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ENRP Exam 1 > Breast Pathology Dr. Dobson > Flashcards

Breast Pathology Dr. Dobson Flashcards

1
Q
  1. How to tell another physician where you felt a mass

2. 25% mass in breast is where

A
  1. Quadrants or which clock hour

2. Internal mass draining into mediastinal LN can only be seen on CT or imaging

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2
Q

Poland Syndrome

A

No pectoral is muscle = one breast is very droopy, the other is normal

= also no shoulder or upper arm and hand anomalies can be present

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3
Q

If pt has supernumerary nipples what to do

A

Make sure you monitor those also due to breast tissue and ducts in those regions also

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4
Q

Accessory axilliary breast tissue or nipple can lead to

A

Risk of carcinoma even if the pt has mastectomy = so keep monitoring

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5
Q

Nipple Inversion is a problem when

A

Only when acquired and not there by birth

Acquired can be cancer or inflammation

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6
Q

2 cells in duct and lobules and importance in bx

A
  1. Epithelial = protection (ductal) + make milk (lobular)
  2. Myoepithelial = contraction

= cancer does not have myoepithelial layer in bx
= most malignancies come from epithelium layer

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7
Q

Malignant cells come from what **

+ most common location

A

TDLU, Terminal Duct Lobular Unit **

= found most in upper outer quadrant

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8
Q

Breast during

  1. Not in pregnancy
  2. During pregnancy
  3. Post menopausal
A
  1. More stroma (dense)
  2. More glands = lobules (for milk)
  3. More fat, lower TDLU
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9
Q

Pain = mastodynia SXs, % cancer

A 
1. Cyclic (diffuse) = menstrual
2 Noncylic (localized) = ruptured cyst, trauma, infection

= 10% cancer present with mastodynia

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10
Q

Breast discharge 2 types and thing to think about

A

Usually normal if discharge from both

  1. Milky = elevated prolactin, repeated stimulation, hyperthyroidism, OC,TCA, methyldopa
  2. Bloody = large duct papilloma, pregnancy, DCIS, other malignancy
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11
Q

Lumpiness is usually what

+ 4 categories

A

Normal glandular hyperplasia

  1. Category A : almost all fat, 10%
  2. Scattered areas of fibroglandular density, 40%
  3. Heterogenously dense, 40%
  4. Extreme dense, 10%
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12
Q

Physical exam feeling of mass that indicates malignant mass

A

Solid, not circumscribed, immobile,

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13
Q
  1. Most palpable BENIGN lesions

2. Most palpable MALIGNANT lesions

A
  1. Cysts, or fibroadenomas

2. Invasive ductal carcinoma

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14
Q

Where does invasive carcinoma usually go

A

Into pectoralis muscle

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15
Q

What to look for on a mammogram :

A
  1. Densities = breast lesions replaced by adipose (how many, shape, size from 1cm—> 15% have already metastasized)
  2. Calcifications = usually apocrine cyst, hyalinized fibroadenoma, sclerosis adenosis, necrotic fat (small, irregular, numerous, clustered = malignancy SIGN of DCIS)**
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16
Q

Precursor lesion of breast cancer

A

DCIS

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17
Q

Palpable mass what do you do

A

Mammogram

If you dont see anything then you AHVE TO do a biopsy

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18
Q

Imaging US does what

MRI does what

A
  1. US : solid vs cystic

2. MRI : BVs seen so more helpful in dense high density breasts

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19
Q

Standardize a pts mammogram findings how

A

BI-RADS

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20
Q

BI-RADS categories (only know what happens from 3 to 4)

A

0 : need more imaging before category assignment
1 : - (annual screening continue)
2: Benign finding (annual screening continue)
3 : Probable benign (6mo redue mammogram)
4 : Suspicious abnormality (need bx)
5 : high chance malignancy (DO BX)
6 : bx proven malignancy (bx confirms cancer before tax starts)

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21
Q

Inflammatory disease of breast cancer can look like and what histo

A
  1. Can mimic mastitis (inflammation in breast = Staph Aureus cellulitis in breast feeding = )
  2. Obstructs dermal BVs with tumor emboli, always consider if you see red swollen breast = DEADLY and poor prognosis
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22
Q

Breast mastitis TX

A

During feeding of baby = staph aureus

TX with Dictoxacillin

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23
Q

SMOLD = Squamous Metaplasia of Lactiferous Ducts

  1. Is what + location
  2. Presents how
  3. Common sx
  4. Associated with
A
  1. Recurrent subareolar abscess or breast mastitis, Zuska disease
  2. Subareolar mass, painful red mass looks like bacterial abscess
  3. Inverted nipple (from fibrosis)
  4. Smokers , VIT A deficiency
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24
Q

SMOLD can cause and what happens in duct

A
  1. Keratin plug in duct from inflammation and squamous metaplasia in duct —-> Abscess in duct
  2. SCC if not corrected
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25
Q

