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STEP 8: EndoRepro PATHOMA FA > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

Ddx of Nipple Retraction:

A

PERIDUCTAL MASTITIS

BREAST CANCER

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2
Q

What is the most common organism responsible for ACUTE MASTITIS?

A

S. aureus

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3
Q

Ddx of MASS in POST-MENOPAUSAL woman:

A

BREAST CANCER

MAMMARY DUCT ECTASIA

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4
Q

Pt is post-menopausal and has a bloody nipple discharge. What is the most likely cause?

A

PAPILLARY CARCINOMA

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5
Q

Pt is pre-menopausal and has bloody nipple discharge. What is the most likely cause?

A

INTRADUCTAL PAPILLOMA

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6
Q

What is the MOST common BENIGN breast neoplasm?

A

FIBROADENOMA

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7
Q

What is the most common tumor seen in PREMENOPAUSAL WOMEN?

A

FIBROADENOMA

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8
Q

Usually, metaplasias are pre-malignant in that it INCREASES the risk of developing future invasive carcinomas. Name 2 instances and 2 exceptions.

A

2 instances: BARRETTS ESOPHAGUS - nonciliated columnar cell with goblet cell metaplasia increases risk of ADENOCARCINOMA + LUNG squamous metaplasia increases risk of dysplasia + SQUAMOUS CELL CARCINOMA
2 exceptions: BENIGN PROSTATIC HYPERPLASIA + APOCRINE METAPLASIA FIBROCYSTIC CHANGE

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9
Q

What are the similarities/differences between FIBROADENOMA and PHYLLODES TUMOR?

A

SIMILARITY: Both are composed of FIBROUS + GLAND tissue although phyllodes is greater outgrowth of FIBROUS tissue
DIFFERENCES: Phyllodes more prevalent in post-menopausal + can become malignant. Fibro more prevalent in pre-menopausal + BENIGN

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10
Q

Is BREAST cancer generally more common in pre-menopausal or post-menopausal women? What is the 1 main exception?

A

More common in POST-MENOPAUSAL women

Exception = Genetic BREAST CANCER

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11
Q

What are 3 causes of GALACTORRHEA?

A

CAUSE 1: Excess nipple stimulation
CAUSE 2: Hyper-PRL secretion by Pituitary adenoma
CAUSE 3: DA Antagonist Drugs (anti-psychotics)

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12
Q

What is the most common cause of PERIDUCTAL MASTITIS? How?

A

SMOKING - Smokers have VitA deficiency -> Highly specialized epithelium in LACTIFEROUS ducts become squamous metaplasia -> Keratin plugs -> Inflammation behind the blockage

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13
Q

What is the most common age population of MAMMARY DUCT ECTASIA (Dilation)?

A

MULTIPAROUS POST-MENOPAUSAL WOMEN

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14
Q

Which breast pathology has BROWN-GREEN PURULENT DISCHARGE?

A

MAMMARY DUCT ECTASIA

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15
Q

Which cells seen in histology are characteristic of MAMMARY DUCT ECTASIA?

A

PLASMA CELLS (chronic inflammation)

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16
Q

What are 2 possible causes of FAT NECROSIS? Which is the more common cause in BREAST FAT NECROSIS?

A
  1. Enzymatic digestion of fat

2. Trauma **- more common cause of breast fat necrosis

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17
Q

Ddx of CALCIFICATIONS shown on mammography:

A
  1. Breast carcinoma
  2. Sclerosing adenosis
  3. Fat necrosis - saponification
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18
Q

What is the most common CHNAGE in the PREmenopausal female breast?

A

FIBROCYSTIC CHANGE

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19
Q

Blue-domed cystic appearance + Lumpy breast + fibrosis/cysts/apocrine metaplasia. What am I?

A

FIBROCYSTIC CHANGE

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20
Q

Fibrosis + Cysts + Apocrine metaplasia infers how much increased risk for developing invasive breast carcinoma?

A

ZERO MINIMAL

21
Q

DUCTAL HYPERPLASIA/ SCLEROSING ADENOSIS infers how much increased risk for developing invasive breast carcinoma?

A

2X

22
Q

ATYPICAL HYPERPLASIA infers how much increased risk for developing invasive breast carcinoma?

A

5X

23
Q

What is the most common BENIGN breast neoplasm in PRE-MENOPAUSAL women?

