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CNS and Skin Pathology > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

What is the anatomical composition of the breast?

A

A modified sweat gland adapted for milk production.

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2
Q

How are breast ducts and glands organized?

A

Into small subdivisions called lobules.

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3
Q

What are the primary components of the breast stroma?

A

Mostly fat plus a network of thin fibrous ligaments.

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4
Q

What hormones affect breast tissue and how?

A

Estrogen and progesterone; they account for the increase in size at puberty and changes during the menstrual cycle.

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5
Q

What is the primary lymphatic drainage pathway for the breast?

A

To the axillary nodes.

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6
Q

Where do lymphatics from the medial aspect of the breast drain?

A

Into the internal mammary nodes.

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7
Q

What changes occur in the breast during pregnancy?

A

Milk-secreting cells develop (prolactin-induced) and secretion begins immediately after birth; glandular epithelium atrophies if breastfeeding fails to occur.

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8
Q

What is acute mastitis and what are its common causes?

A

Acute infection of the breast, typically caused by staphylococcus or streptococcus organisms.

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9
Q

How does staphylococcus infection in the breast typically present?

A

Produces an abscess.

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10
Q

How does streptococcus infection in the breast typically present?

A

Produces generalized swelling, tenderness, and pain.

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11
Q

What is chronic breast inflammation often associated with?

A

Often associated with fibrocystic change.

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12
Q

What is fat necrosis of the breast and what can cause it?

A

An unusual type of necrosis occurring only in fat, often due to trauma.

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13
Q

What is fibrocystic change in the breast?

A

Consists of fibrosis, chronic inflammation, and cystic dilation of breast ducts.

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14
Q

What are the classifications of fibrocystic change?

A

Non-proliferative and proliferative (usual and atypical).

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15
Q

How common is fibrocystic change in women?

A

50% of women have some degree of fibrocystic change, but only about one-quarter of these patients have any symptoms.

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16
Q

What are the usual characteristics of a fibroadenoma?

A

A benign neoplastic lesion that is well-circumscribed and encapsulated.

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17
Q

What is a phyllodes tumor and how does it differ from a fibroadenoma?

A

A spectrum from benign to borderline to malignant, differing in histological features from a fibroadenoma.

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18
Q

What are the differences between fibroadenoma and fibrocystic change?

A

Fibroadenoma is a well-circumscribed, encapsulated, benign neoplastic lesion; fibrocystic change is a diffuse, non-neoplastic lesion, often cystic and associated with inflammation.

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19
Q

What are the common malignant tumors of the breast?

A

Invasive ductal carcinoma and invasive lobular carcinoma.

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20
Q

What is the most common subtype of invasive ductal carcinoma?

A

No specific type (NST).

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21
Q

What is the typical origin of breast cancer?

A

From the inner lining of breast ducts (ductal carcinomas) or breast lobules (lobular carcinomas).

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22
Q

What are the key epidemiological facts about breast cancer?

A

The most commonly diagnosed cancer in women worldwide and the 5th leading cause of cancer death.

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23
Q

What are some key risk factors for breast cancer?

A

Female sex, increasing age, race (higher incidence in Caucasians), increased exposure to estrogen, higher socioeconomic status, significant radiation exposure, family history, BRCA1 & 2 gene mutations, smoking, alcohol intake, sedentary lifestyle, diet.

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24
Q

What are some common clinical presentations of breast cancer?

A

Small breast lump, breast mass with or without skin changes, peri-areolar eczematous changes, bloody nipple discharge, enlarged breast with signs of inflammation, axillary lump, distant metastases.

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25
Q

What is the “triple test” in diagnosing breast lesions?

A

Imaging, clinical examination, and biopsy.

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26
Q

What imaging techniques are critical for diagnosing breast disease?

A

Mammography, ultrasonography, and MRI.

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27
Q

What is the purpose of a vacuum-assisted core biopsy?

A

To obtain tissue samples for diagnosis.

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28
Q

What are the World Health Organization’s recommendations for mammography screening programs?

A

It needs to cover at least 70% of the population at risk.

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29
Q

At what age is annual screening mammography recommended for the general population?

A

Starting at age 40 for the general population.

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30
Q

What is the role of molecular classification in breast cancer?

A

Guides treatment use and results in targeted use of specific treatments, reducing toxicity.

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31
Q

What are the five IHC markers used for molecular classification of breast cancer?

A

ER, PR, HER2, CK5/6, EGFR.

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32
Q

What are the biomarker profiles for Luminal A breast cancer?

