Breast Pathology

Question 1

Female 20-30 years (premenopausal), lumpy bumpy breast, bilateral and multifocal,
Histopathological finding: three morphological changes: cystic change, fibrosis and adenosis, usually no risk for cancer

Answer 1

Fibrocystic Change

Question 2

Female with bloody nipple discharge.

Histopathological finding: Papillary growth within a dilated duct composed of multiple branching fibrovascular cores.

Answer 2

Intraductal Papilloma

Question 3

“lumpy bumpy” breast, cysts →coalesce to form larger cysts; contents may be calcified turbid semi translucent fluid (blue dome cysts) line by metaplastic apocrine cells. Fibrosis- rupture of cyst leads to chronic inflammation and fibrosis→ palpable nodularity

Answer 3

Non- Proliferative Lesions

Question 4

Epithelial hyperplasia
Sclerosing adenosis
- Sclerosing: stromal fibrosis compressing and distorting the acini + Adenosis: increased number of acini per lobule
- Palpable mass, a radiologic density, or calcifications – mimics carcinoma
Radial scar- Components of sclerosing adenosis, papillomas, and epithelial hyperplasia

Answer 4

Proliferative without Atypia

Question 5

Atypical hyperplasia: clonal proliferation having some, but not all, of the histologic features that are required for the diagnosis of carcinoma in situ

Answer 5

Proliferative with Atypia

Question 6

Female in their 60s (post menopausal),
Histopathological finding: : lobulated, cut surface slits and clefts- bulbous protrusions (phyllodes is Greek for “leaf like”) due to the presence of nodules of proliferating stroma covered by epithelium
low grade with local recurrence,
high grade then hematogenous metastasis (may progress to malignancy

Answer 6

Phyllodes Tumor

Question 7

Female in 20-30 years, hormone responsive, found in renal transplant patient on cyclosporin A.
Grossly: well circumscribed and rubbery
Histopathological finding: Intralobular fibroblast proliferation pushes the epithelial cells forms elongated slit like structure

Answer 7

Fibroadenoma

Question 8

History of breast trauma or surgery, painless palpable mass
Mammography shows calcification
Histopathological finding:
acute: hemorrhage+ necrosis + neutrophils + macrophage
chronic: giant cells , calcification and replaced by scars

Answer 8

Fat necrosis

Question 9

Females in 50s-60s (Perimenopausal/Post-menopausal), thick white nipple discharge. Histopathological finding: ectatic ducts filled with inspissated secretions + lipid laden macrophages and granuloma formation with fibrosis

Answer 9

Duct Ectasia

Question 10

Breast feeding females with erythematous and painful breast + fever+ staphylococcus or streptococcus infection.

Answer 10

Acute mastitis

Question 11

Accessory nipples/ supernumerary nipples - result from the persistence of epidermal thickenings along the milk line, which extends from the axilla to the perineum

Answer 11

Polythelia

Question 12

Accessory true mammary gland-

Answer 12

Polymastia

Question 13

Congenital absence of breast

Answer 13

Amastia

Question 14

Usually in old age group calcification on mammography,
Comedo DCIS – necrotic center with toothpaste discharge when pressed, no palpable mass noted
Histopathological finding: Arises from progression of ductal hyperplasia, no breach in basement membrane.

Answer 14

Ductal carcinoma in Situ (DCIS)

Question 15

Relatively young, often bilateral, loss of E-cadherin, no calcification on mammography,
Histopathological finding: monomorphic cells expands in the lobule, no breach in basement membrane, no palpable mass noted

Answer 15

Lobular carcinoma in Situ (LCIS)

Question 16

Eczematous patches on the nipple, Paget’s cells extends from DCIS via lactiferous ducts on the nipple surface, palpable mass present in most of the cases
Histopathological finding: abundant cytoplasm, irregular large nucleus and a prominent nuclei

Answer 16

Paget’s Disease

Question 17

Most common type of invasive carcinoma, hard and irregular mass on palpation, can be detected on mammography
Histopathological finding: desmoplastic stromal reaction, graded on basis of tubule formation, nuclear pleomorphism and mitotic rate

Answer 17

Ductal Carcinoma

Question 18

Infiltrating cells similar to tumor cells seen in LCIS, difficult to detect on mammography (doesn’t incite much desmoplastic reaction)
Histopathological finding: loss of CDH 1 thus loss of E-cadherin, bilateral,” Single file pattern”, increased risk of signet ring carcinoma of the stomach.

Answer 18

Lobular Carcinoma

Question 19

Associated with BRCA-1 mutation, well circumscribed mass
Histopathological finding: minimal desmoplasia, poorly differentiated with good chemotherapeutic response
IHC – ER-, PR-, Her 2 neu-

Answer 19

Medullary Carcinoma

Question 20

The majority are lower-grade ER-positive cancers that are HER2 negative

Answer 20

Luminal A

Question 21

The majority are higher-grade ER-positive cancers that may be HER2 positive

Answer 21

Luminal B

Question 22

The majority overexpress HER2 and do not express ER

Answer 22

HER2-enriched.

Question 23

The majority by gene expression profiling resemble basally located myoepithelial cells and are ER-negative, HER2-negative

Answer 23

Basal-like

Question 24

Risk factors for gynaecomastia

Answer 24

estrogens, reduced androgens/testicular androgen loss
• Cirrhosis
• Klinefelter syndrome (XXY karyotype)
• Estrogen therapy, drugs, alcohol, marijuana, heroin, retroviral treatment, anabolic steroids
• Testicular neoplasms