Breast Pathology Flashcards
Ddx of Nipple Retraction:
PERIDUCTAL MASTITIS
BREAST CANCER
What is the most common organism responsible for ACUTE MASTITIS?
S. aureus
Ddx of MASS in POST-MENOPAUSAL woman:
BREAST CANCER
MAMMARY DUCT ECTASIA
Pt is post-menopausal and has a bloody nipple discharge. What is the most likely cause?
PAPILLARY CARCINOMA
Pt is pre-menopausal and has bloody nipple discharge. What is the most likely cause?
INTRADUCTAL PAPILLOMA
What is the MOST common BENIGN breast neoplasm?
FIBROADENOMA
What is the most common tumor seen in PREMENOPAUSAL WOMEN?
FIBROADENOMA
Usually, metaplasias are pre-malignant in that it INCREASES the risk of developing future invasive carcinomas. Name 2 instances and 2 exceptions.
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
What are the similarities/differences between FIBROADENOMA and PHYLLODES TUMOR?
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
Is BREAST cancer generally more common in pre-menopausal or post-menopausal women? What is the 1 main exception?
More common in POST-MENOPAUSAL women
Exception = Genetic BREAST CANCER
What are 3 causes of GALACTORRHEA?
CAUSE 1: Excess nipple stimulation
CAUSE 2: Hyper-PRL secretion by Pituitary adenoma
CAUSE 3: DA Antagonist Drugs (anti-psychotics)
What is the most common cause of PERIDUCTAL MASTITIS? How?
SMOKING - Smokers have VitA deficiency -> Highly specialized epithelium in LACTIFEROUS ducts become squamous metaplasia -> Keratin plugs -> Inflammation behind the blockage
What is the most common age population of MAMMARY DUCT ECTASIA (Dilation)?
MULTIPAROUS POST-MENOPAUSAL WOMEN
Which breast pathology has BROWN-GREEN PURULENT DISCHARGE?
MAMMARY DUCT ECTASIA
Which cells seen in histology are characteristic of MAMMARY DUCT ECTASIA?
PLASMA CELLS (chronic inflammation)
What are 2 possible causes of FAT NECROSIS? Which is the more common cause in BREAST FAT NECROSIS?
- Enzymatic digestion of fat
2. Trauma **- more common cause of breast fat necrosis
Ddx of CALCIFICATIONS shown on mammography:
- Breast carcinoma
- Sclerosing adenosis
- Fat necrosis - saponification
What is the most common CHNAGE in the PREmenopausal female breast?
FIBROCYSTIC CHANGE
Blue-domed cystic appearance + Lumpy breast + fibrosis/cysts/apocrine metaplasia. What am I?
FIBROCYSTIC CHANGE
Fibrosis + Cysts + Apocrine metaplasia infers how much increased risk for developing invasive breast carcinoma?
ZERO MINIMAL
DUCTAL HYPERPLASIA/ SCLEROSING ADENOSIS infers how much increased risk for developing invasive breast carcinoma?
2X
ATYPICAL HYPERPLASIA infers how much increased risk for developing invasive breast carcinoma?
5X
What is the most common BENIGN breast neoplasm in PRE-MENOPAUSAL women?
FIROADENOMA
What 3 classical features do FIBROADENOMAS have that classify it as a BENIGN tumor?
- Mobile
- Well-circumscribed
- Marble-like mass
What age population is PHYLLODES tumor most commonly seen in?
POST-Menopausal
What makes PHYLLODES tumor similar to FIBROADENOMA? What makes it different from it?
SIM: Growth of fibrous tissue + glands
DIFF: Phyllodes - Overgrowth of particularly the FIBROUS component + Can become malignant, whereas fibroadenoma = ONLY benign
What is the most common carcinoma in women by incidence?
BREAST
What is the strongest risk factor in developing breast cancer?
- FEMALE GENDER (99% of breast cancer cases are female)
2. FAMILY HISTORY
What is the most important factor of breast cancer prognosis?
TUMOR SIZE + METASTASIS
What is the most UESFUL factor of breast cancer prognosis? How can this be confirmed?
Spread to AXILLARY LYMPH nodes
Confirmed by SENTINEL NODE BIOPSY
What are the predictive factors of breast cancer and what response is it associated with?
ER, PR - Response to anti-estrogenic agents (TAMOXIFEN)
Her2/neu gene amplification - Response to anti-Her2/neu mAb (TRASTUZUMAB)
What are the 4 subtypes of INVASIVE DUCTAL CARCINOMA?
TUBULAR
MUCINOUS
MEDULLARY
INFLAMMATORY
What are 2 histologic features that are characteristic of TUBULAR IDC?
- Desmoplastic stroma - CT that grows with the tumor to provide structural support
- Absent myoepithlial cells
Which IDC subtype has increased incidence in BRCA1 genetic mutation carriers?
MEDULLARY IDC
Which inflammatory cells are evident on biopsy for MEDULLARY CARCINOMA?
Plasma cells + Lymphocytes
What should always be considered together on the Ddx of ACUTE MASTITIS?
INFLAMMATORY CARCINOMA
What are the 2 diagnostic criteria of INFLAMMATORY CARCINOMA?
CLINICAL PATHOLOGIC ENTITY:
CLINICAL - Evidence clinically (erythematous + swollen breast)
PATHOLOGIC - Tumor infiltration into dermal lymphatics
How does one differentiate between DUCTAL and LOBULAR carcinomas molecularly?
DUCTAL: E-CADHERIN +
LOBLUAR: E-CADHERIN -
Which breast carcinoma most often pathologically affects BILATERALLY + MULTIFOCALLY?
LOBULAR CARCINOMA IN SITU
What makes LCIS different from other breast carcinomas?
Very LOW risk of progression to invasive breast carcinomas
Does NOT produce mass/calcifications
Considered RISK FACTOR rather than malignant proliferation
What is seen on biopsy of LCIS?
Dyscohesive cells - Bec of the lack of E-cadherin
What is the Tx of LCIS?
Pharmacologic treatment since it’s such low risk of progressing to invasive carcinoma - TAMOXIFEN + close follow up
What is the characteristic finding of LCIS biopsy?
SINGLE FILE PATTERN OF GROWTH + NO DUCT FORMATION
What are the two single most important gene mutations contributing to HEREDITARY BREAST CANCER?
BRCA1
BRCA2
BRCA1 gene mutations increase the risk of ___
BREAST CARCINOMA (specifically MEDULLARY IDC) OVARIAN CARCINOMA
BRCA2 gene mutations INCREASE the risk of ___
MALE BREAST CARCINOMA
What are 2 features that are unique to (or encourage testing of a pt) for HEREDITARY BREAST CANCER
- Tumor in PRE-MENOPAUSAL woman
2. MULTIPLE tumors
What is seen on biopsy of BREAST FAT NECROSIS
NECROTIC FAT + Associated calcifications + Inflammatory GIANT CELLS
