Breast Pathology

Question 1

What are the three basic elements of breast?

Answer 1

skin/nipple
ducts/lobules
fibroadipose stroma

young - mostly fibrous stroma
older - largely adipose stroma

Question 2

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

Answer 2

the epithelia within the breast

Question 3

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

Answer 3

mastitis

fat necrosis

Question 4

What are the two major BENIGN tumors of the breast?

Answer 4

fibroadenoma

lipoma

Question 5

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

Answer 5

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

Question 6

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

Answer 6

in-situ

invasive

Question 7

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

Answer 7

atypical epithelial hyperplasia

Question 8

Uilateral bloody discharge…what’s the usual diagnosis?

Answer 8

intraductal papilloma

Question 9

What does a fibroadenoma look lke grossly?

Answer 9

circumscribe, rubbery, shite

Question 10

WHat does fibroadenoma look like microscopically?

Answer 10

staghorn branching ductal epithelium with bland stroma

Question 11

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

Answer 11

duct system - about 90%

Question 12

Describe the progression from hyperplasia to carcinoma

Answer 12

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

Question 13

What does lobular in situ caricnoma look like?

Answer 13

bland cells filling up the lobules with no acini

Question 14

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

Answer 14

DCIS - the same quadrant on the same breast

LCIS - BOTH breasts will have equal risk!

Question 15

So what is the treatment for LCIS?

Answer 15

usually bilateral mastectomy with chemo or radiation.

Question 16

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

Answer 16

usually less than 10 years

Question 17

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

Answer 17

over 15 years

Question 18

What quandrant is most common for cancer to arise?

Answer 18

upper outer quadrant (has the most breast tissue)

Question 19

Is mucinous carcinoma likely to metastasize?

Answer 19

nope - rarely dose

Question 20

What is Paget’s disease of the breast?

Answer 20

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

Question 21

What cancer can present like a mastitis?

Answer 21

inflammatory carcinoma

Question 22

What is the cause of the inflammation in inflammatory carcinoma?

Answer 22

the cancer cells plug up the lymphatics and impede drainage

Question 23

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

Answer 23

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

Question 24

What is the biggest risk factor for breast cancer?

Answer 24

primary relative (esp with BRCA1 or 2)

Question 25

What percent of breast cancer is familial?

Answer 25

only 5-19%

Question 26

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

Answer 26

56-85% lifetime risk for breast cancer

Question 27

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

Answer 27

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

Question 28

Why are younger breasts harder to screen?

Answer 28

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

Question 29

What percentage of suscicious mammograms actually end up being cancer?

Answer 29

only 25%

Question 30

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

Answer 30

open surgical biopsy

Question 31

What information does an open surgical biopsy give you?

Answer 31

tumor type
tumor size
status of biopsy margins
receptor specificities

Question 32

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

Answer 32

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

Question 33

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

Answer 33

axillary dissection lead to terrible lymphedema.

Question 34

Desribe stage I

Answer 34

tumor less than 2 cm, axillary nodes negative

Question 35

Stage II

Answer 35

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

Question 36

What is Stage III

Answer 36

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

Question 37

Stage IV?

Answer 37

metastatic

Question 38

When do we use radiation for breast cancer?

Answer 38

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

Question 39

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

Answer 39

70%

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

Question 40

What is the malignant equivalent of a fibroadenoma?

Answer 40

phylloides tumor

Question 41

How is phylloies different in terms of spread?

Answer 41

skips LNs and goes right to the lungs

Question 42

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

Answer 42

melanoma or angiosarcoma

Question 43

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

Answer 43

lymphedema from the radical mastectomies

Question 44

What do you see under histology in gynecomastia?

Answer 44

ductal hyperplasia and preiductal edema

Question 45

Breast cancer in males is almost always what type?

Answer 45

ductal - because tey don’t have lobules

Question 46

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

Answer 46

BRCA

Question 47

Is gynecomastia a risk factor for male breast cancer?

Answer 47

no