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Repro > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

The functional unit of the breast is the _

A

The functional unit of the breast is the terminal duct lobular unit
* The lobules make milk that drains from the ducts to the nipple

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2
Q

The lobules and ducts of the breast are lined by two layers of epithelium, the _ and _

A

The lobules and ducts of the breast are lined by two layers of epithelium, the luminal cell layer and myoepithelial cell layer

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3
Q

The inner cell layer that lines the ducts and nipples and makes milk in the lobules is called the _

A

The inner cell layer that lines the ducts and nipples and makes milk in the lobules is called the luminal cell layer

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4
Q

The myoepithelial cell layer is the outer cell layer that lines the ducts and lobules; this layer has _ function

A

The myoepithelial cell layer is the outer cell layer that lines the ducts and lobules; this layer has contractile function to propel milk towards the nipple

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5
Q

Development of the breast after menarche is driven by estrogen and progesterone; lobules and small ducts form and are present in the highest density in the _ quadrant

A

Development of the breast after menarche is driven by estrogen and progesterone; lobules and small ducts form and are present in the highest density in the upper outer quadrant

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6
Q

During pregnancy the _ undergo hyperplasia

A

During pregnancy the breast lobules undergo hyperplasia
* Driven by estrogen and progesterone produced by the corpus luteum, fetus, placenta

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7
Q

Acute mastitis is a _ condition

A

Acute mastitis is a bacterial infection of the breast that is commonly associated with breast-feeding
* Fissures develop in the nipple that provide route of entry for microbes

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8
Q

Acute mastitis is most commonly caused by infection with _

A

Acute mastitis is most commonly caused by infection with staphylococcus aureus

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9
Q

Acute mastitis most commonly presents as _

A

Acute mastitis most commonly presents as erythematous breast with purulent nipple discharge
* It can progress to abscess formation
* Wedge shaped area of tenderness

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10
Q

Treatment for acute mastitis usually involves _ and _

A

Treatment for acute mastitis usually involves continued breast feeding (drainage) and antibiotics (dicloxacillin)

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11
Q

Periductal mastitis is an _

A

Periductal mastitis is an inflammation of the subareolar ducts

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12
Q

Periductal mastitis most commonly occurs in smokers due to _

A

Periductal mastitis most commonly occurs in smokers due to relative vitamin A deficiency –> leads to squamous metaplasia of lactiferous ducts –> duct blockage and inflammation –> fibrosis/ mass formation

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13
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A
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13
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13
Q

Periductal mastitis clinically presents as _

A

Periductal mastitis clinically presents as subareolar mass with nipple retraction

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14
Q

Mammary duct ectasia is _

A

Mammary duct ectasia is inflammation with dilation (ectasia) of the subareolar ducts

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15
Q

Periareolar mass with green-brown nipple discharge is suggestive of _

A

Periareolar mass with green-brown nipple discharge is suggestive of mammary duct ectasia

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16
Q

Mammary duct ectasia is rare but is most classically seen in _ women

A

Mammary duct ectasia is rare but is most classically seen in multiparous postmenopausal women

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17
Q

Mammary duct ectasia will show _ on biopsy

A

Mammary duct ectasia will show chronic inflammation (plasma cells) on biopsy

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18
Q

Fat necrosis of the breast is most commonly caused by _

A

Fat necrosis of the breast is most commonly caused by trauma

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19
Q

Fat necrosis is usually identified via _

A

Fat necrosis is usually identified via mass on physical exam or abnormal calcification on mammography (due to saponification)

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20
Q

Biopsy of fat necrosis will show _

A

Biopsy of fat necrosis will show necrotic fat associated with calcifications and giant cells

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21
Q

_ is the most common change in the premenopausal breast; usually thought to be hormone mediated

A

Fibrocystic change is the most common change in the premenopausal breast; usually thought to be hormone mediated

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22
Q

Fibrocystic change is _ and will present as _

A

Fibrocystic change is fibrosis and cyst formation in breast and will present as vague irregularity in breast tissue (lumpy) often in the upper outer quadrant
* Lumpy “cobblestone” irregularity

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23
Q

Gross pathology of a breast with fibrocystic change would show _ cysts

A

Gross pathology of a breast with fibrocystic change would show cysts with blue-dome appearance

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24
Q

Fibrocystic change on its own is benign; however, some fibrocystic-related changes are associated with increased risk of _

A

Fibrocystic change on its own is benign; however, some fibrocystic-related changes are associated with increased risk of invasive carcinoma

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25
Q

Fibrosis, cysts, and apocrine metaplasia causes (added risk/ no added risk) for invasive carcinoma

