EXAM #1: PATHOLOGY OF THE BREAST Flashcards
What are the risk factors for malignant breast tumors?
1) Female gender
2) Age i.e. postmenopausal
3) Early menarche/late menarche
4) Obesity
5) Atypical hyperplasia
6) First degree relative with breast cancer
In terms of nuclear and extracellular receptors, what kind of breast cancer is more aggressive than the others?
“Triple negative”
- ER
- PR
- HER2
What is the single most important prognostic factor associated with breast cancer?
Axillary lymph node involvement
What are the two most common invasive breast carcinomas?
1) Ductal (majority)
2) Lobular (minority)
What are the least common invasive breast carcinomas?
1) Papillary
2) Inflammatory
Breast cancer is most common in which breast, left or right?
Left (upper outer quadrant)
If nipple discharge is “bloody” is this likely to be a breast malignancy?
No (this is associated with intraductal papilloma)
Peau d’ orange is associated with what type of malignancy?
Inflammatory breast cancer
What is the 5-year survival rate of Stage 0 breast cancer?
92%
What is the 5-year survival rate of Stage 1 breast cancer?
87%
What is the 5-year survival rate of Stage 2 breast cancer?
75%
*Stage 3 and 4 are “bad news”
What is DCIS? Is there typically a mass in DCIS?
Ductal Carcinoma in Situ (DCIS)
- Malignant proliferation of cells in the ducts of the TDLU, without invasion of the basement membrane
- Non-palpable in most cases
How is DCIS commonly identified?
Early microcalcification on mammography WITHOUT basement membrane penetration
What is Comedocarcinoma?
- Subtype of DCIS
- Central DUCTAL CASEOUS NECROSIS surrounded by cancer cells
*Basement membrane is still intact!
What is Paget Disease?
Eczematous patches on the nipple resulting from underlying DCIS–DCIS extends up the ducts to involve the skin of the nipple
What is a Paget Cell?
Large cells in the epidermis with a clear halo
What is the pathognomonic physical exam description of Invasive Ductal Carcinoma?
A mass that is “hard as a rock” with sharp margins
What are the microscopic features of Invasive Ductal Carcinoma?
Small duct-like or glandular cells with collagenous stroma i.e. desmoplastic stroma
What type of breast cancer is typically bilateral with multiple lesions?
Invasive lobular carcinoma
What description is pathognomonic for Invasive Lobular Carcinoma?
“Indian File”
*Cells lack e-cadherin; consequently they don’t stick together and form a single file line
How do the cells in Invasive Lobular Carcinoma appear? What do these cells lack?
- Small, uniform, and dyschoesive
- Lack e-cadherin
What is unique about medullary carcinoma of the breast?
- Contains large high grade cells growing in sheets with lymphocytic and plasma cell infiltration
- GOOD PROGNOSIS
- Associated with BRCA1
Why is Peau d’ orange seen with inflammatory breast cancer?
Carcinoma invades dermal lymphatics, which blocks lymh drainage and leads to the development of the large swollen breast
*Note that this can resemble mastitis, BUT it is NOT responsive to antibiotics
In what patient population are fibroadenomas most common?
Women under 35 y/o
Is a fibroadenoma a precursor to breast cancer?
No
What are the gross features of a fibroadenoma?
Small, mobile, firm mass with sharp edges
*Note that it will get worse with higher estrogen (cyclic with menstrual cycle)
What is an intraductal papilloma?
- This is a fibrovascular projection into the duct of the TDLU
- Contains both epithelial (luminal) cells and myoepithelial cells
*Note that this does carry an increased risk of breast cancer
What is the hallmark clinical presentation of an intraductal papilloma?
Bloody or serous nipple discharge
What is a Phyllodes tumor?
- Fast-growing mass from the periductal STROMA cells
- More common in women that are 50-60 y/o i.e. post-menopausal
*Note that it MAY become MALIGNANT
What are the gross features of a Phyllodes tumor?
- Leaf-like projections
- Large bulky mass with cysts
What is proliferative breast disease?
This is the MOST COMMON CAUSE OF BREAST LUMPS in patients 25-menopause i.e. this is fibrocystic change
*No increased risk of cancer
How does proliferative breast disease present?
- Premenstural breast pain and multiple lesions
- Often bilateral
- Fluctuation in size of the mass with menstrual cycle and pregnancy
What subtypes of proliferative breast disease have an increased risk of malignancy?
1) Sclerosing adenosis
2) Ductal hyperplasia
3) Atypical hyperplasia (if there are atypical cells)
*Note that APOCRINE METAPLASIA is NOT associated with an increased risk of breast cancer
What is the most common cause of acute mastitis?
S. aureus infiltration during breast feeding leading to bacterial infection/abscess development
What antibiotic is used to treat acute mastitis?
Dicloxacillin
*Can CONTINUE breast-feeding
What causes fat necrosis of breast tissue?
Trauma
*Normally results in painless lump that is calcified on mammography
