Breast Pathology Flashcards
What percentage of breast cancers have micro-calcifications?
50%
False negative mammogram rate?
30%
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
Accessory breast tissue in the axillary fossa. Tumors may develop here and they may be confused with:
Axillary lymph nodes and/or mets
Ectopic breast tissue
may develop along mammary ridge to involute
Macromastia
Excessive breast tissue
Nipple inversion
associated with large pendulous breasts. May be confused with cancer
Supernumerary breasts/nipples
persistent epidermal thickenings along milk line from axilla to perineum
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
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!!!
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
Cancer risk increase in Atypical ductal hyperplasia?
Yes. 2- 4x5 times. Risk is equal in both breasts
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
Cancer risk increased in atypical lobular hyperplasi
yes. 4-5 times
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
What is fibroadenomatosis
mulitifocal disease in post renal transplant patients and with EBV in the immunosuppresed
What happens to fibroadenomas during pregnancy
they may grow, they can be hormonally responsive
Phyllodes tumor
Fibroadenoma like tumor with overgrowth of the fibrous part. characteristic leaf like projections on biopsy
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.
