Breast Pathologies

Question 1

adenosis

Answer 1

increase in the number of acini per lobule; normal in pregnant women but not otherwise

Question 2

antagonist

Answer 2

drug which mimics a natural ligand (hormone etc) by binding to a receptor but not eliciting any activity, essentially occupying the receptor so that the hormone cannot bind thus blocking normal cellular responses

Question 3

en bloc

Answer 3

latin for in block. procedure where multiple parts are performed at once or as a unit. eg radical mastectomy where breast and connective tissue, skeletal muscle and ipsilateral axillary lymph nodes are removed all at once

Question 4

gynecomastia

Answer 4

enlargement or development of male breast; development of duct tissue in male breast

Question 5

interlobular

Answer 5

between lobules e.g. in breasts. Interlobular stroma is hormonally insensitive connective tissue found surrounding and between lobules

Question 6

Intralobular

Answer 6

within a lobule e.g., in breasts, intralobular stroma is hormonally sensitive connective tissue found within each lobule

Question 7

metaplasia

Answer 7

transformation of one mature tissue type into another

Question 8

multiparous

Answer 8

pertaining to a woman who has borne more than one offspring

Question 9

nulliparous

Answer 9

pertaining to a woman who has borne no offspring

Question 10

oophorectomy

Answer 10

surgical removal of the ovaries

Question 11

papilloma

Answer 11

a benign, finger or nipple shaped tumor; in the breasts, papillomas protrude into the ductal lumen

Question 12

papillomatosis

Answer 12

the condition of having papillomas

Question 13

scirrhous tumor

Answer 13

a tumor which presents as a hard sometimes gritty mass often found in the breast or liver cancer

Question 14

Interlobular stroma is connective tissue occurring between breast lobules, while intralobular
stroma is connective tissue occurring within a breast lobule

Answer 14

true

This follows from the definitions of ‘intra-‘ and ‘inter-‘

Question 15

Interlobular stroma is estrogen sensitive, while intralobular stroma is usually not.

Answer 15

False; This is reversed. INTRA-lobular stroma is estrogen sensitive

Question 16

refers to elevated levels of estrogen in the blood.

Answer 16

Hyperestrinism.

Question 17

T/F All fibrocystic masses of the breast should be resected as soon as possible to prevent
progression to cancer.

Answer 17

False; Nonproliferative fibrocystic changes are not precancerous and can usually be left alone unless they are causing other
problems (such as pain due to compression). Proliferative changes, on the other hand, and especially if they involve nuclear
atypia, are precancerous and should be removed.

Question 18

T/F All fibrocystic changes in the breast are precancerous, and increase the risk of cancer 5- or 6-
fold.

Answer 18

False. Non-proliferative fibrocystic changes do not increase cancer risk, while proliferative fibrocystic changes without
atypia carry only a 1-2 fold increase.

Question 19

This pre-cancerous condition is often treated with surgical resection of the affected tissue

Answer 19

proliferative fibrocystic change

Precancerous equates to proliferative fibrocystic change

Question 20

This disorder is marked by cystic dilations of terminal ducts and relative increase in stroma, with or without
proliferation of ductal epithelium

Answer 20

Fibrocystic changes (general)

Since proliferation is not in consideration here, this must be referring to fibrocystic changes in general.

Question 21

This specific disorder involves hyperplasia of the ductal epithelium in a context of cystic dilation of the
terminal ducts and stromal expansion; this condition is pre-cancerous

Answer 21

Proliferate fibrocystic change

Since this specific condition is precancerous it must be referring to proliferative fibrocystic changes

Question 22

This specific disorder involves cystic dilation of the terminal ducts and stromal expansion but without
proliferation of the ductal epithelium or atypia; this condition is not pre-cancerous

Answer 22

Nonproliferative Fibrocystic change

Not precancerous, no atypia, no proliferation = nonproliferative fibrocystic change.

Question 23

The development of tubal papillomas in this disorder is considered pre-cancerous and thus unfavorable

Answer 23

Proliferative fibrocystic change

Papillomatosis and the precancerous condition indicate proliferative fibrocystic changes.

