Class: Breast Pathology Flashcards
What effect doe sEstrogen have on breasts
both ductal and alveolar growth
What effect does progesterone have on breasts
alveolar differentiation
What effect does hCG have on breasts
increased branching capacity
What effect does Prolactin have on breasts
milk production
What effect does Oxytocin have on breasts
milk let down/expulsion
principal cell in Stroma of breast
fibrobalst
Luminal and basal layer cell type in ducts of breast
luminal - columnar epithelial cells
basal - Myoepithelial cells
You are seeing a 23yo girl who has been having some intermittent, pains in her left breast and now feels a lump there. What is the best test for initial evaluation
Ultrasound
MRI is possible but expensive and slow
What 2 tests are best for younger breasts?
MRI
Ultrasound
26 yo, 2 week post-partum female complains of left breast pain, tenderness and erythema. What are you concerned about?
acute mastitis
The diagnosis is acute mastitis. What is the most common association with acute mastitis?
staph aureus
What disease is caused by hx of smoking?
periductal mastitis, aka SMOLD (squamous metaplasia of lactiferous ducts)
What disease is caused by breast trauma/surgery?
Fat Necrosis
What is periductal mastitis aka
SMOLD (squamous metaplasia of lactiferous ducts)
periductal mastitis presents as (2)
Painful subareolar mass,
sometimes fistula
Skin/nipple retraction
with greenish brown discharge at nipple. what is dx
mammry duct ectasia
Skin/nipple retraction
with greenish brown discharge at nipple. what is dx
mammry duct ectasia
what batceria causes mammry duct ectasia
non-bacterial so NONE!!!!!
Skin/nipple retraction
with greenish brown discharge at nipple. what is dx
mammary duct ectasia
should all palpable masses be biopsied?
yes
What is MC breast mass in women < 50
fibrocystic disease
how does fibrocystic disease look on gross exam
blue-domed cyst” on gross appearance
What does the cystic fluid look like in fibrocystic breast disease
clear, serous fluid.
You see a 43yo lady with no past medical history or family history of breast cancer returns to your office after an abnormal screening mammography that showed calcifications surrounding an ill-defined breast mass. The ultrasound showed a 5mm nodule and biopsy was recommended. The pathologist ordered special stains to exclude invasive carcinoma. The tissue shows fibrosis both within acini and intralobularly. What lesion do you most suspect?
Sclerosing Adenosis
You see a 43yo lady with no past medical history or family history of breast cancer returns to your office after an abnormal screening mammography that showed calcifications surrounding an ill-defined breast mass. The ultrasound showed a 5mm nodule and biopsy was recommended. The pathologist ordered special stains to exclude invasive carcinoma. The tissue shows fibrosis both within acini and intralobularly. What lesion do you most suspect? and what is the increased risk for cancer if any?
Sclerosing Adenosis
1.5-2x risk for cancer
A 50 yo female presents with bloody nipple discharge. A ductogram demonstrates a dilated duct with an intraductal mass. Biopsy is performed to rule out cancer. What is the most likely diagnosis?
Intraductal papilloma
Does Intraductal papilloma show increased risk for cancer
no
Intraductal papilloma is the Most common cause of bloody nipple discharge in what population
<50y
is Intraductal papilloma benign or malignant
benign- no atypia, just hyperpplasia of ductal cells
treatment of intraductal papilloma
excision of lesion.
What is MC breat tumor < 35
Fibroadenoma
A 28 year old female presents with a palpable, mildly tender mass in the left breast for the past three months. Mainly tender during her menses. She has no family history of breast or ovarian cancer. Dx? and why?
Fibroadenoma
single mass that doesn’t change during cycle
IS fibroadenoma benign or malignant
benign
describe the mass found in fibroadenoma (3)
well-circumscribed
mobile
estrogen sensitive
You are seeing a 63 yo lady who had surgery with resection of a very large, fungating mass. The tumor is shown. Her biopsy shows no malignancy. What is the most accurate statement? (pick 2) and give dx
This is always a benign lesion
It is most likely to occur in post-menopausal women
She will need chemotherapy and possibly radiation
It is estrogen sensitive
It is very likely to recur
It is very likely to recur
It is most likely to occur in post-menopausal women
Phylloides tumor
A 48yo man with history of liver failure comes into your clinic with concern over a change in his breast tissue. What is your next step? Order an ultrasound Obtain more history Order an MRI Consider a referral to a surgeon
(specifically what are you looking for?)
Obtain more history– need to know drugs
spironolactone –> gynecomastia
what is mnemonic and the drugs that –> gynecomastia? (5)
Some Drugs Create Awesome Knockers Spironolactone Digoxin Cimetidine Alcohol ketoconazole
what two conditions will cuase pus to leak from nipples
acute mastitis
chronic mastitis
What 3 conditions cause blood to leak from nipples
• Intraductal Papilloma
• Ductal Cancer
Mammary duct ectasia
