Breast Pathology

Question 1

Galactorrhea

Answer 1

milk production outside of lactation

• not a symptom of breast cancer
• can be due to nipple stimulation, prolactinoma

Question 2

Acute Mastitis

Answer 2

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

Question 3

Periductal mastitis

Answer 3

inflammation of subareolar ducts –> smokers

- relative Vit A deficiency –> squamous metaplasia of lactiferous ducts –> subareolar mass with nipple retraction

Question 4

Mammary Duct Ectasia

Answer 4

inflammation with dilation of subareolar ducts

• presents as periareolar mass with greenish-brown discharge
• chronic inflammation with plasma cells

Question 5

Fat Necrosis

Answer 5

necrosis of breast fat –> usually related to trauma

• abnormal calcification on mammography (saponification)
• necrotic fat with associated calcifications and giant cells

Question 6

Fibrocystic change

Answer 6

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

Question 7

Intraductal Papilloma

Answer 7

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

Question 8

Papillary Carcinoma

Answer 8

fibrovascular projections WITHOUT myoepithelial cells

- risk increases with age, so generally seen in postmenopausal women

Question 9

Fibroadenoma

Answer 9

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)

Question 10

Phyllodes Tumor

Answer 10

fibroadenoma-like tumor with overgrowth of fibrous component –> ‘leaf-like’ projections on biopsy

• post-menopausal women
• tend to skip lymph nodes -> hematogenously

Question 11

Breast cancer basic principles

Answer 11

most common carcinoma in women

• related to estrogen exposure
  
  • age, female, early menarche, late menopause, obesity

Question 12

Ductal Carcinoma In Situ

Answer 12

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

Question 13

Paget disease of breast

Answer 13

DCIS that extends up ducts to involve skin of nipple

• presents with nipple ulceration and erythema
• associated with underlying carcinoma

Question 14

Invasive ductal carcinoma

Answer 14

invasive carcinoma that forms duct-like structures
- mass detected by physical/mammography
- advanced tumors may dimple skin or retract nipple
Biopsy -> desmoplastic stroma

Question 15

Tubular Carcinoma

Answer 15

characterized by well-differentiated tubules that lack myoepthelial cells
- good prognosis

Question 16

Mucinous Carcinoma

Answer 16

characterized by carcinoma with abundant extracellular mucin

• “tumor cells floating in mucus pool”
• older women -> good prognosis

Question 17

Medullary Carcinoma

Answer 17

characterized by large, high grade cells growing in sheets with associated lymphocytes and plasma cells

• well-circumscribed mass
• increased incidence with BRCA-1

Question 18

Inflammatory Carcinoma

Answer 18

carcinoma with dermal lymphatics –> plugs lymphatics

• inflammed, swollen breast with no discrete mass –> can be mistaken for acute mastitis
• poor prognosis

Question 19

Lobular Carcinoma In Situ

Answer 19

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

Question 20

Invasive Lobular Carcinoma

Answer 20

invasive carcinoma that grows in single file pattern and may exhibit signet-ring morphology
- no duct formation –> lacks E-cadherin

Question 21

Biggest risk facto

Answer 21

primary relative with premenopausal bilateral carcinoma

BRCA 1 and 2

Question 22

Prognosis

Answer 22

metastasis is most important factor –> but most patients present before metastasis……..SO

• axillary lymph nodes spread is most USEFUL factor
• sentinel lymph node biopsy

Question 23

Predictive factors

Answer 23

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

Question 24

Hereditary Breast Cancer

Answer 24

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

Question 25

Male breast cancer

Answer 25

Rare, only 1% of breast cancers
- presents as subareolar mass in older males
- highest density of breast tissue is underneath nipple in males
- most common = invasive ductal carcinoma
BRCA 2 mutations or Klinefelter syndrome

Question 26

Angiosarcoma of breast

Answer 26

post-radiation dose –> black plaques

Question 27

Gynecomastia in older male

Answer 27

Cirrhosis of liver –> ductal hyperplasia (used to be treated with estrogen therapy)