- Proliferation of glandular tissue - Risk of Cancer of 1.5- 2x normal - Clustered microcalcifications - If it is palpable what do you call it? adenosis tumor - retains both cell layers!!! retains lobular architecture!!!

Breast Pathology Flashcards by Michael Castellarin

What percentage of breast cancers have micro-calcifications?

50%

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False negative mammogram rate?

30%

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Older or younger women have higher incidence for false negatives on mammograms?

younger. Younger women have denser more sclerotic breasts. Often harder to see things

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Accessory breast tissue in the axillary fossa. Tumors may develop here and they may be confused with:

Axillary lymph nodes and/or mets

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Ectopic breast tissue

may develop along mammary ridge to involute

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Macromastia

Excessive breast tissue

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Nipple inversion

associated with large pendulous breasts. May be confused with cancer

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Supernumerary breasts/nipples

persistent epidermal thickenings along milk line from axilla to perineum

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Fibrocystic change/ disease

Considered a hyperplastic Disorder
Women 25-45 (related to hormone imbalance… up and down Estrogen and Progesterone) KNOW
Increased mitotic and apoptotic rate
May hamper mammography

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Sclerosing adenosis

Proliferation of glandular tissue
Risk of Cancer of 1.5- 2x normal
Clustered microcalcifications
If it is palpable what do you call it? adenosis tumor
retains both cell layers!!! retains lobular architecture!!!

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Atypical ductal hyperplasia

Features are suggestive but not diagnostic of DCIS
Increased risk of cancer 2-5x
Risk is equal in both breasts
enlarged nuclei and nucleoli, progressive loss of nuclear polarity

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Cancer risk increase in Atypical ductal hyperplasia?

Yes. 2- 4x5 times. Risk is equal in both breasts

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Atypical lobular hyperplasia

Resembles Lobular Carcinoma in situ but DOES NOT FILL OR DISTEND 50% or MORE ACINI WITHIN A LOBULE.,
- Still, 4-5x the risk of CA in both breasts, greater risk in pre-menopausal pts

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Cancer risk increased in atypical lobular hyperplasi

yes. 4-5 times

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Most common benign breast tumor

Fibroadenoma

Typical in younger women
MOVES AROUND …like a marble
Malignant transformation risk… less than .1%
Hormonally responsive and may grow in pregnancy

KNOW

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What is fibroadenomatosis

mulitifocal disease in post renal transplant patients and with EBV in the immunosuppresed

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What happens to fibroadenomas during pregnancy

they may grow, they can be hormonally responsive

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Phyllodes tumor

Fibroadenoma like tumor with overgrowth of the fibrous part. characteristic leaf like projections on biopsy

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Serous/ bloody nipple discharge

Could be large duct papilloma or could be papillary carcinoma. How do you tell the difference? In large duct papilloma both cell layers will be present (myoepithelium and luminal cells). In papillary carcinoma, the myoepithelial cells are gone.

What age group is most common for papillary duct carcinoma?

Post menopausal

Age range for large duct papilloma?

Premenopausal

Breast cancer genetics stats

First degree relatives of affected individuals at higher risk

Risk even higher when the affected person has bilateral disease
Li Fraumeni syndrome
BRCA 1 and BRCA2
Cowden Disease

Li Fraumeni syndrome is

germline p53 mutations

BRCA1

17q21

BRCA2

13q12

Cowden Disease

10q mutation... multiple hemartoma syndrome.

What percentage of clinically negative nodes have a tumor?

40%

What percent of clinically positive nodes do not have a tumor

15%

Comedo cardinoma (DCIS)

can be aggressive. Two criteria - necrosis and high grade cells

Finish

look at pathoma and lecture pwrpt, Don't listen

PET scan

basically you just inject a glucose derivative and wherever there is a metastsis, it will take up glucose at a faster rate than the surrounding tissue

Acute Mastitis?

Tender breasts, associated with lactation. Cracks in nipple. Staph and Strep

Silicone implants

form a fibrous capsule (synovial metaplasia). Gel can seep through intact shell

Fibroadenoma cont... What are teh two components?

Stromal and epithelial

Large Duct Papilloma

- papillary growth into large duct - It is characterized by fibrovascular projections that are lined by epithelial and myoepithelial cells - Classic presentation is - bloody nipple discharge - more commonly seen in pre-menopausal women. Gotta distinguish it from papillary carcinoma which is commonly seen in post-menopausal women and lacks myoepithelial cells

Fat Necrosis

Usually related to trauma like sports - Presents as an ill defined mass that may show calcification (saponification) - may cause skin puckering

Gynecomastia

enlargement of breast- hypertrophy and hyperplasia - Increased estrogen to androgen ratio - Puberty- alcohol, cirrhosis, drugs - button or disc like stromal enlargement

Remember that breast cancer tends to be worse in black women

higher stage, higher grade, higher mortality rate, more frequent in women under 40, more likely ER/PR negative

MOdified Bloom Richardson score

3-9 score. Low score is better differentiated and has better prognosis

What does in situ mean?

NO STROMAL INVASION

Which is more common, DCIS or LCIS

Ductal

COmedo Carcinoma

DCIS variant, 40% progress to invasive...this is pretty aggressive. - High grade cells with central necrosis - Her2 amplification, p53 mutation - ER/PR negative

Single file tumor, usually low grade

Invasive Lobular carcinoma

Inflammatory carcinoma

Peau d' orange lymphatic occlusion. q

Colloid Carcinoma

also called Mucinous - Most often seen in older women - Good survivial - Large lakes of mucin present

Tubular Carcinoma

well differentiated- very favorable prognosis | - Average age is 50 yrs old

Phyllodes Tumor

Large bulky mass of connective tissue and cysts. "Leaf-like projections". Most common in 6th decade. May become malignant.