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Repro/Endo FInal > breast pathology > Flashcards

breast pathology Flashcards

1
Q

where is the tissue of highest density in breast?

A

upper outer quadrant

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2
Q

milk production occurs in the….

A

terminal duct lobular unit

all are drained by collecting duct

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3
Q

all ducts and lobules in breast tissue have two epithelial layers…..

A

luminal cells (outer layer) - milk production

myoepithelial layer (inner layer) - contractile function

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4
Q

galactorrhea

A

production of milk NOT during lactation

caused by nipple stimulation, prolactinoma of anterior pituitary, and drugs

is NOT a symptom of breast cancer!

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5
Q

acute mastitis

A

bacterial infection of the breast due to staph aureus

mechanism = due to stress fissures from breast feeding that allow entry for microbes

• Warm erythematous breast, with purulent nipple discharge

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6
Q

how to treat acute mastitis?

A

drainage and dicloxacillin

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7
Q

periductal mastitis

A

inflammation of subareolar ducts that causes subareolar mass with nipple retraction (fibrosis)

seen in smokers
• Smoking causes vitamin A deficiency –> specialized epithelium undergoes keratinizing squamous metaplasia and keratin blocks the duct

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8
Q

mammary duct ectasia

A

inflammation and dilatation of subareolar duct

• Classically in multiparous(multiple births) post-menopausal women

  • Periareolar mass with Green brown nipple discharge*** gives away that it isn’t cancer
  • Biopsy shows chronic inflammation with plasma cells
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9
Q

fat necrosis

A

necrosis of breast fat, usually due to trauma

Presents as a mass on exam or calcification (due to saponification) on mammography
• Biopsy shows necrotic fat with associated calcifications and giant cells

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10
Q

Lymphocytic Mastopathy

Sclerosing Lymphocytic Lobulitis

A
  • Single or multiple very hard masses made of collagenized stroma surrounding atrophic ducts and lobules with lymphocyte infiltrate
  • Common in T1 Diabees and autoimmune thyroid disease
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11
Q

granulomatous mastitis

A

Can be caused by granulomatous diseases (wegener, sarcoid) or infection

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12
Q

fibrocystic changes

A

fibrosis, cysts, and adenosis, due to hormone imbalance; presents as irregular “lumpy breast” usually in upper outer quadrant

Occurs in most breasts between 20-40 years age

  • Proliferative without atypia = Fibrosis, cysts, and apocrine metaplasia = no increased risk of cancer
  • Calcifications are dark purple chunks
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13
Q

sclerosing adenosis

A

benign, proliferation of terminal duct lobule = increased number of acini; multiple firm nodules/cysts; can have calcifications

2 cell layers are present so it is not carcinoma

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14
Q

if two cell layers are present it is not ____

A

a carcinoma

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15
Q

when fibrocystic changes show atypical hyperplasia –>

A

increased risk 5x of carcinoma

o Acquired loss of 16q and 17p; Clonal proliferation with some features of carcinoma in situ

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16
Q

o Atypical ductal hyperplasia

A

monomorphic luminal cells, evenly spaced with peripheral slit like spaces

only partially involving ducts

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17
Q

atypical lobular hyperplasia

A

small monomorphic round cells in lumens; like LCIS but do not fill >50% of acini in a lobule

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18
Q

Intraductal Papilloma

A

papillary growth in large duct near nipple, seen as fibrovascular projections lined by luminal and myoepithelial cells
• Presents as bloody discharge in premenopausal women; usually small/cant feel mass

• **must distinguish from papillary carcinoma (doesnt have underlying myoepithelial cells) which can also present as bloody nipple discharge

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19
Q

papillary carcinoma

A

fibrovascular projections lined by epithelial cells without underlying myoepithelial cells; common in older age

only 1 cell layer type

20
Q

fibroadenoma

A

benign, young women tumor of fibrous tissue and glands; multiple/bilateral

• well-circumscribed rubbery mobile mass that is estrogen sensitive (grows in pregnancy/painful during menses); no risk of carcinoma

21
Q

phyllodes tumor

A

fibroadenoma-like tumor; leaf-like projections; older women (60+); No skin change; Can be malignant; infiltrative borders
• increased stromal cellularity, pleomorphism, and mitoses; treat w wide excision

22
Q

which do you treat with wide excision: fibroadenoma or phyllodes tumor?

A

phyllodes tumor

23
Q

BOTH fibroadenoma and phyllodes tumor….

A

*both fibroadenoma and phyllodes are biphasic (both have epithelial and stromal overgrowth);
AND
arise INTRAlobular

24
Q

risk factors for breast cancer

A

• Risk factors: female, age, lifetime estrogen exposure (early menarche/late menopause), obesity, first degree family history

25
Q

most common mutation in sporadic breast cancer?