Duct Ectasia

  1. Presents how
  2. Dx how (US and BX findings also)
  3. Is what
A
  1. Nipple secretions = white, serous, palpable mass, nipple inversion
  2. Put dye in in duct system = see saccular dilation OR by US, BX = fibrosis + M + lymphocytes + plasma cells
  3. Duct dilations, causing inflammation at times
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26
Q

Fat necrosis presents how + happens how + classified how

A
  1. Mass with fibrosis and calcification (coarse eggshell calcification)
  2. Trauma or surgery (like breast reduction)
  3. BI-RADS 2
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27
Q

Lymphocytic Mastopathy (Sclerosing Lymphocytic Lobulitis)

  1. Presents how (findings)
  2. Is what
  3. Associated with
  4. Histology
A
  1. Single or many HARD palpable masses or mammography can densities
  2. Fibroinflammatory condition uncommon
  3. T1D
  4. Atrophic ducts, thick BM, lymphocytes many seen
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28
Q

Granulomatous inflammation of breast can be what

A
  1. Polyangiitis
    2.. sarcoidosis
  2. TB
  3. Infection inflammatory disorder
    = very uncommmon n
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29
Q

3 types of benign epithelial lesions of breast and what they mean

A
  1. Nonproliferation changes
  2. Proliferative breast disease (with atypia, with no atypia)
  3. Atypical hyperplasia

= no cancer precursor lesions, only increase risk of cancer at some point later

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30
Q

Nonproliferative Breast changes

  1. Other name
  2. What do you see 3 things
  3. Feels like what
A
  1. Fibcystic changes
  2. Cystic changes (apocrine metaplasia), fibrosis, adenosis (increase acini per lobule)
  3. Lumpy bumpy breast on palpating
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31
Q

Cysts

  1. Look like
  2. Can cause what in chronic situation
  3. Concerning when and how to dx
A
  1. Blue dome
  2. Can rupture and cause fibrosis
  3. Solid and firm, do fine-needle aspiration of contents
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32
Q

Adenosis

  1. Presents how
  2. Normal when
A
  1. Increased acini in lobule (many glands)

2. During pregnancy

33
Q

5 proliferative breast disease without atypia + what risk

A

= risk of developing into precursor lesion

  1. Epithelial hyperplasia
  2. Sclerosing adenosis
  3. Complex Sclerosing lesion
  4. Papilloma
  5. Gynecomastia
34
Q

Sclerosing adenoma histology

A
  1. Acini compressed by dense stroma
  2. Calcifications
  3. Acini are in swirling pattern
  4. Enlarged lobular unit
35
Q

Complex Sclerosing lesion histo ho to know it is this

A
  1. You see myoepithelial cells
36
Q

Ductal Papillomas

  1. Present how at times
  2. See what on mammogram
  3. Pt come in usually for what
A
  1. Bloody discharge (Stalk undergoing torsion / infarction)
  2. Calcification
  3. Palpable mass
37
Q

2 types of Proliferative breast diseases with Atypia and what risk meaning

A
  1. Atypical ductal hyperplasia (TDLU hyperplasia)
  2. Atypical Loblar Hyperplasia (TDLU hyperplasia )

= increased risk of carcinoma precursor lesion made in future

38
Q

Atypical hyperplasia pts can do what to reduce risk of developing carcinoma

A
  1. mastectomy bilateral
  2. E antagonist TAMOXIFEN
    = only lower then 20% progress to carcinoma so most choose to monitor
39
Q

Relative risk vs absolute risk

A
  1. Relative : risk change when you change something by HOW MUCH compared to others
  2. Absolute : risk change when you do something relative to yourself
40
Q

Drugs associated with Gynecomastia

A

DISCOS

  1. Digoxin
  2. Isoniazid
  3. Spironalactone
  4. Cimetidine
  5. Oestrogens
  6. Stiboestrol
41
Q

Diseases that can cause gynocomastia

A
  1. Liver dz
  2. Lowered testosterone
  3. XXY Kleinfelters
  4. Testicular neoplasm (secrete hCG)
42
Q

Fibroadenoma and phyllodes tumor are driven by what

A

MED12 mutations

43
Q

Most common benign tumors of female breast

A

Fibroadenoma

44
Q

What drug can cause fibroadenoma and who is given this

A

Cyclosporine A (immunosuppressant) after renal transplant, regress after drug termination

45
Q

Fibroadenoma present how and dx

A

Mass palpable

Core needle bx

46
Q

Phyllodes tumor

  1. Present how
  2. Different from fibroadenoma how
  3. 3 types
A
  1. Mass palpable
  2. More cellularity and active mitotically, more stroma
  3. Low grade, intermediate, high grade

= can grow really big

47
Q

Interlobular stromal lesion stromal type

  1. Benign you see
  2. Malignant you see
A
  1. Myofibroblastoma (myofibroblasts) + Lipoma + Fibromastosis (fibroblasts + myofibroblasts)
  2. Angiosarcoma : stromal malignant tumor, young mean 35yo
48
Q

Angiosarcoma is associated with what 2 things

A
  1. Prior radiation
  2. Stewart Treves Syndrome (Mastectomy with lymphedema as result )
  3. Sporadically
49
Q

