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Repro Week 4 > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

what is each lobe of a breast associated with?

A

main lactiferous duct

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2
Q

what are the three cell types in breast ducts and lobular acini?

A

epithelial
myoepithelial
stem cells

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3
Q

what is the most ocmmon benign breast tumor?

A

fibroadenoma

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4
Q

how do fibroadenomas change over time/

A

can enlarge with pregnancy or menstrual cycles

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5
Q

where do fibroadenomas usually arise?

A

inner quadrants of breast

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6
Q

who gets fibroadenomaS?

A

young females

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7
Q

what is therapy for fibradenoma of breast?

A

surgical excision

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8
Q

how does fibroadenoma feel on exam?

A

firm smooth rubbery and mobile

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9
Q

what is histopath of fibroadenoma?

A

proliferation of the glands and stroma with no cellular atypia

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10
Q

how does fibroadenoma appear on mammogran?

A

well circumcribed hypodense ovoid mass

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11
Q

what is the super bulky tumor of the breast?

A

phyllodes tumor

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12
Q

who often gets phyllodes tumors?

A

AA women

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13
Q

what is rx for phyllodes tumor?

A

local excision of mastectomy

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14
Q

what can phyllodes tumors do but rarely do?

A

metastasize

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15
Q

=is phyllodes tumor benign or malignant?

A

benign

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16
Q

what is the pathopnemonic description of phyllodes tumor growth?

A

leaf like appearance

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17
Q

what is classic symptom of fat necrosis of the breast?

A

it is PAINFUL

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18
Q

what else is on differential of painful breast mass?

A

mastitis

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19
Q

what is fat necrosis associated with?

A

trauma in past history

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20
Q

what do you do to treat fat necrosis of the breast?

A

nada

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21
Q

how does fat necrosis appear on mammogram?>

A

irregular borders with microcalcifications

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22
Q

what are three cells found on histopath of fat necrosis?

A

fat cells without nuclei
giant cells
histiocytes

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23
Q

what is PE findings of mastitis?

A

wedge shaped area of erythema over breast and loss of nipple integrity

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24
Q

what is cause of mastitis?

A

skin flora…usually staph a or strep

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25
Q

what is rx for mastitis?

A

abx and NSAIDs

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26
Q

what is fibrocystic changes of the breast?

A

get cysts of varying sizes surrounded by dense fibrotic tissue

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27
Q

what is an intraductal papilloma?

A

epithelial papillary growth wiht fibrotic components

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28
Q

where are intraductal papillomas located?

A

within a lactiferous duct

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29
Q

what is most common cause of serous or bloody nipple discharge?

A

intraductal papilloma

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30
Q

are intraductal papillomas benign or malignant?

A

benign

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31
Q

what is usual reason for gynecomastia in males?

A

increased estrogent o androgen ratio

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32
Q

what proliferates in gynecomastia?

A

proliferation of branching intermediate size ducts

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33
Q

if you get a palpable mass and imaging is negative, what do you do?

A

ASPIRATE

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34
Q

what are the two in situ breast malignancies?

A

ductal and lobular carcinoma in situ

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35
Q

DCIS is confined to what?

A

ductal tree

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36
Q

DCIS means no invasion into what cell layer?

A

through the myoepithelium or the basement membranes

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37
Q

what is DCIS considered a precursor to?

A

invasive carcinoma

38
Q

risk of recurrent DCIS or change to invasive carcinoma increases with what?

A

higher nuclear grade of DCIS
presence of comedo type necrosis
larger tumor size

39
Q

what is comedo type DCIS? what is found on histo

/

A

high grade nuclei with central necrosis and microcalification s

40
Q

what can you stain for to confirm that DCIS is not spreading invasivley?

A

smooth muscle myosin..will highlight myoepithelial cells that should surround a DCIS

41
Q

what is LCIS a risk factor for?

A

invasive cancer

42
Q

describe the difference in DCIS and LCIS in terms of predictability of future invasive cancer

A

DCIS is a precursor whereas LCIS is risk factor

43
Q

is LCID uni or bilateral?

A

bilateral often

44
Q

what is seen on histopath of LCIS?

A

lobular proliferation of low grade monomorphic tumor cell s

45
Q

define paget disease

A

epidermal involvement of the nipple or areole by malignant cells

46
Q

what is paget disease almost always associated with?

A

underlying in situ or invasive carcinoma

47
Q

what are PE findings of paget disease?