A

FIROADENOMA

24
Q

What 3 classical features do FIBROADENOMAS have that classify it as a BENIGN tumor?

A
  1. Mobile
  2. Well-circumscribed
  3. Marble-like mass
25
Q

What age population is PHYLLODES tumor most commonly seen in?

A

POST-Menopausal

26
Q

What makes PHYLLODES tumor similar to FIBROADENOMA? What makes it different from it?

A

SIM: Growth of fibrous tissue + glands
DIFF: Phyllodes - Overgrowth of particularly the FIBROUS component + Can become malignant, whereas fibroadenoma = ONLY benign

27
Q

What is the most common carcinoma in women by incidence?

A

BREAST

28
Q

What is the strongest risk factor in developing breast cancer?

A
  1. FEMALE GENDER (99% of breast cancer cases are female)

2. FAMILY HISTORY

29
Q

What is the most important factor of breast cancer prognosis?

A

TUMOR SIZE + METASTASIS

30
Q

What is the most UESFUL factor of breast cancer prognosis? How can this be confirmed?

A

Spread to AXILLARY LYMPH nodes

Confirmed by SENTINEL NODE BIOPSY

31
Q

What are the predictive factors of breast cancer and what response is it associated with?

A

ER, PR - Response to anti-estrogenic agents (TAMOXIFEN)

Her2/neu gene amplification - Response to anti-Her2/neu mAb (TRASTUZUMAB)

32
Q

What are the 4 subtypes of INVASIVE DUCTAL CARCINOMA?

A

TUBULAR
MUCINOUS
MEDULLARY
INFLAMMATORY

33
Q

What are 2 histologic features that are characteristic of TUBULAR IDC?

A
  1. Desmoplastic stroma - CT that grows with the tumor to provide structural support
  2. Absent myoepithlial cells
34
Q

Which IDC subtype has increased incidence in BRCA1 genetic mutation carriers?

A

MEDULLARY IDC

35
Q

Which inflammatory cells are evident on biopsy for MEDULLARY CARCINOMA?

A

Plasma cells + Lymphocytes

36
Q

What should always be considered together on the Ddx of ACUTE MASTITIS?

A

INFLAMMATORY CARCINOMA

37
Q

What are the 2 diagnostic criteria of INFLAMMATORY CARCINOMA?

A

CLINICAL PATHOLOGIC ENTITY:
CLINICAL - Evidence clinically (erythematous + swollen breast)
PATHOLOGIC - Tumor infiltration into dermal lymphatics

38
Q

How does one differentiate between DUCTAL and LOBULAR carcinomas molecularly?

A

DUCTAL: E-CADHERIN +
LOBLUAR: E-CADHERIN -

39
Q

Which breast carcinoma most often pathologically affects BILATERALLY + MULTIFOCALLY?

A

LOBULAR CARCINOMA IN SITU

40
Q

What makes LCIS different from other breast carcinomas?

A

Very LOW risk of progression to invasive breast carcinomas
Does NOT produce mass/calcifications
Considered RISK FACTOR rather than malignant proliferation

41
Q

What is seen on biopsy of LCIS?

A

Dyscohesive cells - Bec of the lack of E-cadherin

42
Q

What is the Tx of LCIS?

A

Pharmacologic treatment since it’s such low risk of progressing to invasive carcinoma - TAMOXIFEN + close follow up

43
Q

What is the characteristic finding of LCIS biopsy?

A

SINGLE FILE PATTERN OF GROWTH + NO DUCT FORMATION

44
Q

What are the two single most important gene mutations contributing to HEREDITARY BREAST CANCER?

A

BRCA1

BRCA2

45
Q

BRCA1 gene mutations increase the risk of ___

A 
BREAST CARCINOMA (specifically MEDULLARY IDC) 
OVARIAN CARCINOMA
46
Q

BRCA2 gene mutations INCREASE the risk of ___

A

MALE BREAST CARCINOMA

47
Q

What are 2 features that are unique to (or encourage testing of a pt) for HEREDITARY BREAST CANCER

A
  1. Tumor in PRE-MENOPAUSAL woman

2. MULTIPLE tumors

48
Q

What is seen on biopsy of BREAST FAT NECROSIS

A

NECROTIC FAT + Associated calcifications + Inflammatory GIANT CELLS

STEP 8: EndoRepro PATHOMA FA (7 decks)

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