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Pathoma > Chapter 16: Breast Pathology > Flashcards

Chapter 16: Breast Pathology Flashcards

1
Q

Histologically, what kind of tissue is the breast ?

A

Modified sweat gland derived from skin cells

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2
Q

Where in the body is breast tissue ‘capable’ of being created ? (in a non-teratoma setting, of course)

A

Along the ‘Milk Line’

Can lead to supernumerary nipples and breast tissues.

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3
Q

What is the functional unit of the breast ?

A

Terminal Duct Lobule Unit

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4
Q

What portion of the TDLU makes the milk ?

A

Lobules

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5
Q

What portion of the TDLU is drains the lobules milk secretions ?

A

Duct

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6
Q

What are the two layers of the TDLU epithelium ?

A

Luminal Cell Layer ( Inner,Columnar)

Myoepithelium (Outer, meaning closer to the basement membrane)

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7
Q

Which epithelial cell type is responsible for milk production in the lobule ?

A

Luminal cell layer (inner.)

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8
Q

Which epithelial cell type is responsible for contraction and ejection of milk from the duct ?

A

Myoepithelial

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9
Q

Breast tissue is hormone sensitive. What hormones are most active on the breast during development ?

A

Estrogen

Progesterone

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10
Q

What quadrant of the breast contains the majority of the breast tissue ?

A

Upper Outer Quadrant

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11
Q

Hyperplasia of the breast during pregnancy is driven by estrogen and progesterone. Where is progesterone produced early in pregnancy ? Late ?

A

Early: Corpus luteum
Late: Fetus and Placenta

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12
Q

Define Galactorrhea

A

Milk production at a discordant time (not during months of feeding or after pregnancy)

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13
Q

What are three causes of galactorrhea ?

A

Nipple Stimulation
Prolactinoma
Drugs (dopamine inhibitors etc)

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14
Q

Is Galactorrhea a symptom of breast cancer ?

A

NO !!!!!!

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15
Q

What is the most common organism seen in Acute Mastitis ?

A

S. aureus (Acute Mastitis is really a bacterial infection of the breast)

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16
Q

What activity increases the risk for acute mastitis ?

A

Breast Feeding (creates fissures)

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17
Q

Along with erythematous breast tissue, what common symptom/sign do you see in Acute Mastitis ?

A

Purulent Nipple Discharge ! (w/ possible abscess formation)

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18
Q

What are the two main treatments for Acute Mastitis ?

A

Drainage via feeding

Anti-biotics (Dicloxacillin)

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19
Q

Where in the breast will you see inflammation in Periductal Mastitis ?

A

Sub-areolar ducts

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20
Q

What patient subgroup is at risk for Periductal Mastitis ?

A

SMOKERS !

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21
Q

What does smoking cause that leads to a squamous metaplasia of the luminal duct epithelium ?

A

Relative Vitamin A deficiency (Luminal duct epithelium is typically columnar.)

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22
Q

What is the overall consequence of squamous metaplasia of the luminal epithelium in Periductal Mastitis ?

A

Leads to blockage of the duct, this will lead to inflammation thus Periductal Mastitis

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23
Q

What are the two findings seen on clinical presentation of Periductal Mastitis ?

A

Subareolar Mass and Nipple Retraction.

Note: Nipple retraction is often associated with cancer, but not in this case. Caused by proliferation of fibroblasts due to inflammation.

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24
Q

Mammary Duct Ectasia presents as inflammation with ____________ of the subareolar ducts .

A

Dilatation

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25
Q

In what patient population do you often see Mammary Duct Ectasia ?

A

Multiparous, Post-menopausal Women. (rarely seen)

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26
Q

Mammary Duct Ectasia is often seen with a mass that is located where in the breast ?

A

PERI-areolar region ( Periductal Mastitis shows mass that is SUB-areolar)

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27
Q

Like Acute Mastitis, Mammary Duct Ectasia can present with _____________.

A

Nipple Discharge (Green Brown in the case of Mammary Duct Ectasia, more purulent in case of Acute Mastitis)

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28
Q

Why is the finding of a mass in Mammary Duct Ectasia an initially troubling sign until you realize the association with nipple discharge ?

A

Most patients with Mammary Duct Ectasia are Post Menopausal

Mass in Post-Menopausal women is very much associated with cancer

Green Brown Discharge is NOT a sign of Breast Cancer.

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29
Q

On biopsy of Mammary Duct Ectasia, what kind of cells will be seen ?

A

Plasma Cells ! ( chronic inflammatory state).

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30
Q

What is the major etiology of fat necrosis of the breast ?

A

TRAUMA

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31
Q

What two presentations are seen in patients with Fat Necrosis ?

A

Mass or Abnormal Calcification on Mammography.

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32
Q

What is saponification ?

A

Ca++ + Dead Tissue

33
Q

On biopsy of necrotic fat you will see calcification and….

A

Giant Cells.

34
Q

What is the most common ‘change’ seen in the pre-menopausal breast ?

A

Firbrocystic Change (Benign)

35
Q

Where in the breast do you often see fibrocystic change ?

A

upper outer quadrant (just like most breast cancers)

36
Q

What appearance do cysts seen in this change have on gross exam

A

blue dome

37
Q

Fibrosis, cysts and apocrine metaplasia increase the risk for invasive carcinoma by how much ?

A

None (no correlation)

38
Q

Ductal hyperplasia and sclerosing adenosis ncrease the risk for invasive carcinoma by how much ?

A

2x

39
Q

Atypical Hyperplasia ncrease the risk for invasive carcinoma by how much ?

