Breast Pathology Flashcards
Most common cause?
Intraductal papilloma
(Most associated with bloody discharge)
Demographic in whom this finding is common?
Women < 50 yo
(Fibrocystic change; notice all the cysts….)
A pregnant woman presents with a moveable mass in her left breast that has been growing in size throughout her pregnancy. Excision of the mass would most likely reveal:
Fibroadenoma
(Mobility suggests mass in benign; most common benign tumor is fibroadenoma; hormonally responsive so grows during pregnancy; notice well circumscribed mass)
What causes this appearance?
Plugging of dermal lymphatics
(Peat du orange appearance = inflammatory carcinoma)
Most common cause?
Mammary duct ectasia
(Dilation and inflammation of mammary duct most associated with green/brown discharge)
List some associations with this finding.
Choriocarcinoma of testis
Klinefelter’s
Cirrhosis
Spironolactone and other androgen blockers
Antipsychotics and other DA antagonists
Primary/secondary hypogonadism
(Anything that increases estrogen:androgen ratio = gynecomastia)
A patient reports that her oncologist explained she has a type of tumor that is highly likely to be present in her other breast as well. What would this tumor look like on histology?
LCIS
Prognosis?
Poor
(Indian filing = lobular carcinoma, which is associated with signet ring pattern = bad prognosis)
What is this woman’s chance of developing breast CA?
~2%
(Papilloma - notice mass growing into ductal space)
Dx?
Normal!
(Notice two layers of cells [columnar epithelium + myoepithelium] around glands with no inflammatory cells]
Demographic in whom this finding most typically occurs?
Breastfeeding women
(Inflammed breast + abscess = acute mastitis, associated with lacerations during breastfeeding introducing Staph or Strep)
Dx?
Phyllodes tumor
(Extension of mostly stroma)
Your patient with this finding asks if she has an increased risk of breast cancer. You tell her:
Yes, 5x increased risk
(Atypical ductal hyperplasia - too many cell layers around duct)
Demographic?
Elderly women
(Notice the abundant mucin = colloid carcinoma)
How would this present clinically? What is it associated with?
Rash +/- nipples retraction
Associated with underlying mass (esp DCIS)
(Paget cells = large cells with clear cytoplasm; also notice the biopsy was from the epidermis)
Where can nipples/breast Ca develop?
Along milk line
Most common presentation that would have led to this biopsy?
48 yo woman with bloody nipple discharge +/- nipple retraction
(Large duct papilloma - notice mass moving into ductal space)
A patient present with a breast mass 6 months after receiving radiation for a triple negative ductal carcinoma. What do you expect on biopsy?
Angiosarcoma
(Associated with post-radiation; notice all the RBCs)
Risk of developing cancer?
1/3
(Increased glandular cellularity without stromal invasion = DCIS)
How will this present?
Painful mass in woman < 50 yo that gets bigger during her cycle
(Blue dome cysts = fibrocystic change; hormonally responsive = bigger during menses)
What causes this finding?
Increased estrogen:androgen
(Halo effect = gynecomastia; increased ducts but no lobules because dudes can’t make milk)
Clinical presentation?
Nonpainful, nonmobile mass
(DC NOS)
What is causing this discharge?
Staph or strep
(Purulent discharge = acute mastitis)
A patient with this finding asks you about her risk of developing cancer. You tell her:
Her risk is about the same as the general population (1/8)
(Stromal proliferation + compression of ducts = fibroadenoma; risk of CA is<0.1%)
Dx?
Fat necrosis
(Notice the multinucleated giant cell = macrophage)
Dx?
Comedo carcinoma
(DCIS variant with central necrosis and calcifications [arrows])
What PMH may you expect in this patient?
Radiation
(Bruises on breast - think angiosarcoma)
Risk of developing CA?
5X
(Uniform cells + roundish lumens lined by cells = atypical ductal hyperplasia)
Risk of developing CA?
2x
(Heterogenous cells + irregular lumens = usual ductal hyperplasia)
This breast lesion was stained for CK 5/6. Dx?
Triple negative breast CA
(Also notice the basal appearance)
