Breast Pathology Flashcards
Galactorrhea
milk production outside of lactation
- not a symptom of breast cancer
- can be due to nipple stimulation, prolactinoma
Acute Mastitis
bacterial infection of breast (staph aureus)
- associated with breast feeding (fissures)
- erythematous breast with purulent nipple discharge (can progress to abscess formation)
- continued drainage and tx with dicloxacillin
Periductal mastitis
inflammation of subareolar ducts –> smokers
- relative Vit A deficiency –> squamous metaplasia of lactiferous ducts –> subareolar mass with nipple retraction
Mammary Duct Ectasia
inflammation with dilation of subareolar ducts
- presents as periareolar mass with greenish-brown discharge
- chronic inflammation with plasma cells
Fat Necrosis
necrosis of breast fat –> usually related to trauma
- abnormal calcification on mammography (saponification)
- necrotic fat with associated calcifications and giant cells
Fibrocystic change
development of fibrosis and cysts in breast –> premenopasual breast –> hormone related
- vague irregularity –> lumpy bumpy breast
- cysts have blue-dome appearance on gross exam
1. Apocrine metaplasia -> no risk of carcinoma
2. Ductal hyperplasia/sclerosing adenosis -> increased risk
3. Atypical hyperplasia -> really increased risk
Intraductal Papilloma
papillary growth into large duct
- fibrovascular projections lined by epithlelium and myoepithelial cells
- bloody nipple discharge in premenopausal women
- MUST be distinguished from papillary carcinoma
Papillary Carcinoma
fibrovascular projections WITHOUT myoepithelial cells
- risk increases with age, so generally seen in postmenopausal women
Fibroadenoma
tumor of fibrous tissue and glands
- most common BENIGN neoplasm of breast
- well-circumscribed, mobile marble-like mass (rubbery white)
- estrogen sensitive (grows during pregnancy)
Phyllodes Tumor
fibroadenoma-like tumor with overgrowth of fibrous component –> ‘leaf-like’ projections on biopsy
- post-menopausal women
- tend to skip lymph nodes -> hematogenously
Breast cancer basic principles
most common carcinoma in women
- related to estrogen exposure
- age, female, early menarche, late menopause, obesity
Ductal Carcinoma In Situ
malignant proliferation of cells in ducts with NO invasion of basement membrane
- detected on mammography as calcification (not usually a mass)
- biopsy = necessary to distinguish between benign and malignant
COMEDO type = high-grade cells with necrosis and dystrophic calcification
Paget disease of breast
DCIS that extends up ducts to involve skin of nipple
- presents with nipple ulceration and erythema
- associated with underlying carcinoma
Invasive ductal carcinoma
invasive carcinoma that forms duct-like structures
- mass detected by physical/mammography
- advanced tumors may dimple skin or retract nipple
Biopsy -> desmoplastic stroma
Tubular Carcinoma
characterized by well-differentiated tubules that lack myoepthelial cells
- good prognosis
Mucinous Carcinoma
characterized by carcinoma with abundant extracellular mucin
- “tumor cells floating in mucus pool”
- older women -> good prognosis
Medullary Carcinoma
characterized by large, high grade cells growing in sheets with associated lymphocytes and plasma cells
- well-circumscribed mass
- increased incidence with BRCA-1
Inflammatory Carcinoma
carcinoma with dermal lymphatics –> plugs lymphatics
- inflammed, swollen breast with no discrete mass –> can be mistaken for acute mastitis
- poor prognosis
Lobular Carcinoma In Situ
malignant proliferation of cells in lobules with no invasion of basement membrane
- discovered incidentally on biopsy
- dyscohesive cells lacking E-cadherin –> multifocal and bilateral
- treated with tamoxifen
Invasive Lobular Carcinoma
invasive carcinoma that grows in single file pattern and may exhibit signet-ring morphology
- no duct formation –> lacks E-cadherin
Biggest risk facto
primary relative with premenopausal bilateral carcinoma
BRCA 1 and 2
Prognosis
metastasis is most important factor –> but most patients present before metastasis……..SO
- axillary lymph nodes spread is most USEFUL factor
- sentinel lymph node biopsy
Predictive factors
Estrogen Receptor, Progesterone Receptor, HER2/neu gene amplification
- ER and PR associated with response to antiestrogenic agents (tamoxifen)
- HER2/neu associated with response to transtuzumab (herceptin)
Triple Negative tumors have poor prognosis
Hereditary Breast Cancer
multiple first degree relative with breast cancer, tumor at early age, multiple tumors in single patient
BRCA 1 = breast and ovarian cancer
BRCA 2 = breast carcinoma in males
- after prophylactic mastectomy, SMALL risk is still there, it doesn’t not eliminate the risk