A

p53

26
Q

DCIS

A

Ductal Carcinoma In Situ – malignant proliferation in ducts with no invasion of BM; usually not a mass

detected as calcification on mammography

only THAT breast is at risk of carcinoma

27
Q

two types of DCIS

A

• Comedo subtype = high grade pleomorphic cells, ducts with central necrosis, and calcifications; necrotic cells can be extruded from ducts

  • Noncomedo – lack either high grade nuclei or necrosis; cribiform/cookie cutter, solid, micropapillary or papillary
  • **nuclear grade and necrosis are best indicators of recurrence and progression to invasion
28
Q

Paget disease of the breast

A

malignant large clear cells from underlying DCIS that extends up the ducts to involve the nipple – almost always invasive

unilateral scaly (eczema) nipple ulceration and erythema; associated with underlying carcinoma
o	ER (-); HER2 overexpressed
29
Q

LCIS

A

Lobular Carcinoma In Situ – malignant proliferation of cells in lobules with no BM invasion; DOESNT produce mass or calcification; always found incidentally

  • dyscohesive uniform round cells lacking E-cadherin adhesion protein (acquired loss); Mucin + signet ring cells
  • Often multifocal and bilateral risk; contralateral breast IS at risk
  • Treat: tamoxifen (reduces subsequent carcinoma risk) and watch close; low risk of progression to invasive carcinoma
30
Q

most useful factor to predict progression of in situ to invasive carcinoma?

A

metastasis to axillary lymph nodes

31
Q

presence of ER and PR in carcinoma is associated with…

A

response to antiestrogenic agents
= response to TAMOXIFEN

both receptors are in nucleus

32
Q

presence of HER2/neu in carcinoma is associated with

A

response to trastuzumab (antibody against HER2 receptor which is on cell surface)

33
Q

triple negative tumors

A

are negative for all: ER, PR, and HER2/neu
VERY poor prognosis

increased incidence in AA women

unresponsive to drugs - must use chemo

34
Q

ER ___ HER2neu ____?

1) young women, nonwhite, tp53 mutation
2) young women, BRCA1 mutation, AA and hispanic
3) BRCA2 mutation, older men and women

A

1 ER+ or -, HER2neu +
2 ER-, HER2neu -
3 ER+, HER2neu -

35
Q

invasive ductal carcinoma

A

mass of duct structures; irregular borders

IDC – NST (non special type)
o High grade – poorly differentiated, few or no tubules, pleomorphism and mitoses
o Low grade – well differentiated, lots of tubules still, no nuclear pleomorphism, low mitoses

• Advanced tumors can cause dimpled skin or retracted nipple

36
Q

tubular carcinoma

A

well-differentiated tubules that lack myoepithelial cells; ER+/HER2neu-

good prognosis

37
Q

types of invasive breast cancer associated with ER-/HER2-

A

medullary
cystic
secretory
metaplastic

38
Q

types of invasive breast cancer associated with HER2+ (ER + or -)

A

apocrine

39
Q

types of invasive breast cancer associated with ER+/HER2-

A

lobular, tubular, and mucinous

40
Q

• Mucinous carcinoma

A

tumor cells floating in abundant mucus; usually older (70yo+); good prognosis (better than IDCNST)

41
Q

• Medullary carcinoma

A

– large, high grade cells growing in sheets with associated lymphocytes and plasma cells; well circumscribed mass that can mimic fibroadenoma on mammography; lack ER and PR; good prognosis; increased in BRCA1 carriers

42
Q

• Inflammatory carcinoma

A

carcinoma in dermal lymphatics; presents as inflamed swollen breast (blocked lymph drainage) with no discrete mass; can be mistaken for acute mastitis; poor prognosis

43
Q

IDC-NST, micropapillary and lobular

order from best px to worst px

A

lobular > IDC-NST > micropapillary

44
Q

Invasive Lobular Carcinoma

A

grows in a single-file pattern; cells may display signet-ring morphology; No duct formation due to lack of E-cadherin

45
Q

hereditary breast cancer
classic features?
common mutations?

A 
classic features: multiple first-degree relatives with breast cancer, tumor at early age (premenopausal), and multiple tumors 
•	tP53 mutations common
•	BRCA1 (17q21)= breast and ovarian 
•	BRCA2  (13q12)= male breast carcinoma
•	CHEK2
46
Q

male breast cancer

A

Rare; presents as sub-areolar mass in older males; may make nipple discharge; usually subtype is invasive ductal carcinoma
• Associated with bRCA2 mutation and klinefelter syndrome; and older age! (>70)

47
Q

what is a main cause of gynecomastia?

A

Chronic alcoholism can cause micronodular sclerosis and can lead to impaired estrogen metabolism and gynecomastia!

Repro/Endo FInal (23 decks)

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