Breast Pathology - Witrak

Question 1

Which is largely fibrous stroma: young breast or older breast?

Answer 1

Young breast

Question 2

Which is largely adipose stroma: young breast or older breast?

Answer 2

Older breast

Question 3

What are the three basic elements of the breast?

Answer 3

Skin/nipple

Ducts/lobules

Fibroadipose stroma

Question 4

What patient population suffers from Mastitis?

Answer 4

MOSTLY limited to women breastfeeding (usually Staph aureus)

Question 5

Fat necrosis

Answer 5

indurated lump that is tethered down => due to chest trauma => cause calcification

Question 6

What do diagnostic test do you perform if a woman fails to get better with antibiotic treatment of bacterial mastitis?

Answer 6

Culture

Question 7

Commonist ovarian tumor below age of 30?

Answer 7

dermoid cyst (teratoma)

Question 8

Commonist breast tumor in women below age of 30?

Answer 8

fibroadenoma (fibrous, well circumscribed)

Question 9

Commonist form of a breast lump in reproductive age?

Answer 9

Fibrocystic disease/change = cystic change (dilation) and epithelial hyperplasia

Question 10

What is the dominant major malignancy in women?

Answer 10

breast cancer

Question 11

What is the basic progression of normal breast tissue to invasive carcinoma?

Answer 11

Normal breast => epithelial hyperplasia => atypical hyperplasia => carcinoma-in-situe => invasive carcinoma (ductal or lobular)

Question 12

Where does 90% of breast cancer occur (i.e. what part of the breast)?

Answer 12

***Ductal System

small ducts, not terminal ducts/lobules

Question 13

What areas of the breast do Ductal carcinoma in-situ and Lobular carcinoma in-situ recurr?

Answer 13

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

Question 14

What type of Ductal carcinoma is more likely to be multicentric, recur after local therapy, and be associated with invasive carcinoma?

Answer 14

DCIS with high nuclear grade and comedonecrosis

Question 15

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?

Answer 15

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

Question 16

What are the biologically less aggressive types of Ductal Carcinoma?

Answer 16

papillary
tubular
mucinous
medullary
adenoid cystic
secretory (juvenile)

Question 17

What is Paget’s disease of the breast?

Answer 17

tumor infiltration of nipple (suggests underlying breast cancer)

Question 18

What type of carcinoma can have breast skin involvement?

Answer 18

“inflammatory” carcinoma

Question 19

What lymph nodes does a medial breast tumor infiltrate?

Answer 19

mediastinal nodes

Question 20

What lymph nodes does a lateral breast tumor infiltrate?

Answer 20

axillary nodes

Question 21

How does estrogen production equate to the risk of breast cancer?

Answer 21

More years of estrogen => more risk of breast cancer

menarch at early age +/- menopause at late age

Question 22

What is the Commonest cancer in women in the USA?

Answer 22

Breast cancer

Question 23

What type of cancer is second to lung cancer as a cause of cancer death in American women?

Answer 23

Breast cancer

Question 24

What is the typical clinical course of breast cancer?

Answer 24

Most patients with breast carcinoma have a long, indolent course => requiring long (years) follow-up to accurately evaluate different therapies

Question 25

What is the current standard first biopsy procedure after finding a breast lump?

Answer 25

Stereotactic Needle Core Breast Biopsy

Question 26

What are the surgical thearpies/staging strategies for breast cancer?

Answer 26

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

Question 27

What are the four stages of breast cancer?

Answer 27

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

Question 28

What does it mean that 80% of patients with tumors

Answer 28

I.e. the smaller the tumor, the better the chances of curing the cancer.

Question 29

What is a phyllodes tumor?

Answer 29

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.

Question 30

What causes gynecomastia?

Answer 30

caused by any state with relatively increased estrogen effect relative to androgen effect

Question 31

What are the pathologic causes of gynecomastia?

Answer 31

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

Question 32

What are the drug-related causes of gynecomastia?

Answer 32

Estrogens or antiandrogens (prostate cancer Tx)

“Some Hormones Create Knockers” = Spironolactone, Hormones (estrogen), Cimetidine, Ketoconazole

Question 33

What is the typical case of Male breast cancer?

Answer 33

Typically older age, often advanced stage, almost always ductal type

Question 34

What are the risk factors for male breast cancer?

Answer 34

similar to women:

family history/BRCA mutations

relative hyperestrogenism

Klinefelter’s syndrome