Breast pathology: Fibrocystic disease; tumors; miscellaneous Flashcards
What is the most common breast disorder?
Fibrocystic disease of breast
When and how does fibrocystic disease of breast present?
develops during reproductive life;
lumpy, tender breasts associated w/ menstrual cycle
Pathogenesis of fibrocystic disease of breast
high estrogen levels;
progesterone deficiency
Age and invasive ability of fibrosis in fibrocystic disease of breast
women 35-49;
not premalignant
Gross pathology of fibrosis in fibrocystic disease of breast
dense, rubbery mass;
usually unilateral;
most often upper outer quadrant
Histology of fibrosis in fibrocystic disease of breast
increase in stromal connective tissue;
cysts are rare
Epidemiology of cystic disease of fibrocystic disease of breast
women 45-55;
may predispose to malignancy
Gross pathology of cystic disease of fibrocystic disease of breast
serous cysts, firm to palpation;
may be hemorrhagic;
multifocal and often bilateral
Histo of cystic disease of fibrocystic disease of breast
cysts lined by cuboidal epithelium => may have papillary projections
What may also be associated with cystic disease of fibrocystic disease of breast?
chronic cystic mastitis => stromal lymphocytic infiltrate
Epidemiology of sclerosing adenosis in fibrocystic disease of breast
women 35-45;
does not predispose to breast CA
Gross path of sclerosing adenosis in fibrocystic disease of breast
palpable, ill-defined, firm area in upper outer quadrant;
unilateral
histo path of sclerosing adenosis in fibrocystic disease of breast
glandular patterns of cells in fibrous stroma;
may be confused for cancer
epidemiology for epithelial hyperplasia in fibrocystic disease of breast
women over 30 y/o;
increased breast CA risk
gross path for epithelial hyperplasia in fibrocystic disease of breast
variable w/ ill-defined masses
histo path for epithelial hyperplasia in fibrocystic disease of breast
ductal epithelium is multilayered and produces glandular or papillary configurations
Most common benign breast tumor?
fibroadenoma
How and when does fibroadenoma present?
single movable breast nodule (upper, outer quadrant) that is not fixed to skin;
usually before age 30
What is possible cause of fibroadenoma?
increased estrogen sensitivity
How might a pregnant and postmenopausal women present?
show menstrual variation and increased growth during pregnancy;
postmenopausal regression is usual
gross path of fibroadenoma
round and encapsulated w/ grey-white cut surface
histo path of fibroadenoma
glandular epithelial lined spaces w/ fibroblastic stroma
Tx for fibroadenoma
surgery required for definitive Dx
Distinguish fibroadenoma from cystosarcoma phyllodes
nature of stromal component as cystosarcoma phyllodes => malignant fibrous, carilaginous and bony elements may be present
define cystosarcoma phyllodes
fibroadenoma-like tumors that have become large, cystic and lobulated
Gross path of cystosarcoma phyllodes
irregular mass;
often fungating or ulcerating
Histo path of cystosarcoma phyllodes
myxoid stroma w/ increased cellularity, anaplasia, increased mitoses
what is unique in spread of cystosarcoma phyllodes
initially localized but may spread later to distant sites => NOT LOCAL LYMPH NODES
Epidemiology of intraductal papilloma
women 20-50 w/ solitary lesion w/in a duct
How will a patient present w/ intraductal papilloma?
nipple discharge (serous or bloody), nipple retraction, or small subareolar mass
Gross path of intraductal papilloma
small, sessile or pedunculated that is usually close to the nipple in major ducts
histo of intraductal papilloma
multiple papillae
spread of intraductal papilloma
single => benign;
multiple => increased risk of CA
