Breast Pathology - Witrak Flashcards
Which is largely fibrous stroma: young breast or older breast?
Young breast
Which is largely adipose stroma: young breast or older breast?
Older breast
What are the three basic elements of the breast?
Skin/nipple
Ducts/lobules
Fibroadipose stroma
What patient population suffers from Mastitis?
MOSTLY limited to women breastfeeding (usually Staph aureus)
Fat necrosis
indurated lump that is tethered down => due to chest trauma => cause calcification
What do diagnostic test do you perform if a woman fails to get better with antibiotic treatment of bacterial mastitis?
Culture
Commonist ovarian tumor below age of 30?
dermoid cyst (teratoma)
Commonist breast tumor in women below age of 30?
fibroadenoma (fibrous, well circumscribed)
Commonist form of a breast lump in reproductive age?
Fibrocystic disease/change = cystic change (dilation) and epithelial hyperplasia
What is the dominant major malignancy in women?
breast cancer
What is the basic progression of normal breast tissue to invasive carcinoma?
Normal breast => epithelial hyperplasia => atypical hyperplasia => carcinoma-in-situe => invasive carcinoma (ductal or lobular)
Where does 90% of breast cancer occur (i.e. what part of the breast)?
***Ductal System
small ducts, not terminal ducts/lobules
What areas of the breast do Ductal carcinoma in-situ and Lobular carcinoma in-situ recurr?
If you diagnose Ductal carcinoma in-situ => most likely to recurr in same area/quadrant
If you diagnose Lobular carcinoma in-situ => both breast at equal risk for recurrence
What type of Ductal carcinoma is more likely to be multicentric, recur after local therapy, and be associated with invasive carcinoma?
DCIS with high nuclear grade and comedonecrosis
What percentage of patients with invasive ductal Ca had DCIS in contralateral breast?
What is the cumulative risk of invasive contralateral breast carcinoma at 20 years?
invasive ductal Cancer had DCIS in contralateral breast => 48%
invasive contralateral breast carcinoma at 20 years => 12%
***in-situ or invasive Cancer in one breast = increased risk of Cancer in opposite breast
What are the biologically less aggressive types of Ductal Carcinoma?
papillary tubular mucinous medullary adenoid cystic secretory (juvenile)
What is Paget’s disease of the breast?
tumor infiltration of nipple (suggests underlying breast cancer)
What type of carcinoma can have breast skin involvement?
“inflammatory” carcinoma
What lymph nodes does a medial breast tumor infiltrate?
mediastinal nodes
What lymph nodes does a lateral breast tumor infiltrate?
axillary nodes
How does estrogen production equate to the risk of breast cancer?
More years of estrogen => more risk of breast cancer
menarch at early age +/- menopause at late age
What is the Commonest cancer in women in the USA?
Breast cancer
What type of cancer is second to lung cancer as a cause of cancer death in American women?
Breast cancer
What is the typical clinical course of breast cancer?
Most patients with breast carcinoma have a long, indolent course => requiring long (years) follow-up to accurately evaluate different therapies
What is the current standard first biopsy procedure after finding a breast lump?
Stereotactic Needle Core Breast Biopsy
What are the surgical thearpies/staging strategies for breast cancer?
Biopsy (lumpectomy) alone
Lumpectomy + sentinel axillary node sampling
Lumpectomy followed by simple mastectomy
Lumpectomy followed by modifed radical mastectomy
=> mastectomy + sentinel axillary node(s)
Rarely used: radical mastectomy
=> mastectomy, axillary nodes [extensive], and pectoralis muscles
What are the four stages of breast cancer?
Stage I (tumor less than 2 cm, axillary nodes negative)
Stage II (tumor size >/= 2 cm or positive but ipsilateral, mobile axillary nodes)
Locally advanced breast Cancer (Stage III)
Extensive axillary nodal disease, supraclavicular node involvement, direct tumor extension to chest wall or skin, or inflammatory breast Cancer
Metastatic breast Cancer – Stage IV
What does it mean that 80% of patients with tumors
I.e. the smaller the tumor, the better the chances of curing the cancer.
What is a phyllodes tumor?
typically large, fast-growing masses that form from the periductal stromal cells of the breast.
They account for less than 1% of all breast neoplasms.
What causes gynecomastia?
caused by any state with relatively increased estrogen effect relative to androgen effect
What are the pathologic causes of gynecomastia?
tumors producing estrogen or HCG (testicular, adrenal)
primary (e.g., Klinefelter’s) or secondary hypogonadism
liver disease (unable to break down estrogen), renal disease, hyperthyroidism
enzyme defects in androgen synthesis
miscellaneous (pubertal), idiopathic
What are the drug-related causes of gynecomastia?
Estrogens or antiandrogens (prostate cancer Tx)
“Some Hormones Create Knockers” = Spironolactone, Hormones (estrogen), Cimetidine, Ketoconazole
What is the typical case of Male breast cancer?
Typically older age, often advanced stage, almost always ductal type
What are the risk factors for male breast cancer?
similar to women:
family history/BRCA mutations
relative hyperestrogenism
Klinefelter’s syndrome
