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Book - Molavi > Chapter 19 - Breast > Flashcards

Chapter 19 - Breast Flashcards

1
Q

Why are FNAs rarely performed on breast?

A

Breast cancer is an architectural diagnosis, not a cytologic diagnosis.

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2
Q

What is the functional unit of breast?

How does it appear?

A

The terminal duct-lobular unit (TDLU).

Acini are arranged around ducts. All are lined with an outer myoepithelial layer in addition to the inner epithelial layer. There is also a basement membrane.

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3
Q

What are the three things that should be reported on any breast biopsy?

A

Tumor grade / differentiation

An explanation for microcalcifications

An explanation for mass

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4
Q

How do microcalcifications appear?

What can cause a mass, besides cancer?

A

Usually gritty & dark purple, but can take on the form of calcium oxalate (clear & refractile)

Fibrosis, cysts, fat necrosis, benign tumors…

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5
Q

Recall six forms of fibrocystic changes.

A

Fibrosis

Cysts

Usual duct hyperplasia

Adenosis / Sclerosing adenosis

Apocrine metaplasia

Fibroadenomas

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6
Q

Describe the appearance of adnosis & sclerosing adenosis.

A

Adenosis: Too many glands or lobules, looks crowded & worrisome.

Sclerosing adenosis: Lobules squeezed together by fibrosis, obscuring the myoepithelial layer.

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7
Q

Describe the appearance of apocrine metaplasia.

A

Epithelial cells look apocrine (bright pink, hobnailed, enlarged nuclei similar to Hurthle cells).

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8
Q

Describe the appearance of fibroadenoma.

A

Biphasic lesion with thin, branching ducts with a myxoid halo in a fluffy pink stroma compressing them into slits.

*can hyalinize & calcify*

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9
Q

What is phyllodes tumor, and how does it appear?

A

A biphasic lesion resembling a fibroadenoma but with a much more cellular stroma in a leaf-like pattern.

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10
Q

What are the morphologic traits of fat necrosis?

A

Disrupted & irregular fat cells

Foamy macrophages & giant cells

Edema & hemosiderin

Acute inflammation

Fibrosis & calcification (older lesions)

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11
Q

What can happen to an intraductal papilloma?

A

It can become fibrotic (sclerosing papilloma) or calcified with age.

Rarely, carcinoma can arise from it.

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12
Q

Describe the appearance of usual ductal hyperplasia.

A

Normochromic, pale & heterogeneous cells which appear jumbled & overlapping or even syncytial, streaming in the ducts.

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13
Q

How does DCIS appear?

What are its patterns?

A

Monotonous, clonal cells with evenly spaced cells. Becomes pleomorphic and pink when high-grade.

Cribriform, solid, comedo, micropapillary

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14
Q

What is atypical ductal hyperplasia?

A

An in-between diagnosis from usual ductal hyperplasia and DCIS. Usually for a focus <3mm, and generates additional tissue.

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15
Q

Describe the appearance of IDC and its most common form.

A

(scirrhous)

Large cellular & ugly lesion with dense desmoplasia with necrosis and mitoses. Nests can imitate ducts or tubules & become necrotic.

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16
Q

Name six variants of IDC.

A

Tubular

Cribriform

Mucinous / Colloid

Medullary

Adenoid cystic

Metaplastic

17
Q

Describe the appearance of LCIS.

What is noteworthy about its distribution?

A

Homogenous, round fried-egg shape. Intracytoplasmic vacuoles are common.

It is often multifocal and bilateral.

18
Q

How is LCIS often found?

What is atypical lobular hyperplasia?

A

Incidentally, it is not mass-forming.

Another vague diagnosis that falls short of LCIS.

19
Q

What is E-cadherin, and what is its significance in breast?

A

It is a cell surface adhesion molecule, which is lost in lobular lesions resulting in single-file patterns.

20
Q

Describe the appearance of ILC.

A

Bland, plasmacytoid cells in single files or rings without much desmoplasia. Sneaky–get a cytokeratin.

21
Q

How is Elston grade determined?

A

Tubule formation (1-3)

Mitotic rate (1-3)

Pleomorphism (1-3)

22
Q

What is solid papillary growth pattern?

A

Within DCIS, it is an architectural type with solid balls of cells with entombed residual fibrovascular cores.

23
Q

What is papillary carcinoma?

A

A specific type of carcinoma, with papillary architecture, columnar cells, and a circumscribed profile. The Fibrovascular cores have no myoepithelial cells.

24
Q

What entities may be lumped under “metaplastic carcinoma”?

A

Squamous carcinoma (actually ductal with squamous diff)

Low-grade spindle cell

High-grade with spindle cell features

Any carcinoma with an existing sarcoma (IE carcinosarcoma).

25
Q
A

Normal breast

Left: Terminal duct lobular unit

Right: Benign gland with epithelial and myoepithelial cell layers

26
Q
A

Left: Usual calcifications

Right: Calcium oxalate crystals with foamy macrophages response

27
Q
A

Fibrocystic disease

Arrow: Apocrine metaplasia

28
Q
A

Sclerosing adenosis

Tiny tubules trapped in a fibrotic stroma and among fat (arrow). Intact myoepithelial layer on IHC!

29
Q
A

Fibrocystic disease

30
Q
A

FIbroadenoma

Arrow: Ducts compressed into slits
Arrowhead: Secretory lobules in edematous stroma

31
Q
A

Fat necrosis

Arrow: Foamy macrophages ringing dead adipocytes.
Arrowhead: Fibrosis between fat cells

32
Q
A

Intraductal papilloma

Arrow: Distinct fibrovascular cores
Inset: Intact myoepithelial cells (arrowhead)

33
Q
A

(florid) Usual ductal hyperplasia

Arrow: Peripheral ring of slit-like spaces

34
Q
A

DCIS

Arrow: Cribriforming with polarization around tiny ducts
Arrowhead: High-grade pleomorphic cells with nucleoli and necrosis (asterisk)

35
Q
A

IDC. Note pronounced desmoplasia.

Inset: Irregularly shaped tumor nests with edema and fibrosis.

36
Q
A

Tubular carcinoma (IDC subtype)

Arrow: Well-formed tubules with pointed ends

Arrowhead: Desmoplasia and loss of myoepithelial cells

37
Q
A

Mucinous carcinoma (IDC subtype).

Arrow: Clumps of cells in a pool of mucin dissecting into stroma.

38
Q
A

LCIS

Arrow: Montonous cells with distinct cell borders and small round nuclei.
Arrowhead: Cytoplasmic vacuoles

39
Q
A

ILC

Arrow: Single-file lines of cells. Note little to no desmoplasia.

Book - Molavi (29 decks)

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