Breast Pathology Flashcards
What are the non-invasive malignant tumors of the breast?
DCIS
ComedoCA
Paget Disease
What are the invasive malignant tumors of the breast?
Invasive Ductal (76-79%)
Invasive lobular
Medullary
Inflammatory
What are the risk factors of Malignant Breast tumors?
Inc Estrogen exposure Inc number of menstrual cycles Older age at 1st live birth Obesity/High fat diet BRCA1 and BRCA2 gene African American Radiation exposure
What are the benign tumors of the Breast?
Fibroadenoma
Intraductal Papilloma
Phyllodes tumor
What are the common breast condtions?
Proliferative Br disease
Acute mastitis
Fat necrosis
Gynecomastia
What are the common traits of Malignant breast tumors?
Postmenopausal
Upper outer quadrant
Overexpression of est/progest receptors or HER-2
Triple Negative (ER-, PR-, and HER-) more aggressive
Axillary LN involvement indicating mets is MOST IMPORT prognostic factor
What is the common presentation of Breast CA?
Left Breast Upper outer quadrant Painless mass Skin dimpling, ulceration, nipple retraction Peau d'orange Abn Mammogram- Mass/density/microCa++
What is the most common route of spread of Breast CA?
Local: Skin, nipple, chest wall
Lymph: LN
Blood: lungs, liver, bones
What is the most important prognostic factor in Br CA?
LN status/Size/Grade
What is DCIS?
From ductal atypia
Fills ductal lumen
MicroCa++ on mammogram
Early malignancy w/out BM penetration
What is ComedoCA?
Subtype of DCIS
Ductal Caseous Necrosis
Central Necrosis surrounded by CA cells
What is Paget Disease?
Results from underlying DCIS
Eczematous patches on nipple
Paget cells: Large cells in epidermis w/ clear halo
What are the gross features of Invasive Ductal CA?
Firm, fibrous, Rock hard mass with sharp margins
MOST COMMON
WORST, MOST INVASIVE
What are the Micro features of Invasive Ductal CA?
Small, duct like, or glandular cells with collagenous stroma between cells
What are the features of Ivasive Lobular CA?
Bilateral with multiple lesions in same location
Orderly Row of Cells (indian file)
What are the Micro Features of Invasve Lobular CA?
Indian file strands of neoplastic cells
Small and uniform cells
Dense Stroma
What are the features of Medullary CA of breast?
Good prognosis
Fleshy, cellular, lymphocytic infiltrate.
What is charicteristic of Inflammatory CA of the breast?
1) Dermal lymphatic invasion
2) Peau d’orange
3) Neoplastic cells block lymphatic drainage
What is the most common Benign breast tumor in Pts
Fibroadenoma
What are the features of Fibroadenoma?
1) Not a precursor to Br CA
2) Small, mobile, firm mass with sharp edges
3) Size and tenderness increase when estrogen is higher
WHat are the Microscopic Features of Fibroadenoma?
Circumscribed Tumor
Fibroblastic Stroma enclosing glandular structures lined by Epithelium
What are the features of Intraductal Papilloma?
Beneath Areola
Small mass that grows in lactiferous ducts
Serous or bloody nipple discharge
1.5-2x inc risk for Br CA
What is a Phyllodes Tumor?
6th decade Periductal stomal cells grows fast Bulky mass with cysts Leaf-like projections Some may become malignant
What is the most common cause of breast lumps from 25 to MP?
Proliferative breast Disease
What are the features of Proliferative Br Disease?
Premenstrual Br Pain andMultiple lesions
Bilateral
Fluctuation in size
No inc risk of CA
What are the Histologic Types of Proliferative Br Disease?
SCLEROSING ADENOSIS
EPITHELIAL HYPERPLASIA
Fibrosis
Cystic Changes
What are the features of SCLEROSING ADENOSIS?
Inc acini and intralobular fibrosis
Associated with Ca++
Confused with CA
Inc Risk of CA devt
What are the features of EPITHELIAL HYPERPLASIA?
Pt >30yo
Inc in number of Epi cell layers in terminal duct lobules
Inc risk of CA with Atypical cells
What are the Most common microbes in Acute mastitis?
S. Aureus
Tx with Dicloxacillin and Continue Br Feeding
What are the causes of Gynecomastia?
Hyperestrogenism
Klinefelter syndrome
Drugs
What drugs cause Gynecomastia?
Spironolactone Marijuana Digitalis Estrogen Cimetidine Alcohol Heroin D2 antagonists Ketoconazole
What are the causes of Hyperestogenism?
Cirrhosis
Testicular tumor
Puberty
Old Age
