Breast Pathology Flashcards
The functional unit of the breast is the _
The functional unit of the breast is the terminal duct lobular unit
* The lobules make milk that drains from the ducts to the nipple
The lobules and ducts of the breast are lined by two layers of epithelium, the _ and _
The lobules and ducts of the breast are lined by two layers of epithelium, the luminal cell layer and myoepithelial cell layer
The inner cell layer that lines the ducts and nipples and makes milk in the lobules is called the _
The inner cell layer that lines the ducts and nipples and makes milk in the lobules is called the luminal cell layer
The myoepithelial cell layer is the outer cell layer that lines the ducts and lobules; this layer has _ function
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
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
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
During pregnancy the _ undergo hyperplasia
During pregnancy the breast lobules undergo hyperplasia
* Driven by estrogen and progesterone produced by the corpus luteum, fetus, placenta
Acute mastitis is a _ condition
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
Acute mastitis is most commonly caused by infection with _
Acute mastitis is most commonly caused by infection with staphylococcus aureus
Acute mastitis most commonly presents as _
Acute mastitis most commonly presents as erythematous breast with purulent nipple discharge
* It can progress to abscess formation
* Wedge shaped area of tenderness
Treatment for acute mastitis usually involves _ and _
Treatment for acute mastitis usually involves continued breast feeding (drainage) and antibiotics (dicloxacillin)
Periductal mastitis is an _
Periductal mastitis is an inflammation of the subareolar ducts
Periductal mastitis most commonly occurs in smokers due to _
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
Periductal mastitis clinically presents as _
Periductal mastitis clinically presents as subareolar mass with nipple retraction
Mammary duct ectasia is _
Mammary duct ectasia is inflammation with dilation (ectasia) of the subareolar ducts
Periareolar mass with green-brown nipple discharge is suggestive of _
Periareolar mass with green-brown nipple discharge is suggestive of mammary duct ectasia
Mammary duct ectasia is rare but is most classically seen in _ women
Mammary duct ectasia is rare but is most classically seen in multiparous postmenopausal women
Mammary duct ectasia will show _ on biopsy
Mammary duct ectasia will show chronic inflammation (plasma cells) on biopsy
Fat necrosis of the breast is most commonly caused by _
Fat necrosis of the breast is most commonly caused by trauma
Fat necrosis is usually identified via _
Fat necrosis is usually identified via mass on physical exam or abnormal calcification on mammography (due to saponification)
Biopsy of fat necrosis will show _
Biopsy of fat necrosis will show necrotic fat associated with calcifications and giant cells
_ is the most common change in the premenopausal breast; usually thought to be hormone mediated
Fibrocystic change is the most common change in the premenopausal breast; usually thought to be hormone mediated
Fibrocystic change is _ and will present as _
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
Gross pathology of a breast with fibrocystic change would show _ cysts
Gross pathology of a breast with fibrocystic change would show cysts with blue-dome appearance
Fibrocystic change on its own is benign; however, some fibrocystic-related changes are associated with increased risk of _
Fibrocystic change on its own is benign; however, some fibrocystic-related changes are associated with increased risk of invasive carcinoma
Fibrosis, cysts, and apocrine metaplasia causes (added risk/ no added risk) for invasive carcinoma
Fibrosis, cysts, and apocrine metaplasia causes no increased risk for invasive metaplasia
Fibrocystic-related ductal hyperplasia and sclerosing adenosis carries a _ risk of invasive carcinoma
Fibrocystic-related ductal hyperplasia and sclerosing adenosis carries a 2x increased risk of invasive carcinoma
Fibrocystic-related atypical hyperplasia is associated with _ risk of invasive carcinoma
Fibrocystic-related atypical hyperplasia is associated with 5x increased risk of invasive carcinoma
Intraductal papilloma is _
Intraductal papilloma is papillary growth (fingerlike projection) into a large duct
_ is characterized by fibrovascular projections lined by epithelial (luminal) and myoepithelial cells
Intraductal papilloma is characterized by fibrovascular projections lined by epithelial (luminal) and myoepithelial cells
Intraductal papilloma classically presents as _
Intraductal papilloma classically presents as bloody nipple discharge in premenopausal woman
Bloody nipple discharge in a premenopausal woman is more likely to be (intraductal papilloma/ papillary carcinoma)
Bloody nipple discharge in a premenopausal woman is more likely to be intraductal papilloma
Bloody nipple discharge in a postmenopausal woman is more likely to be (intraductal papilloma/ papillary carcinoma)
