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Repro-Path 2 > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

Do 95% of new cases and 97% of breast cancer deaths occur in women > 40 years of age?

A

Of course they do

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2
Q

Is the 5 yr survival slighter better or worse in younger women with breast cancer?

A

Worse

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3
Q

Does poverty level effect who utilizes mammography?

A

Yep. Poor ppl way less likely to get one

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4
Q

Breasts are what type of glands?

A

The largest skin gland-Modified sweat glands

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5
Q

During breast embryology, when does a solid bud develop and invaginate into underlying mesenchyme ?

A

At the end of the first month

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6
Q

During breast embryology, the primary bud gives off several secondary buds that develop into what kind of duct?

A

Lactiferous ducts: which branch off further to form mammary gland

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7
Q

When does the breast assume it’s complete morphologic and functional maturity?

A

During pregnancy

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8
Q

At what age do the breasts reach normal size?

A

16-19 yrs

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9
Q

Anatomically, where are the breasts located?

A

B/w 2nd and 6th ribs and Sternum and Axilla

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10
Q

The breast is divided into how many lobes?

A

10-20; , each lobe is divided into lobules (ducts + acini= TDLU)`

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11
Q

What is this?

A

Microscopy showing some ducts (on the left) and a terminal duct lobular unit (TDLU) on the right with inactive acini, as is typical of a pre-pregnancy state

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12
Q

What’s this pic showing?

A

By late pregnancy, marked expansion of the milk producing lobules and the associated ducts is seen. These changes take place as the pregnancy proceeds and are generally well established around the birth of the child

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13
Q

What’s this pic showing?

A

In this photomicrograph, lactation has been well established and all the acini contain vacuolated cells (milk fat). Notice back to back individual acini at the expense of intervening stroma (stroma more pronounced in an inactive breast).

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14
Q

What’s this? Normal or abnormal?

A

High power view of the ductal/acinar epithelium. We’re supposed to note the glandular configuration- cells encircling a lumen. This tissue is pseudo-stratified. The well organized cellular arrangement and nuclear features confirm this to be a normal duct.

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15
Q

What is the milk line?

A

The line along which breast tissue/nipples can develop. It includes the vulvar/upper inner thigh location. It’s possible to get breast cancer anywhere along this line. (There’s a really cool House episode you could watch to learn this instead of memorizung this flashcard. I highly recommend it)

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16
Q

What’s this?

A

Breast cancer at mammography. Notice the irregular margins.

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17
Q

What does this MRI show? What pts typically benefit from getting an MRI?

A

Breast cancer. Women whose mammogram is difficult to interpret and have a suspicion for cancer may benefit from an MRI exam with much better resolution

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18
Q

What kind of imaging is this? What does it show?

A

A PET scan showing increased tracer update in the breast and axillary (bilateral) areas, indicating bilateral nodal disease, thus helping with staging of cancer, planning treatment and predicting prognosis

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19
Q

This is a Sestamibi (Mirulima) Scan. What does it show?

A

A radio-nucleotide scan showing increased uptake in breast cancer. This scan is typically used for thyroid and parathyroid lesions as well as for myocardial studies.

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20
Q

Is FNA the preferred biopsy method?

A

Nope, because of the false negative and a relatively small sample, a trucut ®/core stereotactic biopsy is a preferred procedure. But then he said that if the lesion/mass is easily palpable and very superficial then a FNA was ok

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21
Q

What’s Accessory Breast Tissue?

A

It’s in the axillary fossa. Tumors here may be confused with ax. LN or mets

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22
Q

Ectopic Breast Tissue?

A

May develop along mammary line- failure of any portion of mammary ridge to involute

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23
Q

Define Macromastia

A

Excessive breast tissue

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24
Q

What is nipple inversion associated with?

A

Assoc with large pendulous breasts- May be confused with CA

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25
Q

What is Supernumerary Breasts/Nipples?

A

Besides weird as fuck, it’s persistent epidermal thickenings along milk line from axilla to perineum

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26
Q

What is Acute Mastitis/Abscess?

A

Non-neoplastic dz of the breast that’s tender, associated with lactation- cracks in nipple. Staph and Strep (pyogenic bacteria)

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27
Q

What can happen with silicone implants?

A

Form a fibrous capsule (synovial metaplasia). Gel may seep through intact implant shells.

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28
Q

What is this depicting?

