Breast Pathology Flashcards by Marco DiFederico

What is the lactiferous duct and sunis

duct- opens into the nipple

sinus- subadjecent to the nipple (dilation of the duct)

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What are the two types of breast tissue

Epithelial

Stromal

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What is the epithelial component of the breast tissue and why is it pathologically significant

<10% of total volume, contains the terminal duct lobular unit
-most lesions arise from epithelial tissue

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What is the stromal component of the breasts and two sub divisions

Supportive stroma- loose connective tissue/adipose tissue

stromal tissue divides the breast into lobules creating interlobular and intralobular stroma

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What is the dif between interlobular and intralobular stromal tissue

Intra- enclose each lobule, its acini and ducts, chiefly loose connective tissue/lymphocutes

Inter- separates one lobule from other- Adipose tissue, some connective tissue

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What does more connective tissue and adipose tissue do in breasts

more connective tissue-> stops spread of cancerous growth

More adipose tissue-> invasive lesions can easily spread as adipose tissue ins less dense

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Where is the most common loc for breast pathology

Upper outer quad is most dense and thus mc loc for breast cancer

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Where does the upper outer quad and internal quad drain for breast tissue

Upper outer- Drains into axillary lymph nodes

Internal- Drains into internal mammary lymph nodes

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What is galacteorrhea

Nipple discharge (may be a sign of breast pathology

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What does bloody, purulent and greenish/brown discharge indicate

Bloody- typical for intraductal papilloma

Purulent- usually due to acute mastitis

Green/brown- Mammary duct ectasia

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What is acute mastitis and two tyoes

Acute inflammation of the breast

Lactational mastitis- localized, painful inflammation of the breast associated with fever and malaise in breast-feeding women

Non lactational- Inflammation in non breast feeding women

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What is granulomatous mastitis and what is it caused by

Tuberculous matasis- solitary, ill defined, unilateral hard lump

Breast implant- Rupture and leakage of SBI into surrounding tissue evokes chronic inflammatory process and later granulomatous inflammation

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What is mammary duct extasia + age

occurs at 40-70

Periductal inflammation, elastic tissue destruction, resulting in duct ectasia and periductal fibrosis

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What is galactocele

Cystic dilation of one or more ducts occurring during lactation

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What is the mc benign breast condition

Fibrocystic change is the most common benign breast condition (lumpy breast presentation)

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Fibrocystic change of the breasts features

cysric dilation of terminal ducts
relative increase in inter and intra lobular fibrous tissue
formation of cysts of varying sizes
most often in upper/outer quad

Palpable mass or modularity

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What are the proliferative changes in fibrocystic breast conditions

Epithelial hyperplasia or epithliosis
–increase in the layers of epithelial cells over the basement membrane to three or more layer in the ducts (dictal hyperplasia) or lobules (lobular hyperplasia)

How much of an increased relative risk of developing breast cancer if you have general proliferative changes or Proliferative fibrocystic changes

General= 1.5-2 fold increase

Proliferative= 4-5 fold

Fibrocystic change vs breast cancer; side, nodules, menstural changes, pregnancy change, pain

Fibrocystic

bilateral
multiple nodules
menstural variation
cyclic pain
may regress during preg

What are the benign neoplasms of the breast

Fibroadenoma (mc <35)
Phyloodes tumor (60s)
Intraductal papilloma

What is a fibroademoma

Benign neoplasm

Palpable round moveable rubbry mass
increase in size during preg
may spontaneously disappear during preg

What is phyllodes tumor

benign neoplasm (also called serocystic disease of Brodie)

-uncomon bulky leaf like tumor w aggressive clinical behaviour

What is a intraductal papilloma

Benign neoplasm

-commonly presents as a bloody nipple discharge

Risk factors of malig neoplasms of the breast

Age
First degree relative
long/intense estrogen exposure (endogenous, exogenous)
previous proliferative fibrocystic changes (especially atypical hyperplasia)

What genetic muattions put you at a higher risk of Breast cancer

BRCA 1 (located on ch17)- found in 2/3 women w inherited breast and ovarian cancer BRCA 2 (located on Ch 13) Mutation in p53 tumor suppressor gene (ch17)

What is Li Fraumeni syndrome and what causes It

is an inherited autosomal dominant disorder that is manifested by a wide range of malignancies that appear at an unusually early age Associated w p53 mutations

Additional risk factors of breast cancer

- consumption of large amounts of animal fat - cigs - breast augmentation - alcohol - ionizing radiation

What are the 2 classifications of carcinoma of the breast

Non invasive carcinoma- more favourable outcomes invasive carcinoma- has propensity to invagde and metastasize in surrounding lymph nodes and other tissues

What are the breast cancer varients and mc form

- Pre invasive - Invasive ductal (MC) - Invasive lubular - Mucunous - tubular - medullary

Infiltrating duct carcinoma fx

Diffusly infiltrating timor | -microscopic features include formatin of solid nests, cords, gland like streatcures, densely collegnized

Invasive lobular carcinoma features

one wide fules of round regular tumor cells, infiltrating the stroma and arranged circumferentially around ducts

Medullary carcinoma gross pathology

large grey white soft fleshy tumour replacing almost whole of the breast -microscopically shows large tumor cells forming syncytuial arrangement and stroma infiltrated richly with lymphocytes

4 common sites of metastisis of breast cancer

Brain Bones Lungs Liver

What constitutes a triple negative breaast cancer

Defined by absent expression of: 1. Estrogen receptor 2. Progesterone receptor 3. HER2 - these tend to be more aggressive than other types of breast cancer - no targeted tx

What is paget disease of the nipple and what is it associated w

presents as an exzematous eruption on the nipple and areola -associated with an underlying invasive intraductal carcinoma

What determines prognosis of breast cancer

``` Axllary lymp node status Size of tumor Histological type and grade of tumor Estrogen and progesterone receptor status Overexpression of c-erbB2 ```

What is the role of estrogen and progesterone receptor testing

- if a cancer is fed by estrogen its called estrogen receptor positive - if cancer is fed by progesterone its called progesterone receptor positive -this shows that it can be tx with hormonal therapies

What % of cancers are ER+ and PR+

75% are ER+ 65% are PR+ -the more hormone receptos the cancer cells have the better their response to hormone therapy

What is gynecomastia

Benign condition that causes hypertrophy of male breast | -enlargement mainly due to ducts proliferation and periductal stroma

Causes of gynecomastia

Disease associated with increased estrogen levels or decreased androgen levels - Klinefelter - idiopathic - side effect of drugs

What type of breast cancers are mc in men (compared to women)

men= invasive ductal carcinomas women=lobular carcinomas