Disease of the Breast Flashcards
cysts, carcinoma and atypical hyperplasia of the breast arise from ______
terminal ductal lobular unit
duct ectasia, papillomas, Paget’s disease and large duct papilloma arise from ______
large lactiferous ducts
phyllodes tumor and fibroadenoma arise from _____
Intralobular stroma
normal structure of breast epithelium is that there is a DOUBLE LAYER epithelium;
in breast carcinoma there is a loss of _________ layer of the double layer epithelium
outer myoepithelium layer is lost in breast carcinoma
what happens in breast development during menarche
terminal ducts start developing lobules and the interlobular stroma increases
breast tissue changes with the menstrual cycle;
what happens in the follicular phase and the secretory phase?
quiescent in the follicular phase but during the secretory phase, breast tissue undergoes vacuolization and edema
what happens to the content for the interlobular stroma after menopause?
fatty content ↑
pain and nipple discharge is associated more often with a neoplastic/non neoplastic lesion
NON neoplastic
a female patient presents with a painful moveable lump on her breast. She has been recently breast feeding. What is a likely cause of her presentation?
galactocele which is a cystic dilation of an obstructed duct during lactation;
can get infected and then will have pain
can also be acute mastitis
What are 4 possible breast pathologies that are associated with pain and tenderness?
- acute mastitis
- mammary duct ectasia
- traumatic fat necrosis
- reaction to implants
What are the two most common organisms involved in acute mastitis?
staph and strep
staph: small localized under the nipple and can leave a scar
strep: whole breast involved with marked swelling and tenderness and does not leave a scar
a breast feeding female presents with a painful and tender breast. Her nipple is red and swollen. What is the like pathogen involved in this cause of acute mastitis?
Will it leave a scar?
staphylococcus; may leave a indurated scar
_________ cause of acute mastitis involves the whole breast and does not leave a scar
streptococcus
a patient 50-60 years old presents with peri areolar mass with thick white nipple secretes and sometimes see skin retraction is a typical presentation of _______
duct ectasia
what is the pathogenesis of duct ectasia?
dilated lactiferous duct rupture leading to inflammation and fibrosis
fibrosis can lead to nipple retraction (looks like carcinoma clinically)
patients with history of trauma or _______ are usually part of the etiology of traumatic fat necrosis
breast surgery
what are 3 complications of breast implants?
- abscess
- foreign body granuloma
- fistulae
a young female patient with a “lumpy bumpy” pain and tender breast and the changes are associated with menstruation. Of the most likely diagnosis, there is an ↑ in risk for cancer?
diagnosis: fibrocystic changes of the breast
this is a NON proliferative condition and thus as NO INCREASED CHANCES FOR CANCER
would you micro calcifications on mammography of FCC?
Yes; can also see necrotic epithelial cell heaps
blue dome cysts are associated with what breast pathology?
- FCC: unruptured cyst where there is hemorrhagic fluid
in a patient with radial scar/complex sclerosing lesion of the breast, is the double layer epithelium still present?
yes; proliferative lesion without atypia
on physical exam a patient has a hard irregular rubbery lump that is not well defined; what could this be?
sclerosing adenosis;
what would you expect to see on histology of sclerosing adenosis of the breast
↑ number of acini containing double strands of cells, compressed and distorted with stromal fibrosis
still has double Layer lining
if the patient has nipple discharge, you should be thinking of conditions that involve the lactiferous ducts such as: (3)
- intraductal papilloma
- duct ectasia
- carcinoma
large/small intraductal papilloma carries a higher risk for papillary carcinoma of the breast
small because there are multiple papillae
on histology there is hyperplasia of the breast tissue and there are regularly spaced clear spaces. what is the diagnose?
atypical ductal hyperplasia
irregularly spaced clear spaces: ductal hyperplasia
fibroadenoma arises from _________
interlobular stoma;
enlarges in the later part of the menstrual cycle and pregnancy and regresses in menopause
_______ component of the fibroadenoma is neoplastic
fibrous (stromal)
glandular (adenoma) component is a reactive proliferation to the excess estrogen
what are the two types of hisotloical patterns seen in fibroadenoma? what is the clinical significance of these patterns
- pericanalicular: oval ducts surround by stroma
- intracanalicular: elongated compressed and distorted ducts
NO CLINICAL SIGNIFICANCE
if phyllodes tumor becomes malignant (high grade) it will spread ________ (lymph/hematogenous)
hematogenously
a patient’s biopsy of a lump shows rhabdomyosarcoma/liposarcoma. this is a feature of _______
phyllodes tumor; this is called heterologous differentiation