flashcards
Morphological Breast Changes in Old Age (3)
Lobules decrease in size and number
Interlobular stroma replaced by adipose
Mammograms become more lucent from adipose
(makes test more sensitive as you age)
Milk Line Remnants
Description and Clinical Features (2)
Extra nipples or breasts from axilla to perineum
Painful premenstrual enlargements
Low potential for complication
Accessory Axillary Breast Tissue Clinical Significance (2)
Mastectomy may miss accessory tissues
Primary tumors may develop in this ectopic tissue
Mammography
Use (3), Cancer Signs (2) and Contribution (2)
Can detect small, nonpalpable, asymptomatic breast carcinomas
Densities and Calcifications are signs of carcinoma
Detects majority of breast cancers
Most are already invasive or have metastasized
Breast Disease Symptoms (4) with Malignancy Potential
Mastalgia: mostly benign
Palpable mass: usually benign if premenopausal
Nipple Discharge: malignant if spontaneous, unilateral and age > 60
Abnormal Mammogram: usually benign, chance of malignancy increases with age
Acute Mastitis
Symptoms (3) and Clinical Features (4)
Erythematous breast
Painful breast
Fever
Associated with breast feeding
Staph aureus infection causes abscesses
Streptococcus infection causes cellulitis
Treat with antibiotics and continuation of breast feeding
Squamous Metaplasia of Lactiferous Ducts
Symptoms (2), Complication, Risk Factors (2) and Morphology
Painful erythematous subareolar mass
Inverted nipple
Fistula
Smoking
Relative Vitamin A deficiency (from smoking)
Keratinizing squamous metaplasia
Ductal Ectasia
Symptoms (3), Population and Morphology (2)
Nontender, palpable subareolar mass
Thick, white nipple secretions
Bloody discharge
Multiparous females 50-60
Ectatic dilated ducts with giant cell macrophages
Fat Necrosis
Presentation (3), Associations (2)
Painless mass
Skin thickening/retraction
Abnormal mammogram
Prior surgery
Breast Trauma
Lymphocytic Mastopathy
Presentation (2), Morphology (3) and Associations (2)
Hard Mass (can be multiple) Mammographic densities
Dense collagen stroma
Atrophic ducts/lobules
Lymphocytic infiltrate
Type 1 Diabetes
Autoimmune Thyroid Disease (Hashimoto)
Granulomatous Mastitis
Types with Associations (2)
Granulomatous Lobular Mastitis
Only seen in parous women
Hypersensitivity reaction to lactation antigens
Cystic Neutrophilic Granulomatous Mastitis
Caused by Corynebacterium
Nonproliferative (Fibrocystic) Changes
Morphology with Characteristics (4) and Carcinoma Risk
Blue domed cysts with brown-blue fluid
Fibrosis (from ruptured cysts)
Adenosis with acini that may show flat epithelia atypia
Lactational Adenomas in lactating women
No increased risk of developing invasive carcinoma
Proliferative Breast Disease without Atypia
Morphology with Characteristics (5) and Carcinoma Risk
Epithelial Hyperplasia Sclerosing Adenosis (distorted acini) Complex Sclerosing Lesions (can cause radial scar) Papilloma (produce bloody discharge) Gynecomastia
Small increase in carcinoma risk
Proliferative Breast Disease with Atypia
Morphology with Characteristics (2) and Carcinoma Risk
Atypical Ductal Hyperplasia:
monomorphic cell proliferation
Atypical Lobular Hyperplasia:
loss of E Cadherin
Moderately increases risk of carcinoma
Similar to carcinoma in situ
Ductal Carcinoma in Situ
Morphological Types with Descriptions (2)
Diagnostics (2) Treatment (2)
Comedo: microcalcifications, no mass
Non-Comedo: lacks high grade nuclei or central necrosis, forms cribiform spaces and papillae
Almost always detected on mammography
Nuclear grade and necrosis used to predict progression to invasion
Treated with surgical excision and SERM drug
Lobular Carcinoma in Situ
Morphology (3) and Clinical Features (3)
Lack of E Cadherin (discohesive cells)
Mucin (+) Signet Ring cells
ER and PR (+)
Found incidentally due to no calcification or densities for mammography
Risk factor for invasive carcinoma
More commonly bilateral
Paget Disease of the Nipple
Pathogenesis and Clinical Features (3)
Malignant cells travel via lactiferous sinuses to nipple
Unilateral erythema and scaly skin
If palpable mass, most have Her2 (+) invasive carcinoma
If no mass, most have DCIS
Breast Carcinoma Risk Factors (8)
Caucasian females have highest incidence African American females have highest mortality History of breast/ovarian carcinoma History of atypical hyperplasia Early puberty or late menses (estrogen exposure) Obesity Oral Contraceptives No term pregnancies
Familial vs Sporadic Cancer
Pathogenesis (2/2)
Familial:
Caused by common genetic, environment and lifestyle factors (not BRCA)
Causes clustering of specific cancers within a family
Sporadic:
Caused by spontaneous mutations occurring over a person’s lifetime
Associated with estrogen induced breast epithelium proliferation
BRCA1
Risk of Cancer, Associated Cancers (5), Cancer Subgroup
Moderate-high risk (40-90%)
Breast: ER/PR/Her2 (-) Ovarian Prostate Pancreas Fallopian Tube
Hereditary cancers
BRCA2 Mutation
Risk of Cancer, Associated Cancers (5), Cancer Subgroup
Moderate-high risk (30-90%)
Male breast cancer Ovarian Prostate Pancreas Stomach Melanoma Gallbladder
Hereditary cancers
TP53 Mutation
Risk of Cancer, Associated Cancers (5), Cancer Subgroup
Highest risk (90%)
Breast cancer: ER (-) Her2 (+) Sarcoma Leukemia Adrenocortical carcinoma Brain Tumors
Main cause of Sporadic cancer
CHEK2 Mutation
Risk of Cancer, Associated Cancers (7), Cancer Subgroup
Lowest risk (10-20%)
Breast cancer: ER (+) Prostate Thyroid Kidney Colon
Sporadic (after radiation exposure)
ER (+) Her2 (-) Invasive Carcinoma
Types (2) with Genes, Features (2/1) and Treatment
Special Histological Types (3)
*Most common invasive breast cancer
Low Proliferation: ER genes Seen in older women and men Usually metastasizes to bone Responds well to antiestrogenic drugs
High Proliferation:
BRCA2
Nucleus stains for Ki67
Responsive to chemotherapy
Lobular, tubular, mucinous types