Bloody nipple discharge in a postmenopausal woman is more likely to be papillary carcinoma
The most common benign neoplasm of the breast is _
The most common benign neoplasm of the breast is fibroadenoma
* It is usually seen in premenopausal women
* Benign with no increased cancer risk
Fibroadenoma is a _
Fibroadenoma is a tumor of the fibrous tissue and glands
A fibroadenoma presents clinically as _
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
_ is a fibroadenoma-like tumor with an overgrowth of the fibrous component with characteristic “leaf-like” projections seen on biopsy
Phyllodes tumor is a fibroadenoma-like tumor with an overgrowth of the fibrous component with characteristic “leaf-like” projections seen on biopsy
Phyllodes tumor is more commonly seen in (younger/older) women
Phyllodes tumor is more commonly seen in older (postmenopausal) women
* It can be malignant in some cases
* Large and grow fast
Breast cancer is the _ most common cause of cancer mortality in women
Breast cancer is the 2nd most common cause of cancer mortality in women
* It is the most common carcinoma in women by incidence
Risk factors for breast cancer
Risk factors for breast cancer:
* Female gender
* Age
* Early menarche/late menopause
* Obesity
* Atypical hyperplasia
* First degree relative with breast cancer
_ is a malignant proliferation of cells in ducts with no invasion of the basement membrane
Ductal carcinoma in situ (DCIS) is a malignant proliferation of cells in ducts with no invasion of the basement membrane
DCIS is often detected with _
DCIS is often detected with calcification on mammography; DCIS does not usually produce a mass
Mammographic calcifications can be associated with benign conditions such as fibrocystic changes of _ and _
Mammographic calcifications can be associated with benign conditions such as fibrocystic changes of sclerosing adenosis and fat necrosis
DCIS _ type is characterized by high-grade cells with necrosis and dystrophic calcification in the center of ducts
DCIS comedo type is characterized by high-grade cells with necrosis and dystrophic calcification in the center of ducts
_ is DCIS that extends up the ducts to involve the skin of the nipple
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
The most common type of invasive carcinoma of the breast is _
The most common type of invasive carcinoma of the breast is invasive ductal carcinoma
* Accounts for > 80% of cases
Invasive carcinoma classically forms _ structures
Invasive carcinoma classically forms duct-like structures
Clinically, we can usually detect masses that are _ cm or greater; mammography can find masses _ cm and greater
Clinically, we can usually detect masses that are 2 cm or greater; mammography can find masses 1 cm and greater
Biopsy of invasive ductal carcinoma will show _
Biopsy of invasive ductal carcinoma will show duct-like structures in a desmoplastic stroma
Tubular carcinoma is a form of IDC that is characterized by _
Tubular carcinoma is a form of IDC that is characterized by well-differentiated tubules that lack myoepithelial cells
* Relatively good prognosis
Biopsy of _ shows “tumor cells floating in a mucus pool”
Biopsy of mucinous carcinoma shows “tumor cells floating in a mucus pool”
* Carcinoma with abundant extracellular mucin
* Older women, relatively good prognosis
_ is a form of IDC that is characterized by large, high-grade cells growing in sheets with associated lymphocytes and plasma cells
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
IDC that spreads into the dermal lymphatics is called _
IDC that spreads into the dermal lymphatics is called inflammatory carcinoma
Inflammatory carcinoma will present as _
Inflammatory carcinoma will present as inflamed, swollen breast with no discrete mass
* Can be mistaken for acute mastitis
* Poor prognosis
Malignant proliferation of cells in the lobules with no invasion of the basement membrane is called _
Malignant proliferation of cells in the lobules with no invasion of the basement membrane is called lobular carcinoma in situ
LCIS is usually detected on _
LCIS is usually detected incidentally on biopsy
* Does not produce a mass or calcifications
Lobular carcinoma in situ is characterized by _ cells
Lobular carcinoma in situ is characterized by dyscohesive cells lacking E-cadherin protein
* Often multifocal and bilateral
Treatment for LCIS is _
Treatment for LCIS is tamoxifen to reduce the risk of carcinoma
Invasive lobular carcinoma grows in _ pattern
Invasive lobular carcinoma grows in single file pattern
* Signet-ring cells
* No duct formation because of lack of E-cadherin
_ is the most important factor for breast cancer prognosis
Metastasis is the most important factor for breast cancer prognosis
* However, most patients present before metastasis occurs
Given that metastasis is not common at presentation, _ becomes the most useful prognostic factor of breast cancer
Given that metastasis is not common at presentation, spread to axillary lymph nodes becomes the most useful prognostic factor of breast cancer
