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Pathology > Chapter 23- The Breast > Flashcards

Chapter 23- The Breast Flashcards

1
Q

What are the three components of the breast?

A
  1. Lobules
  2. Ducts
  3. Stroma
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2
Q

What are the two types of epithelial cells in breast?

A
  1. Luminal

2. Myoepithelial (contractile)

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3
Q

What are the two types of stroma found in breast?

A
  1. Interlobular (fat and fibrous tissue)

2. Intralobular (epithelial support)

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4
Q

Major ducts are lined by what kind of epithelium?

A

Keratinizing squamous

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5
Q

Remaining ducts (not major) are lined with what kind of epithelium?

A

Luminal and myoepithelial

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6
Q

What do ducts end in?

A

Terminal ductal lobular units (TDLU)

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7
Q

How do TDLU change during menstruation?

A

Cell proliferation

Intralobular stroma become edamatous

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8
Q

When do the breasts become completely mature and functional?

A

Pregnancy onset

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9
Q

What is the composition of completely mature and functional breasts?

A

Almost entirely lobules and scant stroma

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10
Q

What changes happen to breasts after lactation?

A

Epithelial cells undergo apoptosis

Lobules regress but there is a permanent increase in lobule number

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11
Q

What changes occur in breasts during the third decade?

A

Lobules and stroma involute

Composition changes from fibrous to adipose

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12
Q

What are the developmental disorders of the breast?

A

Milk line remnants (supernumerary nipples/breasts)

Accessory axillary breast tissue (ducts into chest wall/axillary fossa)

Congenital nipple inversion

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13
Q

What type of nipple inversion is most concerning?

A

Acquired

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14
Q

What are the clinical presentations of breast disease?

A

Pain/mastalgia/mastodynia

Palpable masses (>2cm)

Nipple discharge

Abnormal mammographic screening

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15
Q

Noncyclic breast pain differs from cyclic pain in what way?

A

Noncyclic pain is normally localized

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16
Q

What percentage of breast cancers present with pain?

A

10%

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17
Q

The likelihood that a palpable mass is malignant increases with what?

A

Age

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18
Q

When is nipple discharge worrisome for cancer?

A

When it’s unilateral and spontaneous

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19
Q

What can cause the two types of nipple discharge?

A

Bloody/serous- cysts or intraductal papillomas

Milky/galactorrhea- PRL producing pituitary adenomas, hypothyroidism, anovulatory cycles, meds

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20
Q

What findings constitute abnormal mammographic screenings?

A

Densities

Calcifiations

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21
Q

What breast cancer mimics inflammatory disorders of the breast?

A

Inflammatory breast cancer

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22
Q

What are the different inflammatory disorders of the breast?

A

Acute mastitis (first month of lactation)

Periductal mastitis- metaplasia causes keratin shedding and plugging of ducts (dilation and rupture)

Mammary duct ectasia- secretions plug ducts, cause dilation and inflammation

Fat necrosis

Lymphocytic mastopathy/sclerosing lymphocytic lobulitis- rock hard masses, lymphocytic infiltrate

Granulomatous mastitis- systemic disease, foreign bodies, infection (Tb)

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23
Q

Periductal mastitis is associated with what behaviour?

A

Smoking

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24
Q

Fat necrosis normally surrounds what malignancy?

A

Breast cancer

25
Q

Half of fat necrosis cases of the breast have a history of what?

A

Trauma or prior surgery

26
Q

What disorders is lymphocytic mastopathy associated with?

A

DMI

Autoimmune thyroid disease

27
Q

What are the different types of benign epithelial lesions of the breast and what are their characteristics?

A
  1. Nonproliferative (fibrocystic) breast changes- cysts from lobular dilation and unfolding, fibrosis, adenosis
  2. Proliferative breast disease without atypia- epithelial or stromal proliferation without cytological or architectural changes
  3. Proliferative breast disease with atypia- clonal proliferation, some features of CIS
28
Q

What are the cancer risks associated with each type of benign epithelial breast lesion?

A

Nonproliferative- no malignant potential

Proliferative without atypia- 1.5-2x increased risk in developing carcinoma

Proliferative with atypia- 4-5x increased risk in developing cancer

29
Q

What are the different forms of proliferative breast disease without atypia and their characteristics?

A
  1. Epithelial hyperplasia- more than two cell layers surround ducts/lobules, epithelial cells fill and distend
  2. Sclerosing adenosis- increased number of acini/lobule with distortion and dilation
  3. Papillomas- epithelial growth with fibrovascular cores, grow within dilated duct
  4. Complex sclerosing lesion- all the above components, “radial scar”
30
Q

What are the differences in large and small duct papillomas of the breast?

A

Large- lactiferous sinuses, solitary

Small- deeper within system, multiple

31
Q

What are the two forms of proliferative breast disease with atypia and their characteristics?

A

Atypical ductal hyperplasia- similar to DCIS

Atypical lobular hyperplasia- similar to LCIS but affecting less than 50% of the lobule

32
Q

Almost all breast carcinomas are what form?