Question 24

This condition may show epithelial hyperplasia with atypia, a definite pre-cancerous development

Answer 24

Proliferative fibrocystic change

Atypia and the precancerous condition equates to proliferative fibrocystic changes.

Question 25

Fibroadenomas most affect elderly women in their 60’s and 70’s

Answer 25

False; Fibroadenoma mostly affects prepubertal and recently postpubertal women in their teens, 20’s and 30’s

Question 26

Fibroadenomas are malignant tumors.

Answer 26

False

Question 27

Fibroadenomas are composed of two components: fibrous stroma and glandular epithelium.

Answer 27

True. The name tells you this: ‘fibro-‘ means fibrous and ‘adeno-‘ means gland.

Question 28

Most fibroadenomas probably represent an abnormal response of breast tissue to sex hormones.

Answer 28

True.

Question 29

Fibroadenomas frequently transform into malignant tumors, and thus should be resected
immediately when found.

Answer 29

False. Fibroadenomas only rarely transform to malignancy

Question 30

_______is the most important and the most common of the benign tumors of the breast

Answer 30

Fibroadenoma

Question 31

Invasive breast cancers is thought to be preceded by a non-invasive stage known as carcinoma
in situ (CIS).

Answer 31

rue; This is true, at least for carcinomas. Remember also that carcinomas are not automatically invasive-they must learn
how to negotiate the basement membrane; once they do this, they progress from carcinoma in situ to invasive carcinoma

Question 32

Estimates are that 1 in 2 women will develop breast cancer at some point in their lives.

Answer 32

False; The statistics are a little better than this- 1 woman in 9 will develop breast cancer sometime in her lifetime.

Question 33

Ductal carcinoma in situ (DCIS) is a pre-cancerous or benign condition that often develops into
cancer.

Answer 33

False; CIS (whether ductal or not) IS cancer; it is early epithelial cancer that has not yeat learned to cross the basement
membrane.

Question 34

Most breast cancers derive from interlobular connective tissue and hence are sarcomas.

Answer 34

False; Most breast cancers are derived from epithelial tissue and hence are carcinomas.

Question 35

Most breast carcinomas occur on the side of the breast medial to the areola.

Answer 35

False. The most common position (45%) is the upper outer quadrant

Question 36

The most common type of breast carcinoma is lobular carcinoma, followed closely by tubular
carcinoma.

Answer 36

False. Ductal carcinoma is by far the most common cancer of the breast (80%)

Question 37

With aggressive treatment, breast cancer patients have 5-year survival rates in excess of 60%,
regardless of the stage of the cancer.

Answer 37

False. While some of the five-year survival rates are in excess of 60%, unfortunately Stages III and IV are not.

Question 38

_______ involves en bloc removal of a breast, all associated axillary
lymph nodes, and underlying chest wall muscles

Answer 38

Radical mastectomy

Question 39

___ involves removal of just the tumorous or swollen tissue

of a breast.

Answer 39

lumpectomy

Question 40

____________ tumor refers to a hard, often gritty tumor; such tumors
often occur in the breast.

Answer 40

scirrhous.

Question 41

Which ONE of the following is NOT considered a POSITIVE risk factor for breast cancer
(meaning it makes a person more likely to develop breast cancer)?
A. Living in Asia
B. Having ovarian or endometrial cancer
C. Having proliferative fibrocystic changes
D. Having a mother or siblings with breast cancer
E. Long-term exposure to estrogen
F. (None. All of the above are positive risk factors for breast cancer)

Answer 41

Living in Asia- not necessarily being of Asian descent- is a NEGATIVE risk factor for breast cancer- it makes a woman
less likely to develop the disease.

Question 42

Which ONE of the following is NOT a typical sign of breast cancer?
A. Tumors lacking sharp margins, because they lack a defined capsule and just infiltrate into the surrounding
tissue
B. Puckering of the skin and retraction of the nipple, due to the dense connective tissue pulling on adjacent tissue
C. Tumors which feel firm on palpation
D. Tumors located either in the upper lateral quadrant or centrally, under the areola
E. Tumors (“lumps”) which deflate when pierced and drained wit

Answer 42

Breast lumps that deflate when pierced are a good sign- it means the lump is probably a benign cyst and not cancerous.

