Chapter 16 Flashcards
what are the 2 histological layers of the lobes and layers?
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.
how do boobs change via pregnancy?
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)
is milk coming out of your nipple necessarily cancerous?
Galactorrhea refers to milk production outside of lactation.
1. It is not a symptom of breast cancer.
what is periductal mastitis?
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
What classically arises in multiparous postmenopausal women and presents as a periareolar mass with green-brown nipple discharge?
mammary duct ectasia
Most common change in the premenopausal breast; thought to be hormone mediated
fibrocystic change - lumpy bumpy breast
histology of fibrocystic adenoma
Cysts have a blue-dome appearance on gross exam.
fibrocystic change is benign, but some fibrocystic changes are associated with an increased risk for invasive carcinoma. what are these?
- Fibrosis, cysts, and apocrine metaplasia -no increased risk
- Ductal hyperplasia and sclerosing adenosis-2x increased risk
- Atypical hyperplasia- 5x increased risk
what is so important to remember about intraductal papilloma?
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
what is the most common benign neoplasm of the breast?
fibroadenoma
Most common benign neoplasm of the breast; usually seen in premenopausal
women
does fibroadenoma have any increased risk of cancer?
NO!! NO INCREASED RISK!
features of DCIS. what type is characterized by high-grade cells with necrosis and dystrophic calcification in the center of ducts?
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
what is pagets disease of the breast? is it dangerous?
Paget disease of the breast is DCIS that extends up the ducts to involve the skin of the nipple
- Presents as nipple ulceration and erythema
- Paget disease of the breast is almost always associated with an underlying
carcinoma.
what are the features of invasive ductal carcinoma?
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.
which invasive carcinoma has special subtypes?
invasive ductal
invasive ductal tubular subtype
Tubular carcinoma-characterized by well-differentiated tubules that lack myoepithelial cells (Fig. 16.7A); relatively good prognosis
invasive ductal mucinous subtype
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
invasive ductal medullary subtype
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
invasive ductal inflammatory subtype
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
in which invasive carcinoma subtype is there a propensity for it to arise in BRCA1 mutations?
medullary
does LCIS present a mass or calcification?
no and no
what are the histological features of LCIS?
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
what are the histological features of invasive LC?
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.
Metastasis is the most ______ factor
Spread to axillary lymph nodes is the most _____ prognostic factor
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.
