Dx Of Breasts Flashcards
Number of lobes per mammary glands
15-20
What is a mammary gland lobe
Individual Compound tubule alveolar gland with its own lactiferous duct and sinus opening on the surface of the nipple
Where do the ductal system drain into
L’activerons sinus
Are congenital malformation of the breast common
No rare
Types of congenital malformation
Polymastia Accessory breasts and nipples Failure of development of breast Precocious development Adolescent hypertrophy
In which syndrome do you say failure of development of breast due to ovarian agenesis
Turner syndrome
In which Disease do you see precocious development of breast
Granulosa cell tumor
Are inflammatory lesions of the best common
No rare
What are some inflammatory lesions of the breast
mastitis
Duct ecTasia
Fat necrosis
Type of infection in acute mastitis
Bacterial infection
Main population affected by Acute mastitis
Postpartum or lactating breast women
Presentation of Acute mastitis
Pain, swelling or redness of breast
Fever
malaise
Most common organism in Acute mastitis
Strep or staph
Gross morphology of Acute mastitis
Firm walled-off nontender abscess
chronic localized scar
Structure involved duct ecTasia
Large ducts
smaller interlobular duct in some cases
At what point in life is a woman Susceptible to duct ecTasia
Second half of reproductive life
after menopause
Why are duct ecTasia often mistaken for carcinoma
Because of nipple discharge which may be blood stained
Main cause of fats necrosis of breast
Trauma
How does Fat Necrosis of breast mimics carcinoma
Calcification in mammography
Presents as discrete lump
Woman at risk of fats necrosis
Obese women
womenin menopause
Gross morphology of fat necrosis of breast
Yellowish and Hemorrhagic tissue
Flecks of Calcification
Microscopy a fat necrosis of breast
Macrophages collection
giant cell with lipid material
Lymphocytes ,fibroblasts ,small vascular channels
What are some non-neoplastic proliferative lesions of the breast
Fibrocystic change
epithelial hyperplasia’s
Is there an increased risk of malignancy with ductal hyperplasia
Yes
Two types of ductal hyperplasia
Proliferative disease without atypia
proliferative diseass atypia
type of neoplastic disease of breast
Benign
malignant
Benign tumor of the breasts
Fibroadenoma
Phyllodes tumor
Intra ductal papilloma
Commonest benign tumor of the best in Ghanaians and Africans
Fibroadenoma
Age of female who commonly have fibroadenoma
Below 30 years
Grass morphology of fibroadenoma
Firm lobulated
Circumscribes
mobile mass ( breast mouse )
Micro of fibroadenoma
Branching ducts and acini
connective tissue proliferation
Is malignant change in fibroadenoma common
No
People at risk of phyllodes tumor
Middle age and elderly persons
Macro of phyllodes tumor
Massive enlargement of breast
large lobulated tumor
Micro phyllodes tumor
Like fibroadenoma
Cellular stroma , Atypical nuclei with mitotic figures
Normal ductal epithelium
How do you cure phyllodes tumor
Mastectomy
When can you have malignancy in phyllodes tumor
If incomplete excision of benign tumor , can turn into malignancy in 5-10%
What are intraductal papilloma
Solitary benign tumor
Common age group affected by intraductal papilloma
20 to 30 years old
Main presentation of intraductal papilloma
Bloody nipple discharge
Duct distention by papillary tumor
When can you get carcinoma in intraductal papilloma
If benign tumor not excised
Group of people more at risk of carcinoma of the breast
Caucasians above 30 years old
Woman with a family history
Risk factors for breast cancer
Gender female Over 50 years old Hereditary history Previous breast pathology Hormones endogenous or exogenous Obesity Lifestyle (lack of exercise ,alcohol ,fatty diet, smoking)
Classification of breast carcinoma stage I and ii
Classification of breast carcinoma stage three and four
What’s impacts the likelihood of invasive cancer rising after in situ carcinoma diagnosis
Histologic subtype
Grade
Extent of in situ disease
Family history for breast cancer
DCIS comedo (high grade ) subtype histology
Very large pleomorphic epithelial cell Abundant cytoplasm irregular nuclei Permanent heterogeneous nucleoli Intraductal necrosis
Grass morphology of high-grade in situ carcinoma
Distended ducts with white necrotic material resembling comedo
Most histologically common type of breast cancer
Invasive ductal carcinoma
Tissue invaded in invasive ductal carcinoma
Stroma of breast
Gross of invasive ductal carcinoma
Firm palpable mass
Modified contour of breasts
Visible dense mass lesion on mammography
Later stage presentation in invasive ductal carcinoma
Large ulcerating masses
Deformation of breast
Regional or distant metastases symptoms
is there a greater incidence of unilaterally or bilaterality in invasive lobular
Bilaterality
Histologic hallmark of invasive lobular carcinoma
Single infiltrating tumor cells or lose clusters of cells
Cells arranged in concentric rings around normal ducts
Signet ring cells
What is paget disease of the nipple
Red scaly eczematous lesion of nipple
Associated to underlying ductal carcinoma of breast
Histology of paget disease of the nipple
Squamous epithelium thickened
Paget cell in epithelium
Chronic inflammatory cells in stroma
Prognosis of paget disease of the nipple
Depends on underlying tumor
Is inflammatory carcinoma of breast a specific histologic subtype of breast carcinoma
No
What os inflammatory carcinoma of breast
Clinical presentation of carcinoma involving dermal lymphatics with enlarged erythematous breast
Morphology of inflammatory carcinoma
Diffuse infiltrating pattern in underlying carcinoma
No palpable mass
Percentage f inflammatory carcinoma in all type of breast cancer
1%
Average age in people with inflammatory ca
56 yo
Prognosis of inflammatory ca
Worse than other tumor
Risk factors of inflammatory ca
Estrogen therapy
Location of breast ca
Upper outer quadrant - 50% Central -20% Lower outer - 10% Upper inner - 10% Lower inner - 10%
Grading system used
Bloom Richardson method
Bloom Richardson method characteristics
Tubule formation
Nuclear Pleomorphism
Number of mitotic figures
Grades of tumors
Grade I - score 3-5
Grade II - score 6-7
Grade III- score 8 and 9
How to assign score in grading system
Two staging in ca
UICC
AJCC
UICC staging
T - size of primary tumor
N - axillary lymph nodes
M - distant metastases
AJCC stage of tumors
Stage O - in situ (DCIS or LCIS)
Stage I - early invasive , tumor <2cm , no , no lymph node metastases
Stage II - tumor size > 2cm , metastasis confined to lymph node
Stage III - locally advanced ,metastatic tumor spread beyond confines of lymph node
Stage IV - metastasis to other organs or parts of body
Prognostic factors
Size of tumor Grade Stage ( most important ) Hormonal status Resection margin Age Histologic subtype Mitotic count Lymphovascular invasion Inflammatory carcinoma
Routes of spread
Direct skin and muscle Lymphatic (seen as peau d’orange ) Blood to lung, liver, bone Transcolemic to pleura and peritoneum Implantation with scar recurrence
Male breast disease
Gynecomastia
Carcinoma
What is Gynecomastia
Enlargement of adult male breast
Causes of Gynecomastia
Hormones
Medication
Klinefelter syndrome
Cirrhosis
Testicular tumor like Leydig cell tumor
Drugs ( alcohol, marijuana , heroin, antiretroviral therapy , anabolic steroids )
Are male breast cancer common
Rare , 1%
Is Gynecomastia a risk factor for Male breast cancer
No
Breast lesions presentation
Breast mass Nipple discharge Eczema Peau d’orange (Invasive ca , Inflammatory ca ) Nipple retraction