A

Fibrosis, cysts, and apocrine metaplasia causes no increased risk for invasive metaplasia

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26
Q

Fibrocystic-related ductal hyperplasia and sclerosing adenosis carries a _ risk of invasive carcinoma

A

Fibrocystic-related ductal hyperplasia and sclerosing adenosis carries a 2x increased risk of invasive carcinoma

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27
Q

Fibrocystic-related atypical hyperplasia is associated with _ risk of invasive carcinoma

A

Fibrocystic-related atypical hyperplasia is associated with 5x increased risk of invasive carcinoma

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28
Q

Intraductal papilloma is _

A

Intraductal papilloma is papillary growth (fingerlike projection) into a large duct

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29
Q

_ is characterized by fibrovascular projections lined by epithelial (luminal) and myoepithelial cells

A

Intraductal papilloma is characterized by fibrovascular projections lined by epithelial (luminal) and myoepithelial cells

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30
Q

Intraductal papilloma classically presents as _

A

Intraductal papilloma classically presents as bloody nipple discharge in premenopausal woman

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31
Q

Bloody nipple discharge in a premenopausal woman is more likely to be (intraductal papilloma/ papillary carcinoma)

A

Bloody nipple discharge in a premenopausal woman is more likely to be intraductal papilloma

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32
Q

Bloody nipple discharge in a postmenopausal woman is more likely to be (intraductal papilloma/ papillary carcinoma)

A

Bloody nipple discharge in a postmenopausal woman is more likely to be papillary carcinoma

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33
Q

The most common benign neoplasm of the breast is _

A

The most common benign neoplasm of the breast is fibroadenoma
* It is usually seen in premenopausal women
* Benign with no increased cancer risk

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34
Q

Fibroadenoma is a _

A

Fibroadenoma is a tumor of the fibrous tissue and glands

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35
Q

A fibroadenoma presents clinically as _

A

A fibroadenoma presents clinically as well-circumscribed, mobile marble-like mass
* It is estrogen sensitive and may grow during pregnancy and be painful during the menstrual cycle

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36
Q

_ is a fibroadenoma-like tumor with an overgrowth of the fibrous component with characteristic “leaf-like” projections seen on biopsy

A

Phyllodes tumor is a fibroadenoma-like tumor with an overgrowth of the fibrous component with characteristic “leaf-like” projections seen on biopsy

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37
Q

Phyllodes tumor is more commonly seen in (younger/older) women

A

Phyllodes tumor is more commonly seen in older (postmenopausal) women
* It can be malignant in some cases
* Large and grow fast

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38
Q

Breast cancer is the _ most common cause of cancer mortality in women

A

Breast cancer is the 2nd most common cause of cancer mortality in women
* It is the most common carcinoma in women by incidence

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39
Q

Risk factors for breast cancer

A

Risk factors for breast cancer:
* Female gender
* Age
* Early menarche/late menopause
* Obesity
* Atypical hyperplasia
* First degree relative with breast cancer

40
Q

_ is a malignant proliferation of cells in ducts with no invasion of the basement membrane

A

Ductal carcinoma in situ (DCIS) is a malignant proliferation of cells in ducts with no invasion of the basement membrane

41
Q

DCIS is often detected with _

A

DCIS is often detected with calcification on mammography; DCIS does not usually produce a mass

42
Q

Mammographic calcifications can be associated with benign conditions such as fibrocystic changes of _ and _

A

Mammographic calcifications can be associated with benign conditions such as fibrocystic changes of sclerosing adenosis and fat necrosis

43
Q

DCIS _ type is characterized by high-grade cells with necrosis and dystrophic calcification in the center of ducts

A

DCIS comedo type is characterized by high-grade cells with necrosis and dystrophic calcification in the center of ducts

44
Q

_ is DCIS that extends up the ducts to involve the skin of the nipple

A

Paget disease is DCIS that extends up the ducts to involve the skin of the nipple
* Almost always associated with an underlying carcinoma
* Presents as nipple ulceration and erythema

45
Q

The most common type of invasive carcinoma of the breast is _

A

The most common type of invasive carcinoma of the breast is invasive ductal carcinoma
* Accounts for > 80% of cases

46
Q

Invasive carcinoma classically forms _ structures

A

Invasive carcinoma classically forms duct-like structures

47
Q

Clinically, we can usually detect masses that are _ cm or greater; mammography can find masses _ cm and greater

A

Clinically, we can usually detect masses that are 2 cm or greater; mammography can find masses 1 cm and greater