A

5x

40
Q

Papillary growth into a large ductule characterized by benign presentation with bloody nipple discharge is most likely..

A

Intraductal Papilloma

41
Q

What cell layer is retained in intraductal papilloma that is lost in papillary carcimon ?

A

Myoepithelial cell layer (both still retain the epithelial (luminal cells)

42
Q

In what age group of patients are you most likely to see papillary carcinoma ?

A

post menopausal women

43
Q

Tumor of fibrous tissue and glands, well circumscribed, estrogen sensitive and grows/regresses with menstrual cycle causing pain is most likely

A

Fibroadenoma (benign)

44
Q

Does firboadenoma carry an increased risk for carcinoma ?

A

NO !

45
Q

Leaf- like projections due to an overgrowth of fibrous components and is most commonly seen in post-menopausal women. What is this tumor and what is its oncogenic potential ?

A

Phyloddes Tumor

Can be malignant in some cases

46
Q

Breast cancer is most often seen in which age group ?

A

Post menopausal women

47
Q

What is the common link in all risk factors for breast cancer ?

A

Exposure to ESTROGEN !

48
Q

Is Late Menarche/Early Menopause a risk factor for breast cancer ?

A

NO !!

That would limit your exposure to estrogen (starting later, ending earlier)

Early Menarche/Late Menopause is associated with higher risk !

49
Q

Is obesity a risk factor for breast cancer ?

A

YES !

Adipose tissue converts androgens to estrogens via aromatase –> Increased estrogen

50
Q

Ductal Carcinoma in Situ is a direct precursor to Ductal carcinoma. What is often seen on mammography of a patient with DCIS ?

A

Calcifications (Also seen in fibrocystic change, fat necrosis and sclerosing adenosis which are benign)

For remninder : Carcinoma in situ is cancer which has not invaded past the basement membrane of the structure it is in

51
Q

Describe the Comedo type of DCIS based on histology.

A

Architecturally there will be necrosis and dystrophic calcification within the ducts.

52
Q

DCIS that extends up to the nipple and cause ulceration, crusting and erythema of the nipple is known as..

A

Pagets Disease

53
Q

Is Pagets Disease of the breast associated with carcinoma ?

A

ALMOST ALWAYS !

54
Q

What is the most common kind of invasive carcinoma seen in the breast ?

A

Invasive DUCTAL Carcinoma.

55
Q

What size Invasive Ductal carcinomas can clinical exam and mammogram find respectively ?

A

2cm or greater

1cm or greater

56
Q

What are the 4 types of Invasive Ductal Carcinoma ?

A

Tubular Carcinoma
Mucinous Carcinoma
Medullary Carcinoma
Inflammatory Carcinoma

57
Q

In tubular carcinoma you will see well differentiated tubules that lack what cell type ?

A

Myoepithelial cells

58
Q

What is the classical description for a mucinous ductal carcinoma ?

A

“Cancer cells floating in pools of mucous’

59
Q

Medullary Ductal carcinoma is often described as high grade cells in sheets associated with what other 2 kinds of cells ?

A

Lymphocytes

Plasma Cells

60
Q

Medullary Ductal carcinoma can mimmic what tumor on mammography ?

A

Firboadenoma (benign, get a biopsy)

61
Q

What disease is Inflammatory Ductal Carcinoma often confused with ?

A

Acute Mastitis

Inflamed swollen breast due to blockage of lymph canals by ductal carcinoma

62
Q

Does lobular carcinoma in situ present with calcifications ?

A

No !

63
Q

What adhesion protein is often lacking in Lobular Carcinoma in Situ ?

A

E-Cadeherin (may explain why it can become malignant)

64
Q

Is obular Carcinoma in Situ multifocal and BILATERAL ?

A

Yes !

65
Q

What is the best treatment for Lobular Carcinoma in Situ ?

A

Tomoxifen and close follow up

Low risk of becoming Lobular Carcinoma

66
Q

What pattern of growth is seen in Lobular Carcinoma ?

A

Single file pattern of cells

67
Q

Like obular Carcinoma in Situ , Lobular Carcinoma lacks what adhesion protein ?

A

E-Cadherin

68
Q

What characteristic cell type is seen in Lobular Carcinoma ?

A

Signet Ring (also seen in Kruckenberg tumor of the Ovary)

69
Q

What is the most important factor in staging tumors ?

A

Metastasis (in this case axillary lymph node involvement)

70
Q

What procedure is used to see which lymph node the tumor is draining to ?

A

Sentinel Lymph Node Procedure

71
Q

HER2/Neu is often over expressed is breast cancer. What kind of molecule is this ?

A

Receptor for epidermal growth factors

72
Q

What drug is useful in treating patients with HER2 amplification ?

A

Trastuzumab (antibody to the receptor)

73
Q

What drug is useful for treating tumors associated with ER and PR over expression ?

A

Tomoxifen

74
Q

BRCA1 mutations are associated with which tumors ?

A

Breast and ovarian cancer

75
Q

BRCA2 mutations are associate with which tumors ?

A

Breast cancer in Men !

76
Q

What kind of mass is seen in male breast cancer ?

A

subareolar

77
Q

Will there be nipple discharge in male breast cancer ?

A

Yes

78
Q

What kind of breast cancer is more likely in men Ductal or lobular ?

A

Ductal (men don’t form lobules in most cases)

79
Q

What congenital disease with XXY genetics is associated with male breast cancer ?

A

Kleinfelter

BRCA2 as discussed earlier is also associated

Pathoma (15 decks)

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