Breast Pathology Flashcards
What are the three basic elements of breast?
skin/nipple
ducts/lobules
fibroadipose stroma
young - mostly fibrous stroma
older - largely adipose stroma
What tissue in the breast makes about 90% of breast cancers?
the epithelia within the breast
WHat are two minor non-cystic breast issues we think about?
mastitis
fat necrosis
What are the two major BENIGN tumors of the breast?
fibroadenoma
lipoma
What is the single most common disease of the breast - 60% of women?
fibrocystic disease with cystic change and epithelial hyperplasia - may cause lumps, may be painful
The big bad entity is carcinoma. What are the two GENERAL flavors?
in-situ
invasive
Fibrocystic change is almost always benign, but can progress to carcinoma if associated with what?
atypical epithelial hyperplasia
Uilateral bloody discharge…what’s the usual diagnosis?
intraductal papilloma
What does a fibroadenoma look lke grossly?
circumscribe, rubbery, shite
WHat does fibroadenoma look like microscopically?
staghorn branching ductal epithelium with bland stroma
Where does most breast cancer occur - the duct system or the lobules?
duct system - about 90%
Describe the progression from hyperplasia to carcinoma
- normal duct
- hyperplasia of the epithelium
- hyperplasia becomes atrypical
- progresse sto carcinoma in situ
- breaks out and invades
- enters lymphatics and venous system - metastasize
What does lobular in situ caricnoma look like?
bland cells filling up the lobules with no acini
If you have DCIS, where is the risk for subsequent cancer? What about with LCIS?
DCIS - the same quadrant on the same breast
LCIS - BOTH breasts will have equal risk!
So what is the treatment for LCIS?
usually bilateral mastectomy with chemo or radiation.
How long does it typically take for DCIS to progress to invasive?
usually less than 10 years
How long does it typically take for LCIS to progress to invasive cancer?
over 15 years
What quandrant is most common for cancer to arise?
upper outer quadrant (has the most breast tissue)
Is mucinous carcinoma likely to metastasize?
nope - rarely dose
What is Paget’s disease of the breast?
it’s tumor infiltration of the nipple epidermis which presents as weeping and ulceration of the nipple Can be crusty.
What cancer can present like a mastitis?
inflammatory carcinoma
What is the cause of the inflammation in inflammatory carcinoma?
the cancer cells plug up the lymphatics and impede drainage
Where do most breast cancers drain to as far as lymph nodes?
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
What is the biggest risk factor for breast cancer?
primary relative (esp with BRCA1 or 2)
What percent of breast cancer is familial?
only 5-19%
What is the absolute risk for breast cancer in s BRCA1 carrier?
56-85% lifetime risk for breast cancer
Describe how breast cancer spreads in general and how this has changed treatment
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
Why are younger breasts harder to screen?
their breasts are more fibrous, which doesn’t work well with mammography - MRI probably better for them.
What percentage of suscicious mammograms actually end up being cancer?
only 25%
What is the gold standard for definitive diagnosis in breast acner?
open surgical biopsy
What information does an open surgical biopsy give you?
tumor type
tumor size
status of biopsy margins
receptor specificities
When is fine needle aspiration helpful and when is it not?
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
Why do we do sentinel node biopsy now instead of complete axillary dissection?
axillary dissection lead to terrible lymphedema.
Desribe stage I
tumor less than 2 cm, axillary nodes negative
Stage II
tumor size over 2 cm or positive, but ipsilateral mobile axillary nodes
What is Stage III
extensive axillary nodal disease, supraclaviular nod einvoelment, direct tumor extension to chest wall or skin, or inflammatory breast Ca
Stage IV?
metastatic
When do we use radiation for breast cancer?
used to be only for more advanced, but not we use it in in situ and early invasive in conjunction with lumpectomy
What percent of LN-negative disease will be cured by local therapy only?
70%
it’s impossible to predict which women will have micrometastases that are not detected at the time of diagnosis
What is the malignant equivalent of a fibroadenoma?
phylloides tumor
How is phylloies different in terms of spread?
skips LNs and goes right to the lungs
If you see black plaques on a previously-irradiated breast, what are the options?
melanoma or angiosarcoma
What post-surgical risk factor will further increase the likelihood of angiosarcoma?
lymphedema from the radical mastectomies
What do you see under histology in gynecomastia?
ductal hyperplasia and preiductal edema
Breast cancer in males is almost always what type?
ductal - because tey don’t have lobules
What is the likely mutation in a male with breast cancer?
BRCA
Is gynecomastia a risk factor for male breast cancer?
no
