Breast Path (Pathoma)

Question 1

How many layers of epithelium are in the normal breast, what are their functions, and the signals responsible for initiating function?

Answer 1

2: Luminal cell layer (columnar) produces milk (prolactin); Myoepithelial cell layer is site of contraction (oxytocin)

Question 2

Under what three conditions is galactorrhea outside of breast feeding / pregnancy common?

Answer 2

Nipple stimulation
prolactinoma
drugs

Question 3

Woman who is breast feeding and has an erythemitous, warm breast with a soft, painful mass hear the areola. What is the most likely cause?

Answer 3

Staph aureus

Question 4

25 year old female smoker with a subareolar mass and nipple dimple. Mass histo reveals granulation tissue with no other abnormalities. What is the most likely diagnosis and pathophysiology behind it?

Answer 4

Mastitis: Smoking creates a Vitamin A deficiency, leading to squamous metaplasia and keratin production with inflammation. Subsequent granulation tissue creates a contraction and dimple.

Question 5

Multiparous post menopausal female presents with a green / brown nipple discharge. Most likely diagnosis?

Answer 5

Mammary duct ectasia

Question 6

Softball player presents with breast pain and a palpable mass on the lower peristernal portion of her breast. What is the most likely diagnosis and probable hits findings?

Answer 6

Fat necrosis will have calcification due to saponification.

Question 7

30 year old female with a lumpy breast in the upper-outer quadrant that fluctuates in size with her menses and has marked blue domed skin markings. What are the three types and associations with cancer risk?

Answer 7

Fibrocytic change

• Fibrosis, cysts, and apocrine metaplasia are benign
• Ductal hyperplasia and sclerosing adenosis (2x)
• Atypical hyperplasia (5x)

Question 8

Histo of a breast mass from a 60 y.o. shows finger-like projections that are lined by 2 cells and project into the ducts. Dx?

Answer 8

Intraductal papilloma

Question 9

30 y.o. with a hard, mobile mass that is shown to be well circumscribed and fluctuates in size with menstrual cycle. Most likely Dx and risk of developing cancer?

Answer 9

Fibroadenoma - none

Question 10

What are the three differences between fibroadenoma and Phyllodes Tumor?

Answer 10

Phyllodes is usually seen postmenopausal, may be malignant, and has a greater increase in fibrous proliferation.

Question 11

Micro calcifications are noticed on mammography. Histo shows malignant cells limited to the duct with necrosis and calcification. What is the name of the highest grade form of the probable diagnosis?

Answer 11

Comedocarcinoma is the most aggressive form of ductal carcinoma in situ

Question 12

40 y.o. presents with ulceration of the nipple. Histo shows malignant cells “walking” to the dermis in single file lines. Dx and special consideration?

Answer 12

Paget - underlying carcinoma (DCIS)

Question 13

What is the most common form of invasive breast cancer?

Answer 13

Invasive ductal carcinoma

Question 14

Woman presents with a palpable mass and dimpling in the upper-outer quadrant of her breast. Histo shows duct-like structures in desmoplastic stoma, with lymphocytes and plasma cells. What is the diagnosis, prognosis, and genetic abnormality associated with this?

Answer 14

Medullary Invasive ductal carcinoma has a POOR prog. and is a/w BRCA1.

Question 15

What are the types of Invasive ductal carcinoma and their respective prognoses?

Answer 15

Tubular - good
Mucinous - good
Inflammatory - poor
Medullary - poor

Question 16

Calcification is found bilaterally on mammogram. Histo shows cells that have a increase N:C ratio and mitotic bodies that are limited to the lobules and appear to be discohesive. What is the most likely Dx and why are they not cohesive?

Answer 16

Lobular carcinoma in situ

Lack E-cahidrin

Question 17

What will be found on histo of an invasive lobular carcinoma?

Answer 17

Single file cells growing into the stoma.

Question 18

What is the technique used in staging breast cancer?

Answer 18

Sentinel node biopsy

Question 19

What is meant by the term triple negative as it relates to breast cancer and the implication of the finding?

Answer 19

The cells do not have Estrogen receptors, Progesterone receptors, nor HER2/neu receptors. Very bad prognosis (hard to treat)

Question 20

What cancers are associated with BRCA1 mutations?

Answer 20

Medullary invasive ductal carcinoma and ovarian (serous) cancer

Question 21

What are the two main risk factors for men developing breast cancer?

Answer 21

BRCA2 mutation and Klinefelter syndrome