A

ER+, PR+, HER2-, Ki67 (<14%).

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33
Q

What are the biomarker profiles for Luminal B breast cancer?

A

ER+, PR+, HER2+, or ER+, PR+, HER2-, Ki67 (>14%).

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34
Q

What are the biomarker profiles for HER2 breast cancer?

A

ER-, PR-, HER2+.

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35
Q

What are the biomarker profiles for triple-negative breast cancer?

A

ER-, PR-, HER2-, CK5/6+, EGFR+.

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36
Q

What are the typical metastasis sites for Luminal A breast cancer?

A

Most commonly to bone; least likely to brain, liver, or lung.

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37
Q

What treatments are effective for Luminal A breast cancer?

A

Good response to hormonal therapy.

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38
Q

What are the typical metastasis sites for Luminal B breast cancer?

A

Most commonly to bone, followed by liver and lung.

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39
Q

What treatments are effective for Luminal B breast cancer?

A

Benefits from chemotherapy and hormonal therapy.

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40
Q

What are the typical metastasis sites for HER2 breast cancer?

A

Most commonly to bone, brain, liver, and lung.

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41
Q

What treatments are effective for HER2 breast cancer?

A

Benefits from chemotherapy and HER2 targeted therapy.

42
Q

What are the characteristics of basal-like triple-negative breast cancer?

A

High grade, often affecting younger patients, benefits from chemotherapy.

43
Q

What gene mutations are commonly associated with the basal phenotype?

A

BRCA1 mutations.

44
Q

What is the role of BRCA1 and BRCA2 genes in breast cancer?

A

Tumor suppressor genes located on chromosomes 17 and 13.

45
Q

What is the significance of non-lethal genetic damage in carcinogenesis?

A

It is the basis of excessive cellular proliferation leading to tumorigenesis.

46
Q

What is clonal expansion in the context of tumorigenesis?

A

Expansion of a single mutated cell leading to a tumor.

47
Q

What are the targets of cancer-causing genetic damage?

A

Specific genes involved in cell proliferation and survival.

48
Q

What is multistep carcinogenesis?

A

The process involving multiple genetic mutations leading to cancer.

49
Q

How does genetic instability contribute to neoplasm development?

A

Leads to mutation accumulation and tumor development.

50
Q

What are the cumulative risks of developing breast cancer in BRCA1 and BRCA2 mutation carriers by age 70?

A

50–70% in BRCA1 carriers and 40-50% in BRCA2 carriers.

51
Q

What role do normal BRCA genes play in cell proliferation?

A

Inhibit cell proliferation.

52
Q

How does germline inheritance of BRCA mutations affect breast cancer risk?

A

Leads to increased breast cancer risk due to genomic instability.

53
Q

What happens when there is a loss of heterozygosity in BRCA mutation carriers?

A

Results in the cessation of growth-inhibiting functions.

54
Q

How does genomic instability influence cancer development?

A

Activates checkpoint mechanisms eliminating affected cells.

55
Q

What specific tissue factors in breast and ovary predispose to cancer in BRCA mutation carriers?

A

These factors predispose cells to prolonged viability and additional mutations.

56
Q

How do staph and strep infections in acute mastitis differ in presentation?

A

Staph usually produces an abscess, while strep produces generalized swelling and tenderness.

57
Q

What is the significance of the terminal duct lobular unit in breast anatomy?

A

The functional unit of breast tissue.

58
Q

What are the key features of chronic breast inflammation?

A

Often presents with pain and is associated with fibrocystic change.

59
Q

How does fat necrosis of the breast mimic cancer?

A

Mimics cancer but is due to trauma.

60
Q

What is the prevalence of symptomatic fibrocystic change in women?

A

50% of women experience fibrocystic change, but only one-quarter have symptoms.

61
Q

What is the difference between non-proliferative and proliferative fibrocystic change?

A

Non-proliferative has no increased cancer risk; proliferative has increased cancer risk.

62
Q

What is the increased cancer risk associated with atypical fibrocystic change?

A

Atypical fibrocystic change has a 5x increased risk of cancer.

63
Q

How is a fibroadenoma typically diagnosed?

A

By clinical examination and imaging.

64
Q

What are the histological features of a fibroadenoma?

A

Well-circumscribed and encapsulated with proliferating epithelial and stromal elements.

65
Q

How does a benign phyllodes tumor differ histologically from a fibroadenoma?

A

Phyllodes tumor can range from benign to malignant and has different stromal characteristics.

66
Q

What is the significance of encapsulation in a fibroadenoma?