Location of DCIS and LCIS

A 
DCIS = Unilateral 
LCIS = bilateral treatment
50
Q

Staging system used for prognosis in breast carcinoma

A

AJCC 8th edition

51
Q

Who has the highest incident of breast cancer

A

European (63yo average for sporadic)

AA dx usually earlier + higher mortality (usually more aggressive types also)

52
Q

Risk of breast cancer in density + other things

A

Higher density (higher TDLUs)

= early menarche (before 12yo
= late menopause (over 55yo)
= Late 1st pregnancy (over 35yo)
= no breast feeding, no pregnancies 
= postmenopausal obesity , inactivity
53
Q

Factors that decrease risk of breast cancer the most

A 
Prolonged breastfeeding 
Early pregnancy (before 20yo)
54
Q

Cancer with the most driver genes

A

Breast adenocarcinoma

55
Q

Hereditary breast carcinoma works how

A

You are born with BRCA1 or BRCA 2 = genetic

Then at any time in your life some epigenetic or spontaneous mutations can happen causing a second BRCA mutation = you get the cancer (breastfeeding, high estrogen are some risks)

56
Q

4 genes

A
  1. BRCA
  2. p53
  3. PTEN (cowden) =
  4. SKT11 (Peutz Jegher) =
57
Q

Luminal type Brest cancer is common in what descent

And age

A

60-70yo, European descent

58
Q

HER2 gene breast cancer % of them and peaked at what age

A

60yo , 20%

59
Q
  1. Luminal cancers express what receptors
  2. HER2 express what
  3. Triple 1 express what
A
  1. ER (BRCA)
  2. HER2 neu (Tyrosine kinase) (TP53)
  3. None including no PR (BRCA1 and TP53 and more)
60
Q

Luminal , HER2, Triple - cancaer recurrence rate in 10yo

A
  1. Luminal (lowest rate

2. HER2 and Triple - have highest recurrence (HER2 has another peak after 7years)

61
Q

Lobular and ductal are usually what type of cancer

A 
Lobular = invasive carcinoma 
Ductal = Adenocarcioma
62
Q

Carcinoma in situ lobular or ductal are

=

A

Noninvasive and in myoepithelial cells present
= DCIS + LCIS are precursor lesions
= when detected with mammogram 70% of DCIS have already progressed to invasion of strome

63
Q

DCIS looks like what and seen how

A

Mammogram = small CA+2 in duct system

64
Q

Comedo type DCIS

A

Necrosis and ca inside several ducts , high grade proliferation

65
Q

Pages disease

A

DCIS that is not in peripheral ducts, only in larger duct under nipple (tumor cells crawl out to surface of nipple = red eruption , itchy)

  1. 50% have an underlying mass in breast
  2. Most are ER - and HER2 +
66
Q

LCIS grows how , Rs it has and how to find it

A

In discohesive fashion due to X CDH1 (no E-Cadherin, adhesion of cells)
= not on mammogram or has a mass due to no fibrosis (bx for other reasons)
= ER + , PR + , HER2-

67
Q

LCIS and DCIS risk of bilateral

A

Higher chance of bilateral effect in LCIS

68
Q

Large carcinomas invade where

A

Pectoralis and chest wall and dermis

69
Q

How to grade invasive carcinomas

A

Nottingham Histologic Score

70
Q

Malignant cancer words you see

A 
Vascular change’
Mitosis
Abnormal nuclear morphology
Pleomorphism
Anaplasia
71
Q

Most common places Lobular Carcinoma invades to

  1. What factors this tumor has
  2. How its found
A

GI, peritoneum, ovaries, brain (leptomeninges)
= grow in single file line
1. CDH1 mutation = no E-Cadherin
2. By accident on checking for something else, no mass

72
Q

Carcinoma with medullary pattern

  1. Type of Rs
  2. Type of cancer/prognosis
  3. Factors it had
A
  1. Triple - type
  2. Better prognosis for this subtype, may Tcells (immune response to tumor)
  3. BRCA1 is usually associated with this type of tumor pattern
73
Q

Mucinous (colloid) carcinomas

  1. Looks like and feel like
  2. Histo, type of cancer
  3. Prognosis
A
  1. Soft, rubbery feel like + Mucin or Gelatin look like
  2. Malignant cells floating in mucin
  3. Good prognosis for this type
74
Q

Inflammatory carcinoma

  1. Survival after 3 years
  2. Ethnicity with higher risk
  3. Looks like
  4. What happens
A
  1. 3-10%
  2. AA
  3. Acute mastitis, Peau d’orange (orange peal)**,
  4. Extensive lymph and BV involvements on dermis
75
Q

Most important prognostic indication of breast cancer

A

Metastasis

76
Q

Carcinoma en cuirasse

A

Spreads of breast cancer all over breast plate if nothing is done to breast cancer

77
Q

Saying in breast cancer stage 2 vs stage 3

A 
2 = 2cm-5cm
3 = over 5cm

(Stage 0 = DCIS, Stage 1 = invasive under 0cm-2cm)

78
Q

Mutations of BRCA cause defects in

A

HRR

ENRP Exam 1 (13 decks)

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