Breast path I

Question 1

how many lobes are in the breast

Answer 1

15-25

Question 2

What is the terminal ducta lobular unit

Answer 2

basic functional unit of breast with acini and secretory units

Question 3

what lines the breast duct system

Answer 3

inner epithelial cell layer is luminal cells

outer layer is basal cells or myoepithelial

Question 4

both layers of the duct system are surrounded by what

Answer 4

basal lamina- BM

Question 5

role of coopers ligaments

Answer 5

connect fascia to the dermis

suspensory support

Question 6

where is the specialized stroma of the breast

Answer 6

the intralobular

Question 7

which cell of the breast is equivalent to BM for invasion of cancer

Answer 7

myoepithelial “basal” cells

Question 8

what stain to we use to see BM

Answer 8

S100

Question 9

ductal carcinomas arise where and easily stained with what?

Answer 9

luminal cells

stain E Receptor +

Question 10

when does milk production begin after delivery

Answer 10

3-5 days

end of P which allows dec hcg

Question 11

what stimulates the let down of milk

Answer 11

prolactin
oxytocin- contraction
FIL- produced in distended breast

Question 12

maternal milk is made up of what

Answer 12

lactose, milk fat, proteins, minerals, neutros, macros and lymphocytes

Question 13

what is colostrum

Answer 13

early milk that is higher in protein and lipids

Question 14

why do breasts become more radiolucent with age

Answer 14

more adipose, less stroma

Question 15

what are supernumerary nipples

Answer 15

milk line remnants

Question 16

ddx for accessory axillary breast

Answer 16

lymph node
lipoma
hidradenitis suppurative
epidermoid cyst

Question 17

congenital inverted nipples are associated with higher risk for what

Answer 17

lactiferous sinus obstruction and inflammation

difficulty breast feeding

Question 18

if patient presents with newly inverted nipple what must you consider

Answer 18

underlying pathology, maybe malignancy

Question 19

Clinical presentation of breast disease in general

Answer 19

pain
nipple discharge
masses

Question 20

what is mastodynia and mastalgia

Answer 20

pain in the breast

Question 21

what can cause breast pain

Answer 21

obstruction, inflammation
cyclic through menses
10% breast Ca painful

Question 22

what can cause galactorrhea

Answer 22

milky discharge assoc with prolactin and meds

Question 23

what can cause serous and bloody nipple discharge

Answer 23

cysts and large duct papillomas

Question 24

most common cause of bloody nipple discharge

Answer 24

benign intraductal papilloma

Question 25

examination of breast masses involves what

Answer 25

PE
mammogram
patholgoy (FNA etc)
—- cancer has to be excluded—-

Question 26

what are the gradings for a mammogram

Answer 26

1-5 5 being most severe

Question 27

what can cause microcalcifications in the breast

Answer 27

form in secretions necrotic debris and involuting stroma

Question 28

characteristics of malignant calcifications

Answer 28

small irregular, clustered, numerous

Question 29

what can US tell you about a breast mass

Answer 29

cystic or solid

Question 30

MRI is useful with breast Ca how

Answer 30

good for staging based on invasion of chest wall

Question 31

does a negative FNA from breast rule out breast CA

Answer 31

no

Question 32

what is the best type biobpsy for breast tissue

Answer 32

core because can see tissue and also allows DNA testing for ER PR Her2neu and etc

Question 33

why are margins of breast tissue inked with different colors upon excision

Answer 33

so know if comes back not clear margins, know where to go in for more

Question 34

what is needle localization of breast

Answer 34

go to radiology to have them stick a needle in mass that is not palpable, then surgeoun just follows needle into the area that needs to be taken out

Question 35

what is a simple masectomy

Answer 35

breast tissue, skin and nipple

Question 36

what is a modified radical mastectomy

Answer 36

breast tissue skin nipple
most axillary lymph nodes
spares pectoralis muscle

Question 37

what lesions can occur in the terminal duct lobular unit

Answer 37

cyst
sclerosing adenosis
small duct papilloma
hyperplasia
atypical hyperplasia
carcinoma

Question 38

what type of lesions can occur in the lobular stroma of the breast

Answer 38

fibroadenoma

phyllodes tumor

Question 39

what are the lesions of the large ducts and lactiferous sinuses

Answer 39

duct ectasia
recurrent subareolar abscess
solitary ductal papilloma
pagets
mastitis

Question 40

what are the lesions of the interlobular stroma of breast

Answer 40

fat necrosis
lipoma
fibrous tumor
PASH
fibromatosis
sarcoma
peripheral mastitis

Question 41

what is puerperal mastitis

Answer 41

post partum acute mastitis

Question 42

what is lactational mastitis

Answer 42

segmental features of acute inflammation

starts at nipple fissure and milk stasis (skin bacteria)

Question 43

common pathogens for lactational mastitis

Answer 43

staph aureus and strep sp.

Question 44

what are the types of non-lactational mastitis

Answer 44

periareolar (mammary duct ectasia)

peripheral

Question 45

what causes periareolar non lactational mastitis

Answer 45

obstructed lactiferous sinus at level of the nipple

Question 46

what are associations with periareolar mastitis

Answer 46

inverted nipple, cigarette smoking– keratin plugging of the nipple

Question 47

periductal mastitis

Answer 47

when the dilated sinuses form a mass which ruptures the duct causing redness, tenderness, heat and pain

Question 48

if periductal mastitis is left untreated, what can happen

Answer 48

fistula

Question 49

peripheral non-lactational mastitis associated with what conditions

Answer 49

DM, RA, steroids or trauma

Question 50

what is a ductogram

Answer 50

radio opaque dye injected into the subareolar sinuses through openings in the nipple