A

A foreign body type granulomatous response to seeped silicone (vacuolated white material) invoking a florid foreign body type giant cell reaction.

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29
Q

What’s this?

A

Breast tissue containing a blue dome cyst in the middle. This is fibrocystic disease.

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30
Q

What’s this?

A

This shows cystic spaces containing fluid, and the lining cells are apocrine metaplastic cells (abundant eosinophilic cytoplasm) in papillary configuration. The fibrous stroma surrounding the cysts is dense. This combination of benign cystic change and fibrosis makes this fibrocystic disease.

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31
Q

Tell me six things about Fibrocystic Changes/Disease

A
  1. Considered a hyperplastic disorder
  2. Proliferative vs. nonproliferative (cystic)
  3. Women 25-45
  4. Decreased risk with oral contraceptive therapy
  5. Increased mitotic and apoptotic rate
  6. May hamper adequate/optimal mammography
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32
Q

What’s this? Is there an increased risk of cancer?

A

Sclerosing adenosis: an increased number of benign but compressed tubular glands surrounded by dense fibrous stroma. Because of dense compressing stroma, it is difficult to identify the normal two cell layering, a feature characteristic of benign lesions.

Risk of CA 1.5 to 2x normal. It’s rarely involved by LCIS

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33
Q

What do you call a palpable sclerosing adenosis?

A

Adenosis tumor

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34
Q

This dz has features suggestive but not diagnostic of DCIS There is an Increased risk of carcinoma(2-4x5). The risk equal in both breasts. Loss of heterozygosity to 16q. 40% clonal.
Histo shows: Multilayering of cells with progressive loss of nuclear polarity, enlarged nuclei, and nucleoli.

Which dz?

A

Atypical Ductal Hyperplasia

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35
Q

Which condition is this: Resembles LCIS but does not fill or distend 50% or more acini within a lobule. Has focal preservation of luminal spaces. There is a 4x5 usual risk of CA in either breast (greater in pre-menopausal)

A

Atypical Lobular Hyperplasia (ALH)

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36
Q

What is the most common benign breast tumor and how often does it turn malignant?

A

Fibroadenoma. It typically presents in younger women 20-35

Fibroadenomatosis- mutifocal disease in post renal transplant and with EBV in immunosuppressed. May have a neoplastic stromal component with polyclonal epithelial component

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37
Q

Are Fibroadenoma’s hormonally responsive?

A

Yes; they may grow in pregnancy

38
Q

Histology described as being the stromal and epithelial component.There are glandular epithelium without atypia. Myoepithelial cells are present.Stroma generally not very cellular, but may have other stromal elements like cartilage, muscle. What is it?

A

Fibroadenoma. These may have coexisting features of fibrocystic change or sclerosing adenosis

39
Q

What is Juvenile/Giant cell variant of fibroadenoma?

A

Seen in the adolescent; often bilateral and very large. May have very cellular stroma and glands

40
Q

What’s this?

A

Fibroadenoma: the well developed fibrous stroma surrounds and compresses benign ducts.

41
Q

This cancer has a mean age 48. Solitary. Close to nipple- lactiferous ducts and sinuses.Serous/bloody nipple discharge (80%)- nipple retraction may be present. What is it?

A

Large Duct Papilloma

42
Q

Size of large duct papilloma?

Basic description?

A

Gross: <3cm, soft, hemorrhagic
Multiple papillae in complex arborizing pattern. Calcification possible. Myoepithelium present (S100+)

43
Q

For large duct papilloma, when would you suspect malignancy? What’s the Tx?

A

Malignant if severe atypia, abnormal mitoses, single cell layered, pseudostratification, no vascular core or cribriform morphology
Treatment is surgical excision

44
Q

What’s this?

A

Photomicrograph showing a single dilated duct, containing a complex cauliflower-like lesion (Papilloma) with arborizing capillaries traversing fibrous stroma that supports finger-like epithelial projections (micro-papillae).

45
Q

What’s this?

A

At microscopy, fat necrosis shows variably sized fat vacuoles and presence of foamy macrophages or giant cells. Calcification may be present and the associated contraction of the connective tissue may result in retraction of the skin or nipple, giving the false appearance of breast cancer.

46
Q

Fat necrosis can present as an ill defined mass. What’s is usually associated with?

A

Trauma- patient may not give history. Generally related to lactation, pregnancy or sports activity

47
Q

Is Gynecomastia the result of hypertrophy or hyperplasia?

