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Endo/Repro II Block 1 > Breast Path > Flashcards

Breast Path Flashcards

1
Q

Morphological Breast Changes in Old Age (3)

A

Lobules decrease in size and number
Interlobular stroma replaced by adipose
Mammograms become more lucent from adipose
(makes test more sensitive as you age)

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2
Q

Milk Line Remnants

Description and Clinical Features (2)

A

Extra nipples or breasts from axilla to perineum

Painful premenstrual enlargements
Low potential for complication

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3
Q 
Accessory Axillary Breast Tissue
Clinical Significance (2)
A

Mastectomy may miss accessory tissues

Primary tumors may develop in this ectopic tissue

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4
Q

Mammography

Use (3), Cancer Signs (2) and Contribution (2)

A

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

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5
Q

Breast Disease Symptoms (4) with Malignancy Potential

A

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

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6
Q

Acute Mastitis

Symptoms (3) and Clinical Features (4)

A

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

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7
Q

Squamous Metaplasia of Lactiferous Ducts

Symptoms (2), Complication, Risk Factors (2) and Morphology

A

Painful erythematous subareolar mass
Inverted nipple

Fistula

Smoking
Relative Vitamin A deficiency (from smoking)

Keratinizing squamous metaplasia

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8
Q

Ductal Ectasia

Symptoms (3), Population and Morphology (2)

A

Nontender, palpable subareolar mass
Thick, white nipple secretions
Bloody discharge

Multiparous females 50-60

Ectatic dilated ducts with giant cell macrophages

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9
Q

Fat Necrosis

Presentation (3), Associations (2)

A

Painless mass
Skin thickening/retraction
Abnormal mammogram

Prior surgery
Breast Trauma

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10
Q

Lymphocytic Mastopathy

Presentation (2), Morphology (3) and Associations (2)

A 
Hard Mass (can be multiple)
Mammographic densities

Dense collagen stroma
Atrophic ducts/lobules
Lymphocytic infiltrate

Type 1 Diabetes
Autoimmune Thyroid Disease (Hashimoto)

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11
Q

Granulomatous Mastitis

Types with Associations (2)

A

Granulomatous Lobular Mastitis
Only seen in parous women
Hypersensitivity reaction to lactation antigens

Cystic Neutrophilic Granulomatous Mastitis
Caused by Corynebacterium

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12
Q

Nonproliferative (Fibrocystic) Changes

Morphology with Characteristics (4) and Carcinoma Risk

A

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

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13
Q

Proliferative Breast Disease without Atypia

Morphology with Characteristics (5) and Carcinoma Risk

A 
Epithelial Hyperplasia
Sclerosing Adenosis (distorted acini)
Complex Sclerosing Lesions (can cause radial scar)
Papilloma (produce bloody discharge)
Gynecomastia

Small increase in carcinoma risk

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14
Q

Proliferative Breast Disease with Atypia

Morphology with Characteristics (2) and Carcinoma Risk

A

Atypical Ductal Hyperplasia:
monomorphic cell proliferation

Atypical Lobular Hyperplasia:
loss of E Cadherin

Moderately increases risk of carcinoma
Similar to carcinoma in situ

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15
Q

Ductal Carcinoma in Situ
Morphological Types with Descriptions (2)
Diagnostics (2) Treatment (2)

A

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

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16
Q

Lobular Carcinoma in Situ

Morphology (3) and Clinical Features (3)

A

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

17
Q

Paget Disease of the Nipple

Pathogenesis and Clinical Features (3)

A

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

18
Q 
Breast Carcinoma
Risk Factors (8)
A 
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
19
Q

Familial vs Sporadic Cancer

Pathogenesis (2/2)

A

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

20
Q

BRCA1

Risk of Cancer, Associated Cancers (5), Cancer Subgroup

A

Moderate-high risk (40-90%)

Breast: ER/PR/Her2 (-)
Ovarian 
Prostate
Pancreas
Fallopian Tube

Hereditary cancers

21
Q

BRCA2 Mutation

Risk of Cancer, Associated Cancers (5), Cancer Subgroup

A

Moderate-high risk (30-90%)

