Class: Breast Pathology

Question 1

What effect doe sEstrogen have on breasts

Answer 1

both ductal and alveolar growth

Question 2

What effect does progesterone have on breasts

Answer 2

alveolar differentiation

Question 3

What effect does hCG have on breasts

Answer 3

increased branching capacity

Question 4

What effect does Prolactin have on breasts

Answer 4

milk production

Question 5

What effect does Oxytocin have on breasts

Answer 5

milk let down/expulsion

Question 6

principal cell in Stroma of breast

Answer 6

fibrobalst

Question 7

Luminal and basal layer cell type in ducts of breast

Answer 7

luminal - columnar epithelial cells

basal - Myoepithelial cells

Question 8

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

Answer 8

Ultrasound

MRI is possible but expensive and slow

Question 9

What 2 tests are best for younger breasts?

Answer 9

MRI

Ultrasound

Question 10

26 yo, 2 week post-partum female complains of left breast pain, tenderness and erythema. What are you concerned about?

Answer 10

acute mastitis

Question 11

The diagnosis is acute mastitis. What is the most common association with acute mastitis?

Answer 11

staph aureus

Question 12

What disease is caused by hx of smoking?

Answer 12

periductal mastitis, aka SMOLD (squamous metaplasia of lactiferous ducts)

Question 13

What disease is caused by breast trauma/surgery?

Answer 13

Fat Necrosis

Question 14

What is periductal mastitis aka

Answer 14

SMOLD (squamous metaplasia of lactiferous ducts)

Question 15

periductal mastitis presents as (2)

Answer 15

Painful subareolar mass,

sometimes fistula

Question 16

Skin/nipple retraction

with greenish brown discharge at nipple. what is dx

Answer 16

mammry duct ectasia

Question 17

Skin/nipple retraction

with greenish brown discharge at nipple. what is dx

Answer 17

mammry duct ectasia

Question 18

what batceria causes mammry duct ectasia

Answer 18

non-bacterial so NONE!!!!!

Question 19

Skin/nipple retraction

with greenish brown discharge at nipple. what is dx

Answer 19

mammary duct ectasia

Question 20

should all palpable masses be biopsied?

Answer 20

yes

Question 21

What is MC breast mass in women < 50

Answer 21

fibrocystic disease

Question 22

how does fibrocystic disease look on gross exam

Answer 22

blue-domed cyst” on gross appearance

Question 23

What does the cystic fluid look like in fibrocystic breast disease

Answer 23

clear, serous fluid.

Question 24

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?

Answer 24

Sclerosing Adenosis

Question 25

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?

Answer 25

Sclerosing Adenosis

1.5-2x risk for cancer

Question 26

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?

Answer 26

Intraductal papilloma

Question 27

Does Intraductal papilloma show increased risk for cancer

Answer 27

no

Question 28

Intraductal papilloma is the Most common cause of bloody nipple discharge in what population

Answer 28

<50y

Question 29

is Intraductal papilloma benign or malignant

Answer 29

benign- no atypia, just hyperpplasia of ductal cells

Question 30

treatment of intraductal papilloma

Answer 30

excision of lesion.

Question 31

What is MC breat tumor < 35

Answer 31

Fibroadenoma

Question 32

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?

Answer 32

Fibroadenoma

single mass that doesn’t change during cycle

Question 33

IS fibroadenoma benign or malignant

Answer 33

benign

Question 34

describe the mass found in fibroadenoma (3)

Answer 34

well-circumscribed
mobile
estrogen sensitive

Question 35

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

Answer 35

It is very likely to recur
It is most likely to occur in post-menopausal women
Phylloides tumor

Question 36

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?)

Answer 36

Obtain more history– need to know drugs

spironolactone –> gynecomastia

Question 37

what is mnemonic and the drugs that –> gynecomastia? (5)

Answer 37

Some Drugs Create Awesome Knockers
Spironolactone
Digoxin
Cimetidine
Alcohol
ketoconazole

Question 38

what two conditions will cuase pus to leak from nipples

Answer 38

acute mastitis

chronic mastitis

Question 39

What 3 conditions cause blood to leak from nipples

Answer 39

• Intraductal Papilloma
• Ductal Cancer
Mammary duct ectasia