Endo/Repro - Breast Pathologies Flashcards
Name the three portions of an individual unit of the breast system from the local of milk production to ejection.
Lobular unit >> Terminal ductule >> Lactiferous ducts
The age-related changes in breast tissue are of a switch from abundant ______ ______ to ______.
The age-related changes in breast tissue are of a switch from abundant fibrous** **stroma** to **adipose.
When does acute mastitis typically occur and due to what etiology?
Breastfeeding;
S. aureus
Fat necrosis in the breast usually occurs due to _______.
Fat necrosis in the breast usually occurs due to trauma.
Describe the histology and X-ray appearance of fat necrosis.
Histology:
Mammography:
Describe the histology and X-ray appearance of fat necrosis.
Histology: Foamy macrophages, lipid-filled cysts, fibrosis
Mammography: Eggshell calcifications
Which women will undergo fibrocystic changes of the breast?
All women
__________ breast change refers to the following: palpably irregular and painful breasts; discrete lumps, multiple nodules, cysts; microcalcifications.
Fibrocystic breast change refers to the following: palpably irregular and painful breasts; discrete lumps, multiple nodules, cysts; microcalcifications.
What are the two major classifications of fibrocystic breast change?
Non-proliferative (no increased risk for breast cancer development)
Proliferative (+/- atypia) (increased risk for breast cancer development)
What is the term for the transition stage in breast tissue between hyperplasia and low-grade ductal carcinoma in-situ?
Atypical ductal hyperplasia
A __________ is a benign tumor of the breast showing evidence of both connective tissue and epithelial proliferation. They are freely moveable and can enlarge with pregnancy.
A fibroadenoma is a benign tumor of the breast showing evidence of both connective tissue and epithelial proliferation. They are freely moveable and can enlarge with pregnancy.
What breath pathology is a benign polyclonal proliferation of myoepithelial and epithelial cells that grow within the ducts?
Intraductal papilloma
(80% of cases present as unilateral serous or bloody discharge)
Name the four major growth patterns of breast ductal carcinomas in-situ.
Micropapillary (finger-like projections);
cribriform (sieve-like pattern);
solid (complete lumen obliteration);
comedo (central necrosis)
What is the number one risk factor for development of breast cancer?
Family history
The overal 5-year survival rate for breast cancer is ____%.
The overal 5-year survival rate for breast cancer is 90%.
What is the most common breast cancer?
Infiltrating, ductal carcinoma
How do invasive ductal carcinomas of the breast appear grossly?
Stellate,
white,
firm
Identify the different subtypes of invasive ductal carcinoma described below:
— favorable prognosis; grows in well-differentiated tubules
— favorable prognosis; malignant clusters of cells floating in pool of extracellular mucin
— High mitotic rate, diffuse lymphoplasmacytic infiltrate, high-grade pleomorphic nuclei
Tubular
Mucinous
Medullary
Medullary carcinoma of the breast is associated with mutation in what gene(s)?
BRCA1
What is Paget’s disease of the nipple?
A form of breast cancer where cancer cells spread into the epidermis of the areola
Lobular carcinoma in-situ is caused in part by a loss of ________, causing cells to have a loose organization.
Lobular carcinoma in-situ is caused in part by a loss of E-cadherin, causing cells to have a loose (and sometimes linear) organization.
Invasive lobular carcinomas of the breast have an increased risk for metastasis to what organs?
Ovaries;
the GI tract
Using the double-TNM rule, what system is used for grading a breast cancer?
What system is used for staging a breast cancer?
Tubules, nuclei, mitoses;
tumor size, nodal involvement, metastases
What immunohistochemistry is assessed in a prognostic breast panel?
ER, PR, HER-2;
Ki-67
What are the three major pathways of breast cancer development?
Luminal;
HER-2–enriched;
basal-like
Invasive breast cancer molecular subtypes
~45% are ___________.
~20% are ___________.
~20% are ___________.
~20% are ___________.
Invasive breast cancer molecular subtypes
~45% are Luminal A.
~20% are Luminal B.
~20% are Her-2.
~20% are basal-like.
The _________ molecular subtype of invasive breast cancer is hormone-driven.
The luminal molecular subtype of invasive breast cancer is hormone-driven.
The _________ molecular subtype of invasive breast cancer is driven by p53 and BRCA.
The basal-like molecular subtype of invasive breast cancer is driven by p53 and BRCA.
A breast cancer develops from a comedo DCIS to a highly aggressive, triple-negative malignancy.
What is the subtype?
Basal-like
Identify any of the following breast cancer subtypes which are not hormone-driven:
Luminal
HER-2–enriched
Basal-like
HER-2–enriched
Basal-like
(only luminal is ER+)
True/False.
Gynecomastia commonly involves a palpable abnormality due to proliferation of ducts and stroma.
True.
How is breast ductal carcinoma in-situ detected?
Microcalcifications;
mass effect, nipple discharge, Paget’s disease
Why do breast ductal carcinomas in-situ often present with microcalcifications?
Duct occlusion by calcium oxalate deposition or cellular debris
How is breast ductal carcinoma in-situ diagnosed?
Stereotactic guided biopsy
Which form(s) of breast ductal carcinoma in-situ is(are) high-grade?
Micropapillary, cribriform, solid, comedo
Comedo only
How are breast ductal carcinomas in-situ treated?
Breast-conserving therapy
+
radiation
True/False.
Breast DCIS can present with multiple foci in the same breast quadrant.
True.
True/False.
Breast cancers are typically split into the following phenotypes: ER+, HER-2+, triple-negative.
True.
(Genomically: luminal, Her-2–enriched, basal-like)
What drug(s) is(are) specific to luminal breast cancer (ER+)?
Tamoxifen
What drug(s) is(are) specific to HER-2–enriched breast cancer
(HER-2+)?
Trastuzumab (Herceptin)
(doxorubicin also blocks HER-2)
What is the main treatment for basal-like breast cancer (triple negative)?
Chemotherapy
Place the following breast cancer subtypes in order of decreasing difficulty in treatment (i.e. with the most lethal at the top and the least lethal at the bottom):
ER+ (luminal)
HER-2 (HER-2–enriched)
Triple-negative (basal-like)
Place the following breast cancer subtypes in order of decreasing difficulty in treatment:
Triple-negative (basal-like) >>
HER-2 (HER-2–enriched) >
ER+ (luminal)