A

Both

48
Q

What condition has Increased estrogen to androgen ratio. Is related to puberty, alcohol, cirrhosis, drugs. Has a button or disc-like stromal enlargement and Periductal stromal edema or fibrosis. “Halo” effect

A

Gynecomastia

49
Q

Genetically speaking, who is at an increased risk for breast cancer?

A

First degree relatives at increased risk. Risk even higher if the affected relative has bilateral disease, early incidence in relative or >1 relative affected

50
Q

Hormonally, who is at an increased risk for developing breast cancer?

A

Risk increases with early menarche, late menopause, nulliparity, having first child after 30, recent use of oral contraceptives, HRT (estrogen+progesterone) in postmenopausal women, physical inactivity and consumption of one or more alcoholic beverages/day

51
Q

Is the risk for breast cancer higher in pre or post menopausal women?

A

Risk higher in postmeno. with obesity or estrogen producing ovarian tumor (over or sustained production of estrogen)

52
Q

What are some of the environmetal/ ethnic risks for breast cancer?

A

US>Japan/Taiwan (5:1). Also N. Europe (?fatty diet and heavy alcohol use)
Not associated with smoking
In Blacks: higher stage, high nuclear grade, higher mortality rate, more frequent in women<40, more likely ER/PR negative

53
Q

What percentage of clinically negative nodes have tumor?

A

40%.

15 % of clinically postive nodes do not

54
Q

Mammography detects 1-2 mm tumors via micro-calcification. Microcals present in 50% of carcinomas . What percentage of suspicious microcals are malignant.

A

20%

55
Q

Breast cancer can locally spread to? Nodal metastasize to where? And distantly mets go to where?

A

Local Spread: Skin/nipple/chest wall
Nodal Mets: Axilla, supraclavicular, internal mammary
Distant Mets: Skeletal system, liver, lung/pleura, ovary, adrenal, CNS etc. Lobular CA favors abdominal cavity/viscera.

56
Q

How are ER and PR receptors identified?

A

by immunohistochemistry

57
Q

What’s the prognosis of ER and PR postive tumors? Where are the ER and PR receptors found in the cell?

A

They’re a very good predictive markers for therapeutic response for anti-estrogen medications. Both are expressed in the nuclei

58
Q

How do you identify HER2/neu?

A

membranous stain

59
Q

HER2/neu prognosis?

A

Her2/neu oncogene overexpression is seen in 30% of breast cancers and typically portends a poor prognosis but also provides useful predictive information for therapeutic usage of monoclonal antibodies against Her2/neu such as trastuzumab

60
Q

What are important predictive variables for response to treatment?

A

ER/PR and Her2 status.

Ploidy and S-phase fraction no predictive value

61
Q

Prognosis with axillary LN involvement?

A

Involvement most important prognostic factor for disease- free & overall survival and for Rx regimen

62
Q

What are the Sentinel Lymph Nodes?

A

The first lymph node that receives breast drainage/mets. Usually central group (level 1). Replacement for axillary dissection in T1 and T2 tumors. Cluster size of 0.2-2 mm may indicate significant axillary dz.

63
Q

What’s Ductal Carcinoma in situ?

A

Tumor confined to glandular component- no stromal invasion (basement membrane intact). Tumor can spread along ducts

64
Q

Is DCIS or LCIS more common?

A

DCIS= 4x more common. It’s 15-30% of all CA- mammography and assoc with development of invasive CA at or near the site

65
Q

What’s Lobular Carcinoma in situ?

A

Generally incidental- no distinguishing features at gross exam and no microcal.

50-70% bilateral (vs. 10% for DCIS) and 75% multicentric

66
Q

What’s a pt with LCIS risk of invavise dz? How many have coexistant CA? What’s the risk of dying from cancer with periodic examine?

A

30% risk of invasive disease in either breast (relative risk 9x normal). Invasive dz may be of ductal or lobular type
5% have coexistent invasive CA. Lobular cancerization of ducts
Minimal risk of dying from cancer if periodically examined

67
Q

What’s this?

A

DCIS

the involved ducts show much more variation in tumor cell morphology and aggregate sizes than the lobular cancer which is much more monomorphic in appearance.

68
Q

What’s this?

A

LCIS

More monomorphic than DCIS

69
Q

What is Comedo Carcinoma and what is it a variant of?

