Ch 16 Pathoma - Breast Pathology Flashcards
_____ is a modified sweat gland embryologically derived from skin
Breast
Breast tissue can develop anywhere along the ____, which runs from the axilla to the vulva (supernumerary nipples)
milk line
_____ is the functional unit of the breast. ___ make milk that drains via ___ to the nipple.
Terminal duct lobular unit; lobules; ducts
Lobules and ducts are lined by these two layers of epithelium
Luminal cell layer - inner layer, responsible for milk production in lobules
Myoepithelial layer - outer cell layer, contractile function propels milk to nipple
Breast tissue is _____. Before puberty, it consists primarily of ____. After menarche, development is driven by ___ and ___. During pregnancy, breast ____ undergo hyperplasia. After menopause, breast tissue undergoes ____.
hormone sensitive; large ducts under nipple; estrogen and progesterone; lobules; atrophy
Where are lobules and ducts found in the highest density of the breast?
upper outer quadrant
_____ refers to milk production outside of lactation. True/False: it is a symptom of breast cancer. Causes include _____, _____, and ____.
Galactorrhea; false; nipple stimulation, prolactinoma, and drugs
_____ is a bacterial infection of the breast, usually due to staph aureus. It is associated with ____ and presents as an ____ breast with ____. It may progress to abscess formation. Treatment involves continued drainage and ____
Acute mastitis; breast-feeding; erythematous; purulent nipple discharge; antibiotics (dicloxacillin)
_____ is inflammation of the subareolar ducts. Usually seen in ____. It is due to a ____ deficiency, that causes a squamous metaplasia of _____, producing blockage and inflammation. It presents as a ____ with _____.
Periductal mastitis; smokers; vitamin A; lactiferous ducts; subareolar mass; nipple retraction (w/inflammation –> fibrosis –> granulation tissue –> myofibroblasts –> contraction –> nipple retraction)
_____ is inflammation with dilation of the subareolar ducts. It classically arises in ____ ____ women. Presents as a perioareolar mass with _______. On bx, ____ are seen.
Mammary duct ectasia; multiparous postmenopausal; green-brown nipple discharge; plasma cells
Fat necrosis of the breast is usually related to _____. It presents as a ____ on physical exam or as _____ on mammography. Bx shows necrotic fat with associated ____ and ____.
trauma (may not always be evident); mass; abnormal calcifications (due to saponification); calcifications; giant cells
Fibrocystic change involves development of ____ and ____ in the breast. It is the most common change in the premenopausal/postmenopausal breast?
fibrosis and cysts; premenopausal
Fibrocystic change presents as _____ of the breast tissue, usually located in the ____. Cysts have a ____ appearance on gross exam. It is benign/malignant.
vague irregularity (lumpy breast); upper outer quadrant; blue-dome; benign
What level of increased risk of invasive carcinoma does this carry: apocrine metaplasia
No increased risk
What level of increased risk of invasive carcinoma does this carry: sclerosing adenosine and ductal hyperplasia
2x increased risk
What level of increased risk of invasive carcinoma does this carry: atypical hyperplasia
5x increased risk
What level of increased risk of invasive carcinoma does this carry: fibrosis, cysts
no increased risk
Intraductal papilloma involves papillary growth into a _____. Characterized by _____ lined by epithelial and myopethelial cells. It classically presents as _____ in ____ women and it must be distinguished from _____ (and how)
large duct; fibrovascular projections; bloody nipple discharge; premenopausal; papillary carcinoma; papillary carcinoma does not have underlying myoepithelial cells and is more commonly seen in post menopausal
_____ is a benign tumor of fibrous tissue and glands. It is the most common benign neoplasm of the breast (/seen in premenopausal women). It presents as ____, ____, ____-like mass, and is sensitive to ____.
Fibroadenoma; well-circumscribed, mobile, marble; estrogen
_____ is a fibroadenoma-like tumor with overgrowth of the fibrous component. It has characteristic ____ projections seen on bx. Most commonly seen in premenopausal/postmenopausal women. Is it benign or malignant?
