Breast Pathology Flashcards
Where can you find breast tissue?
Along the milkline
Functional unit of the breast
terminal duct-lobular unit
*glandular spaces in lobules have milk that drains into ducts
Layers of epithelium that line lobules and ducts
- Luminal cell layer
2. Myoepithelial cells
Galactorrhea (definition, causes, implications)
when milk is produced by the breast outside of normal lactation times due to <b>nipple stimulation, drugs or prolactinoma of anterior pituitary</b>
*not a sign of breast cancer
Acute Mastitis (definition, symptoms, treatment)
bacterial infection of the breast due to S. aureus possibly introduced during breast feeding
- warm, erythematous, purulent discharge
- treatment: drainage and <b>dicloxacillin</b>
Periductal Mastitis (& who it’s commonly seen in)
vitamin A deficiency causing cells to become squamous which plugs the subareolar ducts causing inflammation and nipple retraction
*usually present in smokers
Mammary Duct Ectasia (& who it’s commonly seen in)
build up of debris cauing inflammation with dilation of subareolar ducts and <b>green/brown discharge</b>
*arises in multiparous (>1 child) menopausal women
Fat Necrosis
necrosis from trauma leads to calcifications, from saponification, and giant cells
Fibrocystic changes
fibrosis and cyst development commonly seen in premenopausal breasts mediated by hormones
- cysts= <b>“blue-domed”</b>
- no increased risk for breast cancer
Does apocrine metaplasia increase risk for breast cancer?
No!
Do ductal hyperplasia and sclerosing adenosis increase risk for breast cancer?
Yes, doubles the risk
<b>sclerosing adenosis: proliferation of small ductules/acini in lobule
ductal hyperplasia: ducts are estrogen sensitive</b>
Does atypical hyperplasia increase the risk for breast cancer?
Yes, by 5 times
Intraductal Papilloma
papillary growth (fibrovascular projections lined by both epithelial and myoepithalial cells) into a large duct causing <b>bloody nipple discharge</b>
*occurs in premenopausal women
Intraductal Papilloma vs. Papillary Carcinoma
<b>Intraductal Papilloma</b>= in premenopausal women and projections contain both epithelial and myoepithelial cell layers
<b>Papillary Carcinoma</b>= in postmeopausal women and projections lack myoepithelial cell layer
Fibroadenoma
benign tumor of fibrous tissue and glands that is <b>estrogen sensitive</b> and becomes a marble-like mass that is well-circumscribed and mobile
*stroma proliferates and compresses the ducts
Phyllodes Tumor (& who it commonly affects)
<b>“leaf-like” projections</b> that resembles fibroadenomas due to overgrowth of fibrous component (stromal cells) but can be <b>malignant</b>
*common in postmenopausal women
Risk factors for breast cancer
- <b>estrogen exposure</b>
- female
- age
- early menarche/late menopause
- obesity (aromatization of androstenedione to estrone)
- <b>atypical hyperplasia</b>
- 1st degree relative with breast cancer (mother, daughter, sister)- represents
Ductal Carcinoma In Situ: “DCIS” ( & comedo type)
malignant proliferation of cells that <b>does not invade the basement membrane</b>
*<b>Comedo Type</b>: has high-grade cells with necrosis and dystrophic calcification in center of ducts
Paget Disease
DCIS to skin of nipple presenting as ulceration and erythema
*associated with <b>underlying carcinoma</b>
Invasive Ductal Carcinoma ( & subtypes)
most common type of invasive carcinoma that clinically forms duct-like structures and advanced tumors may cause skin dimpling and/or nipple retraction
<b> Subtypes:</b>
- <b>Tubular Carcinoma:</b> makes excess tubules, affects desmoplastic stroma and 2nd cell layer is missing (good prognosis)
- <b>Mucinous Carcinoma:</b> malignant cells in mucous pools commonly in elderly (excellent prognosis)
- <b>Medullary Carcinoma:</b> high grade malignant tumor cells with inflammatory cells (higher in those with BRCA1 mutation)
- <b>Inflammatory Carcinoma:</b> (peau d’orange) swollen, erythematous breast that does not resolve with antibiotics (as would Acute Mastitis) due to clinical and pathological inflammatory changes and dermal lymphatics cancer (poor prognosis)
Lobular Carcinoma In Situ: “LCIS” (& treatment)
multifocal and bilateral malignant proliferation of cells in lobules that <b> does not invade the basement membrane</b> due to <b>E-cadherin mutation</b>
- Treatment: <b>tamoxifen</b>
- <b>found by mistake</b> since it does not create masses or calcifications
- low risk for invasive carcinoma
Invasive Lobular Carcinoma
grows in single-file pattern or concentric circles (bull’s-eye appearance) without duct formation due to <b>lack of E-cadherin</b>
TNM staging
- metastasis= most <b>important</b>
* spread to axillary lymph nodes= most <b>useful</b>
How type of cancer can help us predict effectiveness of treatment:
ER and PR= response to <b>antiestrogenic agents (tamoxifen)</b>
HER2/neu= response to <b>transtuzumab</b>
BRCA1 vs. BRCA2
<b>BRCA1:</b> breast and ovarian carcinoma
<b>BRCA2:</b> breast carcinoma in males
Male Breast Cancer
subareolar mass under the nipple that may produce discharge and is associated with BRCA2 mutation or Klinefelter syndrome
What are estrogen and progesterone’s roles in breast development?
<b>Estrogen</b>: ductal and alveolar cell growth, fat and stroma
<b>Progesterone</b>: alveolar cell proliferation and lobule differentiation for milk production; swelling in secretory phase
Different nipple discharges and what causes them:
Milk: galactorrhea from stimulation of the nipple, certain drugs or prolactinoma
Blood: Intraductal Papilloma or Ductal Cancer
Purulent: acute mastitis
<b>Greenish-brown: Mammary Duct Ectasia/Plasma Cell Mastitis</b>
Mondor Disease
superficial thombophlebitis of veins overlying the breast presenting as a palpable, painful cord
Breast cancer spread
first via <b> lymphatics</b> to axillary nodes (from outer quadrant cancer) and internal mammary nodes (from inner quadrant cancer)
then <b>hematogenous</b> spread to lungs, bone, liver, brain, ovaries
inflammatory carcinoma of the breast
-peau d-orange (dimpled appearance)
Sentinel Node biopsy
- sampling of initial node that drains the tumor
- if <b>negative</b> then other nodes are usually negative
- if <b>positive</b> then 1/3 chance other nodes have metastases
What can cirrhosis lead to?
Pathologic Gynecomastia since the liver cannot metabolize estrogen