Male breast cancer
Ovarian 
Prostate
Pancreas
Stomach
Melanoma
Gallbladder

Hereditary cancers

22
Q

TP53 Mutation

Risk of Cancer, Associated Cancers (5), Cancer Subgroup

A

Highest risk (90%)

Breast cancer: ER (-) Her2 (+)
Sarcoma
Leukemia
Adrenocortical carcinoma
Brain Tumors

Main cause of Sporadic cancer

23
Q

CHEK2 Mutation

Risk of Cancer, Associated Cancers (7), Cancer Subgroup

A

Lowest risk (10-20%)

Breast cancer: ER (+)
Prostate
Thyroid
Kidney 
Colon

Sporadic (after radiation exposure)

24
Q

ER (+) Her2 (-) Invasive Carcinoma
Types (2) with Genes, Features (2/1) and Treatment
Special Histological Types (3)

A

*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

25
Q

Her2 (+) Invasive Carcinoma

Genetics (2), Histology (2) and Treatment (2)

A 
TP53 mutations (if ER +)
ERBB2 amplification causes excess Her2

Poorly differentiated tumors
Apocrine carcinoma subtype

Herceptin (Trastuzumab) to inhibit Her2
Chemo responsive if ER (-)

26
Q 
Triple Negative (ER/PR/Her2) Invasive Carcinoma
Genetics, Subtypes (4), Morphology (2) and Treatment
A

BRCA1 carriers

Medullary
Adenoid cystic
Secretory
Metaplastic

Poorly differentiated tumors
Prominent lymphocytic infiltrate (if medullary)

Responsive to chemotherapy

27
Q

Lobular Carcinoma

Genetics, Presentation and Metastasis Pattern (4)

A

Biallelic CDH1 loss causing lack of E Cadherin

Most common type of breast cancer to present as occult primary tumor

Peritoneum and Retroperitoneum
Leptomeninges
GI tract
Ovaries and Uterus

28
Q

Inflammatory Carcinoma

Morphology (3)

A

Orange peel look to skin from lymphatic blockage
High grade Lesions (very poor prognosis)
Breast swelling

29
Q

Medullary Carcinoma

Genetics, Morphology (3)

A

Hypermethylation of BRCA1

ER (-) Her2 (-)
Lymphocytic infiltrate
Pushing noninfiltrative border

30
Q

Mucinous (Colloid) Carcinoma

Morphology (2)

A

Soft or rubbery with pale blue-gray gelatin appearance

Cells clustered together surrounded by mucin

31
Q

Breast Cancer Staging Factors

Size (2), Lymph Nodes (2) and Metastasis

A

Size:
Larger tumors have greater risk of spreading to axillary lymph nodes
Her2 (+) and ER (-) tumors can metastasize when small

Lymph Nodes:
Axillary LN metastasis is most important factor in absence of distant metastasis
The more LN’s involved, the worse the prognosis

Metastasis:
Distant metastasis has very poor prognosis (Stage IV)

32
Q

Fibroadenomas

Morphology (2) and Clinical Features (4)

A

Myxoid stroma resembling regular intralobular stroma
Polyclonal hyperplasia of lobular stroma

Most common benign tumors
Multiple and bilateral palpable masses
Hormonally responsive
Considered Proliferative Changes without Atypia

33
Q

Phyllodes Tumors

Morphology and Clinical Features (4)

A

Leaf-like bulbous protrusions

Present as palpable mass in older people
Usually low grade and benign
HOXB13 overexpression seen in high grade lesions
Do NOT metastasize

34
Q

Interlobular Stroma Tumors

Examples with Descriptions (4)

A

Myofibroblastomas: equal male female prevalence
Lipomas: completely benign
Fibromatosis: locally aggressive
Angiosarcoma: malignant, poor prognosis

Endo/Repro II Block 1 (6 decks)

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