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***MS 2 Unit 1 Pathology > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

Where can you find breast tissue?

A

Along the milkline

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2
Q

Functional unit of the breast

A

terminal duct-lobular unit

*glandular spaces in lobules have milk that drains into ducts

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3
Q

Layers of epithelium that line lobules and ducts

A
  1. Luminal cell layer

2. Myoepithelial cells

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4
Q

Galactorrhea (definition, causes, implications)

A

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

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5
Q

Acute Mastitis (definition, symptoms, treatment)

A

bacterial infection of the breast due to S. aureus possibly introduced during breast feeding

  • warm, erythematous, purulent discharge
  • treatment: drainage and <b>dicloxacillin</b>
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6
Q

Periductal Mastitis (&amp; who it’s commonly seen in)

A

vitamin A deficiency causing cells to become squamous which plugs the subareolar ducts causing inflammation and nipple retraction

*usually present in smokers

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7
Q

Mammary Duct Ectasia (&amp; who it’s commonly seen in)

A

build up of debris cauing inflammation with dilation of subareolar ducts and <b>green/brown discharge</b>

*arises in multiparous (>1 child) menopausal women

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8
Q

Fat Necrosis

A

necrosis from trauma leads to calcifications, from saponification, and giant cells

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9
Q

Fibrocystic changes

A

fibrosis and cyst development commonly seen in premenopausal breasts mediated by hormones

  • cysts= <b>“blue-domed”</b>
  • no increased risk for breast cancer
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10
Q

Does apocrine metaplasia increase risk for breast cancer?

A

No!

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11
Q

Do ductal hyperplasia and sclerosing adenosis increase risk for breast cancer?

A

Yes, doubles the risk

<b>sclerosing adenosis: proliferation of small ductules/acini in lobule
ductal hyperplasia: ducts are estrogen sensitive</b>

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12
Q

Does atypical hyperplasia increase the risk for breast cancer?

A

Yes, by 5 times

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13
Q

Intraductal Papilloma

A

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

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14
Q

Intraductal Papilloma vs. Papillary Carcinoma

A

<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

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15
Q

Fibroadenoma

A

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

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16
Q

Phyllodes Tumor (& who it commonly affects)

A

<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

17
Q

Risk factors for breast cancer

A
  • <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
18
Q

Ductal Carcinoma In Situ: “DCIS” ( & comedo type)

A

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

19
Q

Paget Disease

A

DCIS to skin of nipple presenting as ulceration and erythema

*associated with <b>underlying carcinoma</b>

20
Q

Invasive Ductal Carcinoma ( & subtypes)

A

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>

  1. <b>Tubular Carcinoma:</b> makes excess tubules, affects desmoplastic stroma and 2nd cell layer is missing (good prognosis)
  2. <b>Mucinous Carcinoma:</b> malignant cells in mucous pools commonly in elderly (excellent prognosis)
  3. <b>Medullary Carcinoma:</b> high grade malignant tumor cells with inflammatory cells (higher in those with BRCA1 mutation)
  4. <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)
21
Q

Lobular Carcinoma In Situ: “LCIS” (& treatment)

A

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
22
Q

Invasive Lobular Carcinoma

A

grows in single-file pattern or concentric circles (bull’s-eye appearance) without duct formation due to <b>lack of E-cadherin</b>

23
Q

TNM staging

A
  • metastasis= most <b>important</b>

* spread to axillary lymph nodes= most <b>useful</b>

24
Q

How type of cancer can help us predict effectiveness of treatment:

A

ER and PR= response to <b>antiestrogenic agents (tamoxifen)</b>

HER2/neu= response to <b>transtuzumab</b>

25
Q

BRCA1 vs. BRCA2

A

<b>BRCA1:</b> breast and ovarian carcinoma

<b>BRCA2:</b> breast carcinoma in males

26
Q

Male Breast Cancer

A

subareolar mass under the nipple that may produce discharge and is associated with BRCA2 mutation or Klinefelter syndrome

27
Q

What are estrogen and progesterone’s roles in breast development?

A

<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

28
Q

Different nipple discharges and what causes them:

A

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>

29
Q

Mondor Disease

A

superficial thombophlebitis of veins overlying the breast presenting as a palpable, painful cord

30
Q

Breast cancer spread

A

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

31
Q

inflammatory carcinoma of the breast

A

-peau d-orange (dimpled appearance)

32
Q

Sentinel Node biopsy

A
  • 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
33
Q

What can cirrhosis lead to?

A

Pathologic Gynecomastia since the liver cannot metabolize estrogen

***MS 2 Unit 1 Pathology (3 decks)

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