A

Variant of DCIS. It’s 1/3 multicentric, 10% Bilateral. 40% progress -> invasive. Some patients have ax. mets. High grade cells with central necrosis. Her2 amplification, p53 mutation positive. ER/PR negative, aneuploid

70
Q

What’s this?

A

DCIS plus invasion

71
Q

What is Paget’s Disease of Breast?

A

It’s from excretory ducts and extends into skin of nipple/areola. Assoc DCIS/Invasive. 50% underlying lump/mass. Large cells with clear cytoplasm, nucleoli and abundant mucin

72
Q

What is Ductal Carcinoma NOS?

A

Most common type (80%)- scirrhous. Penetrative and Calcification. Tumor may be fixed to the chest wall
Tubule formation, Nuclear pleomorphism and number of mitoses- MBR grading

73
Q

?

A

A widely invasive infiltrating ductal carcrcinoma with tumor tubules invading into the connective tissue stroma.

Gross pic shows with normal breast fat in yellow and a poorly circumscribed white malignant lesion

74
Q
A

Ductal carcinoma. The tumor cells are arranged in a sheet, with very high nuclear/cytoplasmic ratio, nuclear membrane irregularity, nuclear grooving and cytologic monomorphism. Myoepithelial cells are not present

75
Q

This cancer comprises 10% of all breast carcinomas; 20% bilateral, often multicentric. A mass lesion may not be present
Histo shows single (Indian) file/targetoid, usually low grade appearance, and signet ring cells. Cancer?

A

Lobular Carcinoma

76
Q

Where does lobular carcinoma met to?

A

CSF, BM, GIT, Serosal surfaces, ovary, uterus

77
Q

WHat kind of cancer is this?

A

Inflammatory Carcinoma (it’s a clinical Dx). It’s aggressive and needs aggressive Rx.

Peau d’orange= lymphatic occlusion- thickened skin

78
Q
A

High power view of a dermal lymphatic channel plugged by a tumor embolus.

79
Q

What is Colloid Carcinoma?

A

Also called Mucinous CA. Older women- slow growth. Better survival than ductal (12+ years after therapy)
Large lakes of mucin

80
Q

What is tubular carcinoma?

A

2-6% of all malignant tumors. Well differentiated- very favorable prognosis
Avg age 50 yrs (younger than ductal)
Good prognosis even with lymph node + 75% tubules (angulated)

81
Q

What tumor is this?

A

Colloid Carcinoma: tumor cellular aggregates floating in a background of abundant mucin

82
Q

What’s this?

A

Tubular carcinoma: shows tumor cells arranged in angulated tubules while invading the connective tissue stroma.

83
Q

What’s Angiosarcoma?

A

Malignancy with anastomosing vascular channels lined by atypical cells. Has both low and high grade. Usually younger women or older women sp radiation. Poor prognosis

84
Q

Carcinoma In Males?

A

1% the rate of women (10%) in Egypt. Similar risk factors as women. Usually painless subareolar mass. Advanced stage presentation. Prognosis same as women when stage-matched

85
Q
A

Angiosarcoma: atypical and freely anastomosing vascular channels are seen, coursing the connective tissue stroma and lined by hyperchromatic malignant endothelial cells, which stain positive for Factor VIII antigen and CD34 with immunohistochemistry

86
Q

What’s Phyllodes Tumor?

A

It’s also called Cystosarcoma phyllodes
Avg age 45. Latin American Hispanics. Like Fibroadenoma arises from intralobular stroma, but recur and may be frankly malignant Discrete palpable mass- rapidly enlarges
Rx: Surgical- Adequate margins essential

87
Q

Benign phyllodes tumor?

A

Most tumors. Resemble Fibroadenoma with cellular stroma. Rx- Wide local excision

88
Q

Borderline Phyllodes tumor?

A

More mitotic figures than benign. Tend to recur. Rx- Wide excision

89
Q

Malignant phyllodes tumor?

A

Rare; >5 mitoses/10HPF AND stromal>ductal growth, tumor necrosis, heterologous stromal elements, marked nuclear atypia. Stroma may be sarcomatous. Local recurrence. 3-12% mets (stromal). Simple mastectomy

90
Q
A

The tumor is comprised of very cellular stroma surrounded by epithelium, the typical appearance is that of leafs. Even the gross specimen has a lobulated appearance, smooth and pearly white on cut surface. The tumor can range from benign to frankly sarcomatous.

Repro-Path 2 (1 decks)

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