Disease of the Breast

Question 1

cysts, carcinoma and atypical hyperplasia of the breast arise from ______

Answer 1

terminal ductal lobular unit

Question 2

duct ectasia, papillomas, Paget’s disease and large duct papilloma arise from ______

Answer 2

large lactiferous ducts

Question 3

phyllodes tumor and fibroadenoma arise from _____

Answer 3

Intralobular stroma

Question 4

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

Answer 4

outer myoepithelium layer is lost in breast carcinoma

Question 5

what happens in breast development during menarche

Answer 5

terminal ducts start developing lobules and the interlobular stroma increases

Question 6

breast tissue changes with the menstrual cycle;

what happens in the follicular phase and the secretory phase?

Answer 6

quiescent in the follicular phase but during the secretory phase, breast tissue undergoes vacuolization and edema

Question 7

what happens to the content for the interlobular stroma after menopause?

Answer 7

fatty content ↑

Question 8

pain and nipple discharge is associated more often with a neoplastic/non neoplastic lesion

Answer 8

NON neoplastic

Question 9

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?

Answer 9

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

Question 10

What are 4 possible breast pathologies that are associated with pain and tenderness?

Answer 10

• acute mastitis
• mammary duct ectasia
• traumatic fat necrosis
• reaction to implants

Question 11

What are the two most common organisms involved in acute mastitis?

Answer 11

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

Question 12

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?

Answer 12

staphylococcus; may leave a indurated scar

Question 13

_________ cause of acute mastitis involves the whole breast and does not leave a scar

Answer 13

streptococcus

Question 14

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 _______

Answer 14

duct ectasia

Question 15

what is the pathogenesis of duct ectasia?

Answer 15

dilated lactiferous duct rupture leading to inflammation and fibrosis
fibrosis can lead to nipple retraction (looks like carcinoma clinically)

Question 16

patients with history of trauma or _______ are usually part of the etiology of traumatic fat necrosis

Answer 16

breast surgery

Question 17

what are 3 complications of breast implants?

Answer 17

• abscess
• foreign body granuloma
• fistulae

Question 18

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?

Answer 18

diagnosis: fibrocystic changes of the breast

this is a NON proliferative condition and thus as NO INCREASED CHANCES FOR CANCER

Question 19

would you micro calcifications on mammography of FCC?

Answer 19

Yes; can also see necrotic epithelial cell heaps

Question 20

blue dome cysts are associated with what breast pathology?

Answer 20

• FCC: unruptured cyst where there is hemorrhagic fluid

Question 21

in a patient with radial scar/complex sclerosing lesion of the breast, is the double layer epithelium still present?

Answer 21

yes; proliferative lesion without atypia

Question 22

on physical exam a patient has a hard irregular rubbery lump that is not well defined; what could this be?

Answer 22

sclerosing adenosis;

Question 23

what would you expect to see on histology of sclerosing adenosis of the breast

Answer 23

↑ number of acini containing double strands of cells, compressed and distorted with stromal fibrosis

still has double Layer lining

Question 24

if the patient has nipple discharge, you should be thinking of conditions that involve the lactiferous ducts such as: (3)

Answer 24

• intraductal papilloma
• duct ectasia
• carcinoma

Question 25

large/small intraductal papilloma carries a higher risk for papillary carcinoma of the breast

Answer 25

small because there are multiple papillae

Question 26

on histology there is hyperplasia of the breast tissue and there are regularly spaced clear spaces. what is the diagnose?

Answer 26

atypical ductal hyperplasia

irregularly spaced clear spaces: ductal hyperplasia

Question 27

fibroadenoma arises from _________

Answer 27

interlobular stoma;

enlarges in the later part of the menstrual cycle and pregnancy and regresses in menopause

Question 28

_______ component of the fibroadenoma is neoplastic

Answer 28

fibrous (stromal)

glandular (adenoma) component is a reactive proliferation to the excess estrogen

Question 29

what are the two types of hisotloical patterns seen in fibroadenoma? what is the clinical significance of these patterns

Answer 29

1. pericanalicular: oval ducts surround by stroma
2. intracanalicular: elongated compressed and distorted ducts

NO CLINICAL SIGNIFICANCE

Question 30

if phyllodes tumor becomes malignant (high grade) it will spread ________ (lymph/hematogenous)

Answer 30

hematogenously

Question 31

a patient’s biopsy of a lump shows rhabdomyosarcoma/liposarcoma. this is a feature of _______

Answer 31

phyllodes tumor; this is called heterologous differentiation