Chapter 16

Question 1

what are the 2 histological layers of the lobes and layers?

Answer 1

Luminal cell layer-inner cell layer lining the ducts and lobules; responsible for milk production in the lobules

Myoepithelial cell layer-outer cell layer lining ducts and lobules; contractile function propels milk towards the nipple.

Question 2

how do boobs change via pregnancy?

Answer 2

During pregnancy, breast lobules undergo hyperplasia.
i. Hyperplasia is driven by estrogen and progesterone produced by the corpus
luteum (early first trimester), fetus, and placenta (later in pregnancy)

Question 3

is milk coming out of your nipple necessarily cancerous?

Answer 3

Galactorrhea refers to milk production outside of lactation.

1. It is not a symptom of breast cancer.

Question 4

what is periductal mastitis?

Answer 4

Inflammation of the subareolar ducts
B. Usually seen in smokers
Relative vitamin A deficiency results in squamous metaplasia of lactiferous ducts, producing duct blockage and inflammation.
C. Clinically presents as a subareolar mass with nipple retraction

Question 5

What classically arises in multiparous postmenopausal women and presents as a periareolar mass with green-brown nipple discharge?

Answer 5

mammary duct ectasia

Question 6

Most common change in the premenopausal breast; thought to be hormone mediated

Answer 6

fibrocystic change - lumpy bumpy breast

Question 7

histology of fibrocystic adenoma

Answer 7

Cysts have a blue-dome appearance on gross exam.

Question 8

fibrocystic change is benign, but some fibrocystic changes are associated with an increased risk for invasive carcinoma. what are these?

Answer 8

1. Fibrosis, cysts, and apocrine metaplasia -no increased risk
2. Ductal hyperplasia and sclerosing adenosis-2x increased risk
3. Atypical hyperplasia- 5x increased risk

Question 9

what is so important to remember about intraductal papilloma?

Answer 9

Papillary growth, usually into a large duct

Characterized by fibrovascular projections lined by epithelial (luminal) and myoepithelial cells

Classically presents as bloody nipple discharge in a premenopausal woman

Must be distinguished from papillary carcinoma, which also presents as bloody nipple discharge

Question 10

what is the most common benign neoplasm of the breast?

Answer 10

fibroadenoma
Most common benign neoplasm of the breast; usually seen in premenopausal
women

Question 11

does fibroadenoma have any increased risk of cancer?

Answer 11

NO!! NO INCREASED RISK!

Question 12

features of DCIS. what type is characterized by high-grade cells with necrosis and dystrophic calcification in the center of ducts?

Answer 12

Malignant proliferation of cells in ducts with no invasion of the basement membrane

Often detected as calcification on mammography; DCIS does not usually produce a mass.

comedo type is characterized by high-grade cells with necrosis and dystrophic calcification in the center of ducts

Question 13

what is pagets disease of the breast? is it dangerous?

Answer 13

Paget disease of the breast is DCIS that extends up the ducts to involve the skin of the nipple

1. Presents as nipple ulceration and erythema
2. Paget disease of the breast is almost always associated with an underlying
   carcinoma.

Question 14

what are the features of invasive ductal carcinoma?

Answer 14

Invasive carcinoma that classically forms duct-like structures

B. Most common type of invasive carcinoma in the breast, accounting for > 80% of cases

Advanced tumors may result in dimpling of the skin or retraction of the nipple.

Question 15

which invasive carcinoma has special subtypes?

Answer 15

invasive ductal

Question 16

invasive ductal tubular subtype

Answer 16

Tubular carcinoma-characterized by well-differentiated tubules that lack myoepithelial cells (Fig. 16.7A); relatively good prognosis

Question 17

invasive ductal mucinous subtype

Answer 17

Mucinous carcinoma-characterized by carcinoma with abundant extracellular mucin (‘tumor cells floating in a mucus pool’, Fig. 16.7B)
Tends to occur in older women (average age is 70 years)
ii. Relatively good prognosis

Question 18

invasive ductal medullary subtype

Answer 18

Medullary carcinoma-characterized by large, high-grade cells growing in
sheets with associated lymphocytes and plasma cells
i. Grows as a well-circumscribed mass that can mimic fibroadenoma on
mammography
ii. Relatively good prognosis
iii. Increased incidence in BRCA1 carriers

Question 19

invasive ductal inflammatory subtype

Answer 19

Inflammatory carcinoma-characterized by carcinoma in dermal lymphatics (Fig. 16.8)

i. Presents classically as an inflamed, swollen breast (tumor cells block drainage of lymphatics) with no discrete mass; can be mistaken for acute mastitis
ii. Poor prognosis

Question 20

in which invasive carcinoma subtype is there a propensity for it to arise in BRCA1 mutations?

Answer 20

medullary

Question 21

does LCIS present a mass or calcification?

Answer 21

no and no

Question 22

what are the histological features of LCIS?

Answer 22

Characterized by dyscohesive cells lacking E-cadherin adhesion protein

Often multifocal and bilateral

Treatment is tamoxifen (to reduce the risk of subsequent carcinoma) and close follow-up; low risk of progression to invasive carcinoma

Question 23

what are the histological features of invasive LC?

Answer 23

Invasive carcinoma that characteristically grows in a **single-file* pattern cells may exhibit signet-ring morphology.

No duct formation due to lack of E-cadherin.

Question 24

Metastasis is the most ______ factor

Spread to axillary lymph nodes is the most _____ prognostic factor

Answer 24

Metastasis is the most important factor, but most patients present before metastasis occurs.

Spread to axillary lymph nodes is the most useful prognostic factor (given that metastasis is not common at presentation); sentinel lymph node biopsy is used to assess axillary lymph nodes.

Question 25

BCRA1 vs. BRCA2 associations

Answer 25

BRCA1 mutation is associated with breast and ovarian carcinoma.

• ***increased propensity for medullary carcinoma
• ***as for the ovary, serous carcinoma that can also occur in the fallopian tube

BRCA2 mutation is associated with breast carcinoma in males.

Question 26

male breast cancer is associated with…

Answer 26

klinefelters and BRCA1

Usually presents as a subareolar mass in older males