Breast Pathology Flashcards

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1
Q

What are the three basic elements of breast?

A

skin/nipple
ducts/lobules
fibroadipose stroma

young - mostly fibrous stroma
older - largely adipose stroma

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2
Q

What tissue in the breast makes about 90% of breast cancers?

A

the epithelia within the breast

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3
Q

WHat are two minor non-cystic breast issues we think about?

A

mastitis

fat necrosis

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4
Q

What are the two major BENIGN tumors of the breast?

A

fibroadenoma

lipoma

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5
Q

What is the single most common disease of the breast - 60% of women?

A

fibrocystic disease with cystic change and epithelial hyperplasia - may cause lumps, may be painful

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6
Q

The big bad entity is carcinoma. What are the two GENERAL flavors?

A

in-situ

invasive

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7
Q

Fibrocystic change is almost always benign, but can progress to carcinoma if associated with what?

A

atypical epithelial hyperplasia

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8
Q

Uilateral bloody discharge…what’s the usual diagnosis?

A

intraductal papilloma

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9
Q

What does a fibroadenoma look lke grossly?

A

circumscribe, rubbery, shite

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10
Q

WHat does fibroadenoma look like microscopically?

A

staghorn branching ductal epithelium with bland stroma

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11
Q

Where does most breast cancer occur - the duct system or the lobules?

A

duct system - about 90%

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12
Q

Describe the progression from hyperplasia to carcinoma

A
  1. normal duct
  2. hyperplasia of the epithelium
  3. hyperplasia becomes atrypical
  4. progresse sto carcinoma in situ
  5. breaks out and invades
  6. enters lymphatics and venous system - metastasize
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13
Q

What does lobular in situ caricnoma look like?

A

bland cells filling up the lobules with no acini

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14
Q

If you have DCIS, where is the risk for subsequent cancer? What about with LCIS?

A

DCIS - the same quadrant on the same breast

LCIS - BOTH breasts will have equal risk!

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15
Q

So what is the treatment for LCIS?

A

usually bilateral mastectomy with chemo or radiation.

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16
Q

How long does it typically take for DCIS to progress to invasive?

A

usually less than 10 years

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17
Q

How long does it typically take for LCIS to progress to invasive cancer?

A

over 15 years

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18
Q

What quandrant is most common for cancer to arise?

A

upper outer quadrant (has the most breast tissue)

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19
Q

Is mucinous carcinoma likely to metastasize?

A

nope - rarely dose

20
Q

What is Paget’s disease of the breast?

A

it’s tumor infiltration of the nipple epidermis which presents as weeping and ulceration of the nipple Can be crusty.

21
Q

What cancer can present like a mastitis?

A

inflammatory carcinoma

22
Q

What is the cause of the inflammation in inflammatory carcinoma?

A

the cancer cells plug up the lymphatics and impede drainage

23
Q

Where do most breast cancers drain to as far as lymph nodes?

A

usualy to the axilla or supraclavicular region depending on where the cancer is

if the cancer is in the medial breast, it can do to the internal thoracic lymph node chain

24
Q

What is the biggest risk factor for breast cancer?

A

primary relative (esp with BRCA1 or 2)

25
Q

What percent of breast cancer is familial?

A

only 5-19%

26
Q

What is the absolute risk for breast cancer in s BRCA1 carrier?

A

56-85% lifetime risk for breast cancer

27
Q

Describe how breast cancer spreads in general and how this has changed treatment

A

multiple theories

can invade both locally and distantly - and distant metastases may develop despite small primary tumors and initially negative axillary lymph nodes

this means it’s better to to more conservative local surgery followed by systemic chemo

28
Q

Why are younger breasts harder to screen?

A

their breasts are more fibrous, which doesn’t work well with mammography - MRI probably better for them.

29
Q

What percentage of suscicious mammograms actually end up being cancer?

A

only 25%

30
Q

What is the gold standard for definitive diagnosis in breast acner?

A

open surgical biopsy

31
Q

What information does an open surgical biopsy give you?

A

tumor type
tumor size
status of biopsy margins
receptor specificities

32
Q

When is fine needle aspiration helpful and when is it not?

A

best use: confirming lcinically benign cyst disease or clinically obvious cancer

if it’s negative but there’s a suspicious lump of mammo finding, it’s not helpful and you’ll need a tissue biopsy

33
Q

Why do we do sentinel node biopsy now instead of complete axillary dissection?

A

axillary dissection lead to terrible lymphedema.

34
Q

Desribe stage I

A

tumor less than 2 cm, axillary nodes negative

35
Q

Stage II

A

tumor size over 2 cm or positive, but ipsilateral mobile axillary nodes

36
Q

What is Stage III

A

extensive axillary nodal disease, supraclaviular nod einvoelment, direct tumor extension to chest wall or skin, or inflammatory breast Ca

37
Q

Stage IV?

A

metastatic

38
Q

When do we use radiation for breast cancer?

A

used to be only for more advanced, but not we use it in in situ and early invasive in conjunction with lumpectomy

39
Q

What percent of LN-negative disease will be cured by local therapy only?

A

70%

it’s impossible to predict which women will have micrometastases that are not detected at the time of diagnosis

40
Q

What is the malignant equivalent of a fibroadenoma?

A

phylloides tumor

41
Q

How is phylloies different in terms of spread?

A

skips LNs and goes right to the lungs

42
Q

If you see black plaques on a previously-irradiated breast, what are the options?

A

melanoma or angiosarcoma

43
Q

What post-surgical risk factor will further increase the likelihood of angiosarcoma?

A

lymphedema from the radical mastectomies

44
Q

What do you see under histology in gynecomastia?

A

ductal hyperplasia and preiductal edema

45
Q

Breast cancer in males is almost always what type?

A

ductal - because tey don’t have lobules

46
Q

What is the likely mutation in a male with breast cancer?

A

BRCA

47
Q

Is gynecomastia a risk factor for male breast cancer?

A

no