48
Q

Biopsy of invasive ductal carcinoma will show _

A

Biopsy of invasive ductal carcinoma will show duct-like structures in a desmoplastic stroma

49
Q

Tubular carcinoma is a form of IDC that is characterized by _

A

Tubular carcinoma is a form of IDC that is characterized by well-differentiated tubules that lack myoepithelial cells
* Relatively good prognosis

50
Q

Biopsy of _ shows “tumor cells floating in a mucus pool”

A

Biopsy of mucinous carcinoma shows “tumor cells floating in a mucus pool”
* Carcinoma with abundant extracellular mucin
* Older women, relatively good prognosis

51
Q

_ is a form of IDC that is characterized by large, high-grade cells growing in sheets with associated lymphocytes and plasma cells

A

Medullary carcinoma is a form of IDC that is characterized by large, high-grade cells growing in sheets with associated lymphocytes and plasma cells
* Well-circumscribed mass that can mimic fibroadenoma
* Relatively good prognosis
* Increased incidence in BRCA1 carriers

52
Q

IDC that spreads into the dermal lymphatics is called _

A

IDC that spreads into the dermal lymphatics is called inflammatory carcinoma

53
Q

Inflammatory carcinoma will present as _

A

Inflammatory carcinoma will present as inflamed, swollen breast with no discrete mass
* Can be mistaken for acute mastitis
* Poor prognosis

54
Q

Malignant proliferation of cells in the lobules with no invasion of the basement membrane is called _

A

Malignant proliferation of cells in the lobules with no invasion of the basement membrane is called lobular carcinoma in situ

55
Q

LCIS is usually detected on _

A

LCIS is usually detected incidentally on biopsy
* Does not produce a mass or calcifications

56
Q

Lobular carcinoma in situ is characterized by _ cells

A

Lobular carcinoma in situ is characterized by dyscohesive cells lacking E-cadherin protein
* Often multifocal and bilateral

57
Q

Treatment for LCIS is _

A

Treatment for LCIS is tamoxifen to reduce the risk of carcinoma

58
Q

Invasive lobular carcinoma grows in _ pattern

A

Invasive lobular carcinoma grows in single file pattern
* Signet-ring cells
* No duct formation because of lack of E-cadherin

59
Q

_ is the most important factor for breast cancer prognosis

A

Metastasis is the most important factor for breast cancer prognosis
* However, most patients present before metastasis occurs

60
Q

Given that metastasis is not common at presentation, _ becomes the most useful prognostic factor of breast cancer

A

Given that metastasis is not common at presentation, spread to axillary lymph nodes becomes the most useful prognostic factor of breast cancer

61
Q

We use _ , a special kind of biopsy that allows us to take only affected axillary lymph nodes

A

We use sentinel lymph node biopsy , a special kind of biopsy that allows us to take only affected axillary lymph nodes

62
Q

The most important breast cancer markers to predict response to treatment include _ , _ , and _

A

The most important breast cancer markers to predict response to treatment include estrogen receptor (ER) , progesterone receptor (PR) , and HER2/neu gene amplification

63
Q

Presence of ER and PR is associated with response to antiestrogenic agents like _

A

Presence of ER and PR is associated with response to antiestrogenic agents like tamoxifen

64
Q

HER2/neu amplification is associated with response to _

A

HER2/neu amplification is associated with response to trastuzumab

65
Q

HER2/neu is a type of _ present on the cell surface

A

HER2/neu is a type of growth factor present on the cell surface

66
Q

Triple negative breast cancer tumors are negative for _ , _ , _

A

Triple negative breast cancer tumors are negative for ER , PR , HER2/neu
* Have a poor prognosis
* AA women at increased propensity

67
Q

_ and _ are the two most important single gene mutations associated with hereditary breast cancer

A

BRCA1 and BRCA2 are the two most important single gene mutations associated with hereditary breast cancer

68
Q

(BRCA1/BRCA2) mutation is associated with breast and ovarian carcinoma

A

BRCA1 mutation is associated with breast and ovarian carcinoma

69
Q

(BRCA1/BRCA2) is associated with breast carcinoma in males

A

BRCA2 is associated with breast carcinoma in males

70
Q

Breast cancer in males usually presents as _

A

Breast cancer in males usually presents as subareolar mass in an older male
* Highest density of breast tissue in a male is underneath the nipple
* May produce a nipple discharge

71
Q

The most common histological subtype of male breast cancer is _

A

The most common histological subtype of male breast cancer is invasive ductal carcinoma
* Lobular carcinoma is rare in males because they develop very few lobules