A

localized skin erythema scaling and ulceration at nipple

48
Q

what does histopath of nipple show in paget disease?

A

tumor cells infiltrating the epidermis

49
Q

what are cell characteristics of those in paget disease?

A

have pale cytoplasm with atypical nucleu

50
Q

what is most common breast cancer?

A

invasive ductal carcinoma

51
Q

what infiltrates the breast stroma in invasive ductal carcinoma?

A

infiltrating ducts within stroma…they have broken through myoepithelial and basement membrane

52
Q

what increases in response to invasive ductal carcinoma? cellular level

A

stromal response…get reactive fibrosis

53
Q

some lobules will lack what in invasive ductal carcinoma?

A

myoepithelial cells

54
Q

where does invasive lobular carcinoma often metastasize?

A

gynecologic and GI areas

55
Q

what is estrogen, progesterone and HER2/neu status of invasive lobular carcinoma usually?

A

hormone receptor positive and her 2 negative

56
Q

how do tumor cells appear in invasive lobular carcinoma?

A

linear/single file arrangement of tumor cells

57
Q

what does not happen in invasive lobular carcinoma that does happen in ductal?

A

desmoplastic stromal response

58
Q

what is inflammatory carcinoma?

A

when there is erythema and induration of the skin with breast cancer

59
Q

is inflammatory carcinoma a good prognosis?

A

hell no

60
Q

what is pathology of inflammatory carcinoma?

A

invasive carcinoma invades the superficial dermal lymphatic spaces of the skin

61
Q

what is peau d orange

A

dimpling of skin due to retraction of lymphatics from invasive involvement

62
Q

what will you see in dermal lymphatic spaces on histo in inflammatory carcinoma?

A

tumor cells fill the dermal lymphatic spaces

63
Q

name five key risk factors for breast cancer

A 
older age
family history
radiation
postmenopausal obesity
prior breast disease
64
Q

how much of breast cancer is actually familial?

A

only 5-10%

65
Q

name the two big time breast cancer genes?

A

BRCA12

66
Q

what chromosome is BRCA 1 on?

A

17

67
Q

what chromsome is brca 2 on?

A

13

68
Q

what is inheritance of BRCA1/2 mutations?

A

AD

69
Q

what is BRCA1 gene in charge of?

A

tumor suppressor via DNA repair and cell cycle regulation

70
Q

BRCA1 associated tumors have what findings for hormonal and HER 2 receptors?

A

all negative

71
Q

BRCA2 is in charge of what processes in cell?

A

tumor suppressor…involved in DnA recombination and repair

72
Q

BRCA2 mutations increase risk for breast cancer and what other cancers?

A

ovarian and fallopian

73
Q

patient has BRCA2 breast cancer…what should you advise?

A

maybe get rid of the ovaries too `

74
Q

what is most common form of male breast cancer?

A

by far…invasive ductal carcinoma

75
Q

what is staging for breast cancer?

A

T
N
M

76
Q

what is most important prognostic factor of breast cancer if no metastasis?

A

regional axillary node involvement

77
Q

what is prognostic value of ER/PR positivity of breast cancer?

A

longer disease free survival and better overall survival

78
Q

what is predictive factor with positivity of ER/PR in breast cancer ?

A

predicts response to hormonal therapy like SERMs and sromatase inhibitors

79
Q

where is gene for HER2/neu?

A

on chromosome 17

80
Q

what type of receptor is HER2/neu?

A

EGF/erbB growth factor receptor family…transmembrane growth factor receptors

81
Q

what is role of HER2/neu in cell cycle if overexpressed ?

A

increases cell proliferation

82
Q

what does HER2 overexpression increase risk for?

A

breast cancer

83
Q

what is prognostic factor of HER2 overexpression in breast cancer?

A

decreased survival and shorter disease free interval after rx

84
Q

what is predictive factor of HER2 overexpression in breast cancer?

A

predicts response to HER2 targeted therapy

85
Q

how to test for HER2 overexpression?

A

FISH

86
Q

what are two surgical options for breast canceR?

A

modified radical mastectomy and breast conversation…

87
Q

what is breast conservation?

A

lumpectomy with nodal assessment

88
Q

what is risk with axillary node dissection?

A

can often cause lymphedema of the arm

89
Q

what is a biologic therapy for breast cancer?

A

trastuzamab

90
Q

what is target of trastuzamab?

A

anti HER2 MAB

Repro Week 4 (8 decks)

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