A

Indicates a benign nature with clear boundaries.

67
Q

What are the clinical features of invasive lobular carcinoma?

A

Presents as a breast mass, often with diffuse thickening.

68
Q

What percentage of breast cancers are invasive ductal carcinoma?

A

Approximately 70%.

69
Q

How is breast cancer incidence different across racial and ethnic groups?

A

Higher incidence in Caucasians.

70
Q

What lifestyle factors increase breast cancer risk?

A

Increased exposure to estrogen, higher socioeconomic status, significant radiation exposure.

71
Q

What dietary factors are associated with increased breast cancer risk?

A

High fat, high-calorie diets, intake of red meat, and low intake of fruits and vegetables.

72
Q

What role does family history play in breast cancer risk?

A

Mutations in BRCA1 & 2, p53, and CHEK2 genes increase risk.

73
Q

How do mutations in the p53 and CHEK2 genes influence breast cancer risk?

A

Significantly increase breast cancer risk.

74
Q

What are common symptoms that indicate breast cancer?

A

Small lump, skin changes, nipple discharge, axillary lump.

75
Q

How does mammography contribute to breast cancer diagnosis and management?

A

Essential for early detection and management.

76
Q

What are the benefits of mammography in high-risk populations?

A

Reduces mortality in high-risk populations.

77
Q

What is the role of ultrasonography in breast cancer diagnosis?

A

Assists in differentiating solid from cystic masses.

78
Q

What is the significance of MRI in breast cancer screening?

A

Provides detailed imaging for complex cases.

79
Q

How are calcifications assessed in breast biopsies?

A

To confirm adequate sampling.

80
Q

What is the purpose of the C5 scoring system in breast cytology?

A

Assesses the likelihood of malignancy.

81
Q

What factors contribute to the poor outcomes in male breast cancer?

A

Due to less frequent diagnosis and often more advanced stage at presentation.

82
Q

What is the role of exogenous estrogen in breast cancer risk?

A

Increases risk due to prolonged exposure.

83
Q

How does postmenopausal obesity contribute to breast cancer risk?

A

Increases estrogen levels, contributing to risk.

84
Q

What are the common sites of distant metastases in breast cancer?

A

Bone, brain, liver, and lung.

85
Q

How is hormonal therapy used in the treatment of Luminal A breast cancer?

A

Effective for ER+ and PR+ tumors.

86
Q

What are the distinguishing features of triple-negative breast cancer?

A

Lacks hormone receptors and HER2, more aggressive.

87
Q

How is HER2 targeted therapy used in breast cancer treatment?

A

Targets HER2-positive cancer cells.

88
Q

What is the clinical significance of CK5/6 and EGFR in basal-like breast cancer?

A

Indicative of basal-like subtype, aggressive behavior.

89
Q

What are the common genetic alterations in basal-like breast cancer?

A

Commonly involves BRCA1 mutations.

90
Q

How does CK5/6 positivity influence breast cancer classification?

A

Indicates a basal-like phenotype.

91
Q

What are the founder mutations of BRCA1 and BRCA2 in Ashkenazi Jews?

A

Common mutations increasing breast cancer risk.

92
Q

How does mutation of caretaker genes contribute to genetic instability?

A

Leads to genetic instability and increased mutation rate.

93
Q

What is the role of checkpoint mechanisms in genomic stability?

A

Eliminate cells with genomic instability.

94
Q

What factors facilitate the acquisition of mutations in BRCA mutation carriers?

A

Prolonged cell viability in breast and ovary increases mutation accumulation.

95
Q

What is the relationship between socioeconomic status and breast cancer risk?

A

Higher status associated with increased risk.

96
Q

How does the menstrual cycle influence breast tissue?

A

Influences cyclical changes in size and sensitivity.

97
Q

What are the primary imaging modalities used in the staging of breast cancer?

A

Mammography, ultrasonography, and MRI.

98
Q

How does hormone replacement therapy affect breast cancer risk?

A

Increases risk due to prolonged estrogen exposure.

99
Q

What is the relationship between alcohol intake and breast cancer risk?

A

Associated with increased breast cancer risk.

100
Q

How does sedentary lifestyle influence breast cancer risk?

A

Associated with increased breast cancer risk.

101
Q

What are the clinical implications of multicentric disease in breast cancer?

A

Indicates a higher likelihood of recurrence and metastasis.

102
Q

How is local recurrence managed in breast cancer patients?

A

Managed with surgery, radiation, and systemic therapies.

CNS and Skin Pathology (3 decks)

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