Breast Pathology (Non cancerous)

Question 1

What is the composition of the terminal duct lobular unit (TDLU)?

Answer 1

Made of the lobule and the extralobular terminal duct.

Question 2

In a normal breast histology, what are 2 things that you should be able to see?

Answer 2

The “Ductal” and “Myoepithelial” layers.

Question 3

Where is the breast embryonogically derived from?

Answer 3

It is a modified sweat gland, ergo derived from skin.

Question 4

What is the “Milk line?”

Answer 4

Anywhere from the axilla and the vulva, this is an area where breast tissue can develop.

Question 5

In the terminal duct-lobular unit, what makes the milk?

Answer 5

The lobules make the milk and that milk is drained via the ducts to the nipple.

Question 6

What are the “Luminal cell layers?” What do they do?

Answer 6

The epithelial cells of the ducts, and in the ducts they protect the ducts. However in the lobules they would be the cells producing the milk.

Question 7

What is the function of the myoepithelial cells?

Answer 7

They have contractile functions so their job is to squeeze and propel the milk across the duct.

Question 8

Where is the highest concentration of breast tissue in a female?

Answer 8

The upper outer quadrant of the breast.

Question 9

What is “Galactorrhea?”

Answer 9

Production of milk however it is outside of lactation, meaning she is not nursing a baby but producing milk anyway.

Question 10

What are some causes of galactorrhea?

Answer 10

Excessive nipple stimulation, prolactinoma in the anterior pituitary, and drugs.

Question 11

What is “Acute mastitis?” Major cause of this is?

Answer 11

Bacterial infection of the breast usually due to Staph Aureous, usually due to fissures induced during breast feeding.

Question 12

What is the classic drug administered to tx Acute Mastitis?

Answer 12

Dicloxacillin, as well as continued drainage.

Question 13

How would a patient with acute mastatis present?

Answer 13

Warm, red breast with a purulent nipple discharge.

Question 14

Can patients with acute mastitis present with a mass?

Answer 14

It can form an abscess and in that case there will be a mass that is formed.

Question 15

What is “Periductal Mastitis?” Where is this seen?

Answer 15

Inflammation of the subaerolar ducts, seen in smokers.

Question 16

How do periductal mastitis present?

Answer 16

Subareolar mass with nipple retraction.

Question 17

What is a general requirement of any specialized epithelium cells, including those that are found in the lactiferous ducts?

Answer 17

They require Vitamin A to maintain their integrity.

Question 18

Why are smokers the people mostly seen with periductal mastitis? What is the principal behind this pathology?

Answer 18

Smokers have a relative deficiency of Vitamin A, and as a result the specialized epithelium of the lactiferous ducts esp closer to the nipple lose their integrity, undergo squamous metaplasia. There begins to be some degree of keratin formation –> blocking of the lactiferous duct. As a result, everything behind the block clogs up and we have inflammation –> Periductal mastitis.

Question 19

Why is there nipple retraction in periductal mastitis? What about the mass?

Answer 19

Because of the inflammation behind the block, there will be granulation tissue which includes myofibroblasts, which contract. As a result the nipples will be pulled inwards resulting in nipple retraction. The granulation tissue can also feel like a mass.

Question 20

What is Mammary duct ectasia?

Answer 20

Ectasia means “dilation” and therefore in this disease there is inflammation of the walls of the subaerolar duct which leads to dilation of the sub areolar ducts . The inflammatory debris can slip out of the nipple as a “green brown nipple discharge.” Can present as a mass with the inflammation.

Question 21

What is the buzzword for mammary duct ectasia?

Answer 21

“Green Brown Nipple Discharge.”

Question 22

Who is more prone to have Mammary duct ectasia?

Answer 22

Multiparous (multiple births) postmenopausal woman.

Question 23

If a biopsy reveals chronic inflammation with plasma cells in addition to the clinical presentation being a green brown nipple discharge, what is the diagnosis?

Answer 23

Mammary Gland ectasia.

Question 24

What causes fat necrosis of the breast? Why would this alarm the physician?

Answer 24

Usually trauma, this will alarm the physician because it can either present as a mass (due to fat necrosis leading to fibrosis), or on a mammogram it will present as calcification (because fat necrosis will lead to soapanofication, which occurs via the addition of calcium). This is alarming because calcification is an early sign of breast cancer.

Question 25

Biopsy shows necrotic fat w/ associated fat and giant cells. What is the diagnosis?

Answer 25

Fat necrosis of breast tissue.

Question 26

Why is the disease called “Fibrocystic change?” What causes this?

Answer 26

Due to the fluctuating levels of estrogen and progesterone in a pre menopausal woman, eventually this can lead to cysts forming in the lobules or the terminal duct, and this will stretch the connective tissues to form fibrosis, hence “fibrocystic changes.”

Question 27

What does the fibrocystic changes present as?

Answer 27

Presents as “lumpy breasts” where parts of the breasts feel weirder than other parts, cysts have a “blue domed” appearance on gross examination. Seen usually in the upper outer quadrant.

Question 28

Is fibrocystic change benign or malignant?

Answer 28

Benign in itself but can have other things present in the biopsy that might be a predictor of cancer.

Question 29

A woman with fibrocystic changes presents with fibrosis cysts and aprocrine metaplasia on biopsy. Should you be worried?

Answer 29

No, this has no risk of cancer.

Question 30

What kind of cancers are associated with apocrine metaplasia?

Answer 30

Unlike most other metaplasia, apocrine metaplasia has no associated cancers.

Question 31

If a breast biopsy show ductal hyperplasia or sclerosing adenosis, what does that mean?

Answer 31

Ductal hyperplasia means that there is increased ductal epithelium, sclerosing adenosis means that there are more glands in the lobules which leads to fibrosis (and can also lead to calcification). Both of these findings means there is x2 increase of invasive carcinoma in the future than normal.

Question 32

If a biopsy reveals atypical ductal or lobular hyperplasia what does that mean?

Answer 32

This means that there is in increased number of atypical cells in the lobules or ducts and is associated with x5 increase in risk of invasive carcinoma.

Question 33

What is “Intraductal Papilloma?”

Answer 33

Benign tumor in which there is a papillary growth in the duct, and since it is a papilloma this means its a finger like projection with fibrovascular blood supply and epithelium cells around the finger (the epithelial cells has the normal 2 layer of epithelial and myoepithelial cells as found in normal breast tissue).

Question 34

Young woman (pre menopausal) with bloody nipple discharge is indicative of?

Answer 34

Intraductal papilloma.

Question 35

How do papillary carcinoma and intraductal papilloma compare?

Answer 35

Intraductal papilloma occurs in younger pre menopausal woman, papillary carcinoma occurs in older women. Both these processes involve a papillary growth in the duct however in papillary carcinoma the epithelial cells WILL NOT HAVE MYOEPITHELIAL CELLS, intraductal papilloma will.

Question 36

What if fibroadenoma?

Answer 36

Most common benign tumor of the breast in pre menopausal females, this tumor involves both the fibrous tissue and glands.

Question 37

A benign, estrogen sensitive, well circumscribed mobile marble like mass is diagnostic of?

Answer 37

Fibroadenoma.

Question 38

What is a fibroadenoma like tumor with an overgrowth of the fibrous component, with “Leaf like” projections seen in post menopausal women called?

Answer 38

Phyllodes tumor, its like a fibroadenoma but it has an overgrowth of the fibrous part. Unlike fibroadenoma, this has the potential to be malignant.