A

Adenocarcinomas

33
Q

What single gene mutations are most commonly associated with breast cancer?

A

BRCA1 and 2

34
Q

What are the chromosome locations of BRCA1 and 2?

A

1- 17q21

2- 13q12.3

35
Q

Which BRCA mutation is more often ER pos?

A

BRCA2

36
Q

Why is the major risk factor for developing sporadic breast cancer?

A

Hormone exposure

37
Q

What are the three genetic pathways for carcinogenesis of the breast?

A
  1. ER+HER-/luminal- BRCA2, dominant pathway of breast cancer development
  2. HER2+/HER2 enriched- pathway strongly associated with HER2 gene amplification
  3. HER2-/basal-like- pathway independent of ER mediated genetic changes and HER2 gene amplification, BRCA1
38
Q

What are the different morphologies of DCIS?

A
  1. Comedocarcinoma- dilated ducts and lobules due to sheets of pleomorphic cells with central necrosis
  2. Noncomedo- monomorphic cell population, varying nuclear grades and patterns
  3. Paget disease- extension into nipple, cells move up duct and embed in epidermis, poorly differentiated
  4. Microinvasion
39
Q

What is the prognosis of DCIS?

A

Progresses to invasive cancer at 1% per year

Mastectomy curative in 95%

<2% of patients die with or without treatment

40
Q

What are the characteristics of LCIS?

A

Clonal proliferation of cells within ducts and lobules that grow in a discohesive fashion (E cadherin loss)

41
Q

What is the molecular subtype of most LCIS?

A

ER+/PR+

42
Q

What are the different types of breast carcinomas?

A

Invasive/ductal carcinoma- 80-90%

Lobular carcinoma- E cadherin loss, metastatic spread is characteristic

Medullary carcinoma- soft, fleshy with pushing border, solid sheets of cells with lymphocytic infiltrate

Mucinous/colloid carcinoma- well differentiated, gel/mucoid

Tubular carcinoma- well formed tubules

Inflammatory carcinoma- invasion and proliferation in lymphatic channels (swelling and dimpling)

43
Q

What are the different types of invasive/ductal carcinomas and their characteristics?

A

ER+HER2-/luminal A- 40-55%

ER+HER2+/luminal B- higher grade, nodal mets common

ER+HER2-/normal breast like- most like normal tissue

ER-HER2-PR-/basal like/triple neg- high grade and aggressive

HER2+ER- poorly differentiated, metastatic

44
Q

What is the characteristic metastatic spread of lobular carcinoma?

A

Involves peritoneum and retroperitoneum, leptomeninges, GI tract, ovaries and uterus

45
Q

What morphologies are tubual carcinomas associated with?

A

Flat epithelial atypia

Atypical lobular hyperplasia

LCIS

Low grade DCIS

46
Q

What are some prognostic factors related to the extent of breast cancer?

A

Invasive vs in situ

Distant mets

Lymph node mets

Size (<1cm = 90% 10yr vs >2cm = 77% 10yr)

Locally advanced disease

Inflammatory carcinoma

Lymphovascular invasion

47
Q

What prognostic factors are related to tumour biology?

A

Molecular subtype (ER/HER2)

Special histological types

Histological grade

Proliferative rate (measured by mitotic counts)

ER and PR pos tumours (respond to hormone therapy)

HER2 overexpression- poorer survival and therapy response

48
Q

What are the stages of breast cancer?

A

0- DCIS or LCIS, no mets

I- invasive microcarcinoma <2cm, no/micro mets

II- invasive 2-5cm, 0-3 positive lymph nodes without distant mets

III- invasive >5cm/any size, neg or pos lymph nodes/more than 4 pos, without distant mets

IV- any invasive carcinoma (distant mets)

49
Q

What are the different types of stromal breast tumours and what are their characteristics?

A

Fibroadenomas- intralobular, circumscribed, rubbery, grey-white nodules with slit-like spaces, whorled

Phyllodes- intralobular, more stromal overgrowth, infiltrative borders

Interlobular- stromal cells without epithelial component

50
Q

What is the most common benign breast cancer?

A

Fibroadenomas

51
Q

What are the different types of interlobular tumours?

A

Myofibroblastomas

Lipomas

Fibromatosus- proliferation of fibroblasts and myofibroblasts

Angiosarcoma

Any mesenchymal tumour is possible

52
Q

What is the most common interlobular tumour?

A

Angiosarcoma

53
Q

What interlobular tumour is equally common in men?

A

Myofibroblastoma

54
Q

What is a risk factor of developing angiosarcoma?

A

Radiation

55
Q

What is the composition of the male breast?

A

Almost entirely fat with little fibrous tissue

56
Q

What is gynecomastia?

A

Button-like subareolar enlargement

57
Q

What does gynecomastia indicate?

A

Estrogen and androgen imbalance

58
Q

Breast cancer in males is strongly associated with what mutation?

A

BRCA2

Pathology (25 decks)

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