72
Q

Male breast cancer is associated with BRCA2 mutations and _ syndrome

A

Male breast cancer is associated with BRCA2 mutations and Klinefelter syndrome

73
Q

Sensation of fullness, firm “wooden-log” mass, mobile mass, well-circumscribed

A

Sensation of fullness, firm “wooden-log” mass, mobile mass, well-circumscribed: phyllodes tumor

74
Q
A

Fat necrosis

75
Q

Ductal hyperplasia and sclerosing adenosis are (non-proliferative/proliferative) fibrocystic changes in the breast

A

Ductal hyperplasia and sclerosing adenosis are proliferative fibrocystic changes in the breast

76
Q

Fibroadenomas arise from _ in the inner quadrants of the breast

A

Fibroadenomas arise from intralobular stroma in the inner quadrants of the breast
* Rubbery, mobile masses

77
Q

Histopathology of fibroadenomas will show _

A

Histopathology of fibroadenomas will show proliferation of glands and stroma; no cellular atypia

78
Q

Phyllodes tumors arise from the _

A

Phyllodes tumors arise from the intralobular stroma

79
Q

_ is a cyst consisting of milk that arises from the mammary glands when milk flow is obstructed

A

Galactocele is a cyst consisting of milk that arises from the mammary glands when milk flow is obstructed
* Most often occurs during lactation
* Can be drained if causing sx

80
Q

_ is the benign enlargement of breast tissue in males

A

Gynecomastia is the benign enlargement of breast tissue in males

81
Q

Gynecomastia is caused by a relative increase in _ ratio

A

Gynecomastia is caused by a relative increase in estrogen: androgen ratio
* Exogenous estrogens
* Antiandrogens
* Prolactin stimulators
* Adrenal/testicular tumors
* Paraneoplastic syndromes
* Metabolic disorders (cirrhosis, hyperthyroidism)

82
Q

Gynecomastia on histology will appear with _

A

Gynecomastia on histology will appear with proliferation of branching, intermediate-sized ducts; ductal epithelial hyperplasia; loose stroma

83
Q

Favorable histology of invasive ductal carcinoma is _

A

Favorable histology of invasive ductal carcinoma is tubular or mucinous carcinoma

84
Q

Unfavorable histology of invasive ductal carcinoma is _

A

Unfavorable histology of invasive ductal carcinoma is metaplastic or inflammatory carcinoma

85
Q
A
86
Q

The second most common type of breast cancer is _

A

The second most common type of breast cancer is invasive lobular carcinoma
* Higher risk of bilateral breast cancer
* Propensity to metastasize to unusual sites (gyn, GI tract)

87
Q

Medullary carcinoma is often _ grade with _ prognosis

A

Medullary carcinoma is often high grade with relatively good prognosis
* Slow growing, does not spread beyond the breast

88
Q

Peu d’orange sign is associated with _

A

Peu d’orange sign is associated with inflammatory breast cancer

89
Q
A

Inflammatory carcinoma with tumor cells in dermal lymphatic spaces

90
Q

BRCA1 gene is _

A

BRCA1 gene is 17q21

91
Q

BRCA2 gene is _

A

BRCA2 gene is 13q12

92
Q

Fine needle aspiration (FNA) vs core-needle biopsy

A

FNA: fluid masses
Core needle: solid masses

93
Q

TMN classification is based on _

A

TMN classification is based on tumor size, lymph nodes, metastasis

94
Q

Stages of breast cancer

A

Stage 0: precancerous disease, carcinoma in situ
Stage 1-3: disease within the breast or regional LN
Stage 4: metastatic disease that has spread beyond the breast/lymph nodes

95
Q

Mastectomy is _
Lumpectomy is _

A

Mastectomy is removal of one or both breasts
Lumpectomy is segmental mastectomy

96
Q

_ is a selective estrogen receptor modulator that can be used to treat ER positive breast cancers

A

Tamoxifen is a selective estrogen receptor modulator that can be used to treat ER positive breast cancers

97
Q

Tamoxifen causes an increased risk of _ cancer

A

Tamoxifen causes an increased risk of endometrial cancer
* Receptor agonism in the uterus

98
Q

_ is a monoclonal antibody that blocks proliferative signal transduction pathway initiated by HER2 receptor binding

A

Trastuzumab is a monoclonal antibody that blocks proliferative signal transduction pathway initiated by HER2 receptor binding

99
Q

Side effects of trastuzumab:

A

Side effects of trastuzumab:
* Cardiotoxicity
* Fever, infection
* Cough
* Headache
* Insomnia
* Rash

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