Breast Pathology I Flashcards
TDLU
terminal ductal lobular unit
end of collecting duct in breast
function unit of breast
cell layers of breast
inner luminal cells
outer layer of myoepithelial basal cells
surrounding basal lamina layer
all surrounded by fat with arteries, veins, and lymph vessels
tanner scale
classification of pubertal breast
coopers ligaments
help breast stay elevated
constriction - dimpling
pectoralis fascia
forms deep margin of breast for surgery
expanding duct
bad sign
can form abscess and fissures to outside
lactiferous duct
enlarged and dilated near base of nipple - at lactiferous sinus
sinus - holds milk and discharges with smooth m contraction
cross section - scalloped - to allow expansion
most breast cancer
arise from TDLU
TDLU stroma
less dense
collagenous
S100
stains the myoepithelial cell protein
IPX stain
mammaglobin
breast secretion protein
luminal cells
secretory
myoepithelial cells
BM equivalent for invasion of cancer
S100 marker
young breast
harder to see on mammogram
ductal carcinoma
typically estrogen positive
basal carcinoma
typically estrogen negative
oxytocin
myoepithelial contraction - milk letdown
colostrum
earliest milk
-higher in protein and lower in lipids
supernumerary nipples
milk line remnants
older breasts
lobules decrease in size and number
interlobular stroma replaced by adipose
higher risk of lactiferous sinus obstruction
with inverted nipple
also difficulty breastfeeding
if congenital
acquired inverted nipple
must rule out underlying pathology - malignancy
painful breast cancer
only 10%
mastodynia
painful breast
aka mastalgia
bloody nipple discharge
must be investigated
galactorrhea
milky discharged associated with prolactin and meds
most presentation of breast cancer
abnormal mammogram
then palpable mass
some pain and nipple discharge
patient symptoms of breast cancer
most often - lumpiness or palpable mass
mammogram
sensitivity and specificity improve with age
-due to decreased density
see densities - to 1cm
microcalcifications
ultrasound of breast
differentiate cystic vs. solid
posterior shadow
on U/S of breast with solid lesion
malignant calcifications
small, irregular, clustered and numerous
commonest way to diagnose DCIS
diagnosis of palpable breast pass
cytology
biopsy - needle core, incisional, excisional
simultaneous staging (if malignant)
negative FNA rule out cancer
no
10% false negative rate
needle core biopsy
can determine if invasion has occured
can also do cytohisto marker studies
needle localization
to determine location of breast palpable mass
modified radical mastectomy
also removes axillary nodes
NOT pectoralis muscle
radical mastectomy
removes pectoralis muscle
lactational mastitis
acute mastitis - first month post partum (puerperal)
segmental with acute inflammation - 10% to abscess
start - nipple fissure and stasis - skin bacteria infection
-staph aureus and strep
non-lactational mastitis
periareolar - mammary duct ectasia
peripheral
mammary duct ectasia
obstructed lactiferous sinus at level of nipple
-with inverted nipple - and cigarette smoking
cigarette smoking
squamous metaplasia of lactiferous sinus - with keratin plugging
leads to non-lactational mastitis
periductal mastitis
with rupture
painful nursing
obstruction of breast duct
ectasis
dilation
ductogram
radio-opaque dye injected to sub-areolar sinus through openings of nipple
dye outlines duct architecture
trauma to breast
can lead to fat necrosis
fat necrosis
trauma to breast
-liquefactive necrosis of fat cells release cytoplasmic fat
acute foreign body granulomatous response - fibrosis repair
requires biopsy**
hard breast mass, dimpling of skin, following trauma
fat necrosis
breast implants
can induce fibrosis
- form constricting capsule - causes implant to rupture
- hard to determine cancer with implants
implants
no link to disease
atypical ductal hyperplasia
bridges form in ducts
