Breast Pathology (Gianani) - SRS

Question 1

What are the normal anatomical breast components?

Answer 1

1. Lobules and terminal ducts
2. Large ducts
3. Intralobular stroma
4. Interlobular stroma

Question 2

What are some lesions of the lobules and terminal ducts? 6

Answer 2

1. Cysts
2. Sclerosin adenosis
3. Small duct papilloma
4. hyperplasia
5. atypical hyperplasia
6. carcinoma

Question 3

What are some lesions associated with large ducts?4

Answer 3

1. Duct ectasia
2. Squamous metaplasia of lactiferous ducts
3. Large duct papilloma
4. Paget disease

Question 4

What are some lesions of the intralobular stroma? 2

Answer 4

1. Fibroadenoma
2. Phyllodes tumor

Question 5

What are three breast related disorders of development?

Answer 5

1. Milk line remnants
2. Accessory Axillary Breast Tissue.
3. Congenital Nipple Inversion.

Question 6

Where do people typically get supranumerary nipples?

Answer 6

Usually along the milk lines.

Question 7

What is the main reason why congenital nipple inversion is problematic?

Answer 7

Problems with breast feeding

Question 8

Most congenital nipple inversions are sporadic, but there are three congenital disorders that feature this. What are they?

Answer 8

Chromosome 2q37 deletion

Ulnar mammary syndrome

Congenital disorders of glycosylation

Question 9

What are five inflammatory breast diseases?

Answer 9

1. Acute Mastitis.
2. Chronic Mastitis.
3. Squamous metaplasia of lactiferous ducts.
4. Duct Ectasia.
5. Fat necrosis.

Question 10

What causes acute mastitis?

How rapid is the onset?

Answer 10

•Sudden infectious inflammation caused by the bacterium staphylococcus aureus and sometimes streptococcus.

Question 11

When does acute mastitis usually appear?

What contributes to the pathogenesis?

Answer 11

• First three weeks of nursing.
• Irregular nursing contributes to the pathogenesis.

Question 12

In acute mastitis, the breast becomes swollen, painful and reddened (sometime abscess with purulent discharge). What must you distinguish this from?

Answer 12

Must differentiate from inflammatory carcinoma

Question 13

What do you see in the histo that points to this being acute mastitis?

Answer 13

Presence of a bunch of neutrophils and a giant cell

Question 14

Chronic mastitis is usually secondary to what three things?

Answer 14

1. TB
2. Fungal Infection
3. Syphilis

Question 15

What are the types of chronic mastitises? 3

Answer 15

1. Lymphocytic mastitis
2. idiopathic granulomatous mastitis
3. plasma cell mastitis

Question 16

What are two conditions associated wtih lymphocytic mastitis?

Answer 16

DM I

Sjogren Syndrome

Question 17

What conditions/infections is idiopathic granulomatous mastitis associated with?

Answer 17

TB

Connective metaplasia

Question 18

What is a sneaky, but common predisposing factor to squamous metaplasia of lactiferous ducts?

Answer 18

Smoking

Question 19

Plasma cell mastitis (Duct ectasia) usually occurs in multiparous women who have an history of?

Answer 19

difficult nursing

Question 20

•The presentations of fat necrosis are protean and can closely mimic cancer—as a painless palpable mass, skin thickening or retraction, or mammographic densities or calcifications. About half of affected women have a history of?

Answer 20

breast trauma or prior surgery.

Question 21

What are four benign epithelial lesions of the breast?

Answer 21

• Non proliferative breast changes.
• Proliferative breast disease with atypia.
• Proliferative breast disease without atypia.
• Benign histological changes.

Question 22

Your female patient comes in with a hard lump below the nipple and thinks cancer. Based on the biopsy, what do they have?

Answer 22

Duct Ectasia, likely d/t Plasma cell mastitis

Question 23

What are the non-proliferative breast changes?

Answer 23

1. Fibrocystic changes (Not associated with an increased risk of cancer).
2. Lumpy breast at palpation.
3. Radiologically dense with cyst.

Question 24

In fibrocystic change of the breast, what causes the cysts to form?

What is another name for these?

What type of epithelium is seen in these?

Answer 24

1. Dilated lobules turn into small cyst and might coalesce to form larger cysts; filled with brown or blue fluid
2. AKA: blue-domed cyst
3. Flat atrophic epithelium or squamous metaplastic epithelium.

Question 25

In fibrocystic changes of the breast what does the fibrosis stem from?

Answer 25

• resulting from chronic inflammation secondary to cyst rupture.

Question 26

Fibrocystic changes to the breast tissue can come with an increased number of acini per lobule. What is this called

Answer 26

Adenosis

Question 27

Calcifications are occasionally present within the lumens. The acini are lined by columnar cells, which may appear benign or show nuclear atypia (“flat epithelial atypia”). Flat epithelial atypia is a clonal proliferation associated with deletions of what?

Answer 27

Chromosome 16q

Question 28

What type of change to the breast tissue is depicted here?

What is shown in each image A-C?

Answer 28

Fibrocystic change

A. Clustered rounded calcifications seen on radiograph

B. cysts filled with dark turbid fluid contents

C. Cysts lined by apocrine cells with round nuclei and abundant granular cytoplasm. (note the luminal calcifications which form on secretory debris)

Question 29

Lesions characterized by proliferation of epithelial cells, without atypia, are associated with a small increase in the risk of subsequent carcinoma in either breast. •They are commonly detected as mammographic densities, calcifications, or as incidental findings in biopsies performed for other reasons. These lesions are not clonal and are not commonly found to have genetic changes. Thus they are predictors of risk but unlikely to be true precursors of carcinoma.

What are four examples of this?

Answer 29

1. Epithelial Hyperplasia.
2. Sclerosing adenosis.
3. Complex Sclerosing Lesion.
4. Papilloma.

Question 30

Normal breast ducts and lobules are lined a double-layer of myoepithelial cells and luminal cells. In epithelial hyperplasia, there are increased numbers of what cell types?

What does this lead to?

Answer 30

Both luminal and myoepithelial cell types fill and distend ducts and lobules.

Question 31

Shown here are breast ducts. Describe the findings in each image.

Answer 31

A. Normal duct/acinus with a single basally located myoepithelial cell layer (cells with dark compact nuclei and scant cytoplasm) and a single luminal cell layer (cells with larger open nuclei , small nucleoli and more abundant cytoplasm).

B. Epithelial hyperplasia - lumen is filled by a heterogenous mixed population of luminal and myoepithelial cell types. Irregular slitlike fenestrations are prominent at the periphery.

Question 32

In Sclerosing Adenosis there are an increased number of acini that are compressed and distorted in the central portion of the lesion. On occasion, stromal fibrosis may completely compress the lumens to creating what histological findings?

What does this pattern sometimes resemble?

Answer 32

Solid cords or double strands of cells in dense stroma.

Can mimic invasive carcinoma, since may come to attention as a palpable mass, radiologic density or calcifications.

Question 33

On radiography of your patient, a lesion is identified with an irregular shape, with a central nidus of entrapped glands in a hyalinized stroma with long projections into the stroma. If it is not a cancer, what is it?

Answer 33

Complex sclerosing lesion.

Question 34

Where do papillomas grow?

What are they composed of?

Answer 34

Grow within dilated duct and composed of multiple branching fibrovascular cores.

Question 35

Your patient comes in with bloody nipple discharge. You remove the attached lesion from their breast.

What is this?

Why the bloody discharge?

Answer 35

Papilloma

More than 80% of large duct papillomas produce a nipple discharge, it may be bloody if the stalk undergoes torsion causing infarction.