Phyllodes tumor; leaf-like; postmenopausal; can be malignant sometimes
Risk factors for breast cancer are mostly related to ____.
Estrogen exposure (female, age (postmenopausal), obesity, early menarche/late menopause, atypical hyperplasia, first-degree relative)
DCIS is malignant proliferation of cells in ducts with/without invasion of basement membrane. Often detected as ____ on mammography.
Without; calcification
Mammographic calcifications can be associated with these 2 benign conditions and this malignant condition
fibrocystic change (sclerosing adenosis) and fat necrosis; DCIS (bx needed to distinguish)
_______ of the breast is DCIS that extends up the ducts to involve the skin of the nipple. Presents as _____ and ____. It is/never is associated with an underlying carcinoma
Paget disease; nipple discharge; erythema; is (almost always - different then extramammary which is usually not)
_____ type of DCIS is histologically characterized by high grade cells with necrosis and dystrophic calcification in the center of ducts
comedo
What is the most common type of invasive carcinoma of the breast?
invasive ductal carcinoma
Invasive ductal carcinoma presents as a ____ detected by PE or mammography. Clinically detected usually __ cm or greater on PE or __ cm or greater on mammography.
mass; 2; 1
advanced tumors may result in dimpling of the skin or retraction of the nipple
Name the four subtypes of invasive ductal carcinoma (and their prognosis)
Tubular carcinoma (good prognosis); Mucinous carcinoma (good); Medullary carcinoma (good); Inflammatory carcinoma (poor)
Tubular carcinoma is characterized by well-differentiated tubules that lack _____. Mucinous carcinoma tends to occur in ____ women.
myoepithelial; older (~70yrs)
_____ is a type of invasive ductal carcinoma that is characterized by large, high grade cells growing in sheets with associated lymphocytes and plasma cells. It has increased incidence in ____. It grows as a well circumscribed mass that can mimic ____ on mammography.
Medullary carcinoma; BRCA1 cariers; fibroadenoma
Inflammatory carcinoma (a type of invasive ductal) is characterized by carcinoma in _____. Presents as an ___, ___ breast with no discrete mass. Easily mistaken for ____.
dermal lymphatics (hence a poor prognosis); inflamed, swollen; acute mastitis
_____ is a malignant proliferation of cells in lobules with no invasion of the basement membrane.
Lobular carcinoma in situ (LCIS)
LCIS does not produce a ___ or ____, and is usually discovered incidentally. It is characterized by dyscohesive cells lacking ____. It is often focal/multifocal and unilatera/bilateral. Treatment is ____.
mass; calcifications; E-cadherin adhesion protein; multifocal; bilateral; tamoxifen
LCIS has a low/high risk of progression to invasive carcinoma
low
Invasive lobular carcinoma grows in a ____ pattern, and cells may exhibit signet ring morphology. There is no duct formation due to lack of _____.
single-file; E-cadherin
_____ is the most important factor in prognosis of breast cancer and ____ is the most useful.
Metastasis; spread to axillary lymph nodes
Presence of ER and PR receptors (both located ____) are associated with response to _____. Presence of HER2/neu (growth factor receptor located ____) amplification is associated with response to _____.
in the nucleus; anti-estrogenic agents (tamoxifen); on the cell surface; trastuzumab (Herceptin - an antibody against the HER2 receptor)
_____ women have an increased propensity to develop triple negative carcinoma.
African american
BRCA1 mutation is associated with ____ and ____ carcinoma; BRCA 2 is associated with _____.
breast and ovarian carcinoma; breast carcinoma in males
Male breast cancer represents __% of all breast cancers. It usually presents as a ___ mass in older males and may produce ____. Most common histological type is ____, and it is associated with _____ mutations and ____ syndrome.
1; subareolar (where the highest density of breast tissue is in males); nipple discharge; invasive ductal carcinoma (lobular is rare - lobules produce milk so not as prominent in men); BRCA2; Klinefelter