Question 43

T/F Gynecomastia often develops as a result of an imbalance between estrogens, which stimulate
breast tissue, and androgens, which counteract these effects.

Answer 43

True. This means that conditions favoring hyperestrinism in a male also favor gynecomastia.

Question 44

T/F Testicular cancer may cause gynecomastia.

Answer 44

True; The tumor (such as a Leydig cell tumor) may hypersecrete estrogen.

Question 45

T/F The most common cause of gynecomastia is Klinefelter syndrome.

Answer 45

False; While Klinefelter syndrome may raise estrogen levels and thus lead to gynecomastia, the most common cause is
cirrhosis of the liver. Recall that the liver is the main metabolic organ of the body. One of the tasks it is charged with is to metabolize (i.e., degrade) hormones like estrogen. If the liver is sick, it cannot degrade estrogens and thus hyperestrinism
may result, leading to gynecomastia. This can clearly be seen on advanced alcoholics- most of them have boob
development

Question 46

T/F Histologically, gynecomastia results in the development of numerous mature lobules in the
male breast.

Answer 46

False; There are several things wrong with this statement. First, gynecomastia does not lead to the development of
numerous mature lobules- this would mean that the gynecomastic breast breast was essentially the mature, lactating breast
of pregnancy. Not true. Gynecomastic breasts have been likened to the breasts of adolescent girls: there is definitely
breast development, but it is mostly tubular development, not lobular. Secondly, recall that even in women, lobular
development does not reach its pinnacle until the end of pregnancy. Since the gynecomastic breast is not a functional,
lactating breast, it clearly does not have ‘numerous mature lobules’.

Question 47

T/F Gynecomastia is a major risk factor in the development of breast cancer in males.

Answer 47

False; And surprisingly so. With the higher estrogen levels seen in gynecomastia one would also expect to see a higher
incidence of male breast cancer, but this does not appear to be the case.

Question 48

Breast cancer in men occurs about 1/100 as often as in women.

Answer 48

True. This equates to 1500 new cases and 400 deaths per year in the US

Question 49

Although breast cancer occurs in both men and women, the causes for breast cancer in men are
substantially different from the causes in women.

Answer 49

False; Similar causes and similar treatment.

Question 50

Papillary (ductal) carcinomas are more common in men (than women) and lobular carcinomas
less common.

Answer 50

True. This makes sense since men do not have the lobular development that a woman has, so that breast cancer in men is
skewed toward ductal carcinomas, esp. of the papillary type.

Question 51

Breast cancers in men tend to disseminate to the medial (mediastinal) lymph nodes (in contrast
to the upper lateral quadrant in women).

Answer 51

False. Dissemination patterns are the same in men and women, with almost half of the tumors spreading to the lymph nodes
in the upper lateral quadrant.

Question 52

Because of the relatively sparse amount of breast tissue present, breast cancers in men tend to
spread rather easily to the underlying thoracic wall (e.g., pectoralis major m.) and overlying
skin.

Answer 52

True. Thus, skin ulceration and nipple discharge are quite common in men with breast cancer

Question 53

Men with breast cancer tend to present at a more advanced stage than women.

Answer 53

True. Women are taught from an early age to be wary of lumps in the breast, and seek medical attention quickly when
lumpy breast changes occur. Men, on the other hand, are not taught this. When a breast lesion or lump arises, many men
will ignore it, believing that (1) it can’t be cancer ‘cos men don’t get breast cancer, or (2) it will go away on its own so just
ignore it. Thus, by the time men seek medical advice the tumor has had many months to grow, and is correspondingly
more advanced.

Question 54

When matched for stage, men with breast cancer have a much better prognosis than women

Answer 54

False. When matched for stage the prognoses are the same between men and women. But keep in mind that men tend to
present at a more advanced stage, so overall the prognosis tends to be worse in men.

Question 55

_____ refers to enlargement of, or development of tubules in, the
male breast.

Answer 55

Gynecomastia