We use _ , a special kind of biopsy that allows us to take only affected axillary lymph nodes
We use sentinel lymph node biopsy , a special kind of biopsy that allows us to take only affected axillary lymph nodes
The most important breast cancer markers to predict response to treatment include _ , _ , and _
The most important breast cancer markers to predict response to treatment include estrogen receptor (ER) , progesterone receptor (PR) , and HER2/neu gene amplification
Presence of ER and PR is associated with response to antiestrogenic agents like _
Presence of ER and PR is associated with response to antiestrogenic agents like tamoxifen
HER2/neu amplification is associated with response to _
HER2/neu amplification is associated with response to trastuzumab
HER2/neu is a type of _ present on the cell surface
HER2/neu is a type of growth factor present on the cell surface
Triple negative breast cancer tumors are negative for _ , _ , _
Triple negative breast cancer tumors are negative for ER , PR , HER2/neu
* Have a poor prognosis
* AA women at increased propensity
_ and _ are the two most important single gene mutations associated with hereditary breast cancer
BRCA1 and BRCA2 are the two most important single gene mutations associated with hereditary breast cancer
(BRCA1/BRCA2) mutation is associated with breast and ovarian carcinoma
BRCA1 mutation is associated with breast and ovarian carcinoma
(BRCA1/BRCA2) is associated with breast carcinoma in males
BRCA2 is associated with breast carcinoma in males
Breast cancer in males usually presents as _
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
The most common histological subtype of male breast cancer is _
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
Male breast cancer is associated with BRCA2 mutations and _ syndrome
Male breast cancer is associated with BRCA2 mutations and Klinefelter syndrome
Sensation of fullness, firm “wooden-log” mass, mobile mass, well-circumscribed
Sensation of fullness, firm “wooden-log” mass, mobile mass, well-circumscribed: phyllodes tumor
Fat necrosis
Ductal hyperplasia and sclerosing adenosis are (non-proliferative/proliferative) fibrocystic changes in the breast
Ductal hyperplasia and sclerosing adenosis are proliferative fibrocystic changes in the breast
Fibroadenomas arise from _ in the inner quadrants of the breast
Fibroadenomas arise from intralobular stroma in the inner quadrants of the breast
* Rubbery, mobile masses
Histopathology of fibroadenomas will show _
Histopathology of fibroadenomas will show proliferation of glands and stroma; no cellular atypia
Phyllodes tumors arise from the _
Phyllodes tumors arise from the intralobular stroma
_ is a cyst consisting of milk that arises from the mammary glands when milk flow is obstructed
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
_ is the benign enlargement of breast tissue in males
Gynecomastia is the benign enlargement of breast tissue in males
Gynecomastia is caused by a relative increase in _ ratio
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)
Gynecomastia on histology will appear with _
Gynecomastia on histology will appear with proliferation of branching, intermediate-sized ducts; ductal epithelial hyperplasia; loose stroma
Favorable histology of invasive ductal carcinoma is _
Favorable histology of invasive ductal carcinoma is tubular or mucinous carcinoma
Unfavorable histology of invasive ductal carcinoma is _
Unfavorable histology of invasive ductal carcinoma is metaplastic or inflammatory carcinoma
The second most common type of breast cancer is _
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)
Medullary carcinoma is often _ grade with _ prognosis
Medullary carcinoma is often high grade with relatively good prognosis
* Slow growing, does not spread beyond the breast
Peu d’orange sign is associated with _
Peu d’orange sign is associated with inflammatory breast cancer
Inflammatory carcinoma with tumor cells in dermal lymphatic spaces
BRCA1 gene is _
BRCA1 gene is 17q21
BRCA2 gene is _
BRCA2 gene is 13q12
Fine needle aspiration (FNA) vs core-needle biopsy
FNA: fluid masses
Core needle: solid masses
TMN classification is based on _
TMN classification is based on tumor size, lymph nodes, metastasis
Stages of breast cancer
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
Mastectomy is _
Lumpectomy is _
Mastectomy is removal of one or both breasts
Lumpectomy is segmental mastectomy
_ is a selective estrogen receptor modulator that can be used to treat ER positive breast cancers
Tamoxifen is a selective estrogen receptor modulator that can be used to treat ER positive breast cancers
Tamoxifen causes an increased risk of _ cancer
Tamoxifen causes an increased risk of endometrial cancer
* Receptor agonism in the uterus
_ is a monoclonal antibody that blocks proliferative signal transduction pathway initiated by HER2 receptor binding
Trastuzumab is a monoclonal antibody that blocks proliferative signal transduction pathway initiated by HER2 receptor binding
Side effects of trastuzumab:
Side effects of trastuzumab:
* Cardiotoxicity
* Fever, infection
* Cough
* Headache
* Insomnia
* Rash
