Exam 3 Review Flashcards
1) Which is the only finding in fibrocystic condition of the breast that has an increased risk of having carcinoma?
*Atypical Epithelial Hyperplasia
- epithelial hyperplasia becomes multilayered, with atypical nuclear change
- the more severe and atypical the hyperplasia the greater the risk
2) General features of fibroadenoma?
- what do they consist of?
- what age group are you more likely to see a fibroadenoma?
(Remember a woman undergoes her highest amount of estrogenic control after puberty and no longer after menopause)
- MOST common of the BENIGN breast tumors (99%)
- Typically, the diameter 2-5 cm & are well encapsulated spherical nodules, well-circumscribed from breast parenchyma & freely moveable from surrounding breast substance
- Compose of 2 components : fibrous stroma & glandular epithelium (dense/rubber like)
- The fibroblastic component of the tumor resembles normal interlobular stroma enclosing glandular & cystic spaces lined by epithelium
- Tumors of young women in UPPER OUTER quadrant
- Easily removed w/out consequences, they DONT undergo malignant change & have excellent prognosis
3) Signs and symptoms of a woman with fibrocystic disease? (remember it is bilateral disease)
- Fibrocystic changes usually affects BOTH breasts, & b/c changes are symmetrical, patients may complain mostly of pain, modularity, & sensitivity on palpation
- Small lumps may fluctuate, corresponding to the fluid filled cysts, and even areas of calcification
- Mammography reveals condensed areas, cysts, & calcification -> indistinguishable from those seen in cancer, **BIOPSY examination, only safe way to establish definitive diagnosis
Typically doesn’t require Tx unless premalignant changes from atypical epithelial hyperplasia are found, additional surgical resection is recommended.
-Most surgeons perform an extended lumpectomy, they remove indurated glandular part of breast parenchyma. The prognosis overall is excellent.
4) Most characteristic clinical features of intraductal papilloma
- Neoplastic papillary growth w/in a duct.
- MOST are solitary & found w/in principle lactiferous ducts or sinuses. Presents clinically as serous or bloody discharge from nipple a small sub-areolar mass & “RARELY nipple retraction.”
- Complete excision of the duct system should be performed to ovoid local recurrence.
- “Multiple papillomas” are associated w/ an increased risk of Papillary Carcinomas. Solitary ones = BENIGN.
Note: Bloody/Serous nipple discharge= intraductal papilloma
*Single nodule in a single breast (characteristic of ductal)
5) Which conditions have blue dome cysts?
- Blue dome cysts are only seen in FIBROCYSTIC CHANGE!
1. Any imbalances of estrogen/progesterone hormones are thought to be the etiology with changes in the ducts, lobules and stroma.
2. Normal loose intralobular CT is replaced by dense CT, rich in collagen and unresponsive to hormones.
3. Ductal epithelium continues to proliferate because it retains its responsiveness to hormones. The dilated ducts may become entrapped in the dense connective tissue stroma, leading to a Blue-Domed cyst.
4. Besides the fibrosis and the cysts, called Blue-Domed Cysts, which are the most common types of alterations, there is also Epithelial Hyperplasia which is always present
5. When the epithelial hyperplasia becomes multilayered, with atypical nuclear change, this is referred to as Atypical Epithelial Hyperplasia, which is the only change related to the development of carcinoma
5) Which conditions have fibrous tissue?
- **Chronic Mastitis
- Rare disease of unknown cause
- produces small lumps in the breast may mimic cancer, biopsy needed.
- When extensive necrosis occurs from acute matitis, destroyed breast tissue is replaced by fibrous scar & may have nipple retraction–> mistaken for carcinoma
- **Fibrocystic change of the breast
- **Fibroadenomas
- **Gynecomastia/Carcinoma
- Male breast -enlargement w/ hormonal changes during puberty
- enlargement is secondary to inordinate proliferation of ducts & surrounds CT
5) Which conditions have encapsulation?
- know the definition of desmoplasia
Benign Tumors of the Breast Fibroadenomas:
- The most common of the benign tumors
- Typically, diameter 2-5 cm & are well-encapsulated spherical nodules, well-circumscribed from breast parenchyma & are freely moveable from surrounding breast substance
- Tumor is composed of 2 components: fibrous stroma and glandular epithelium
**Desmoplasia - Where the tumor cells infiltrating the tissue are surrounded by dense connective tissue that is produced by the host in response to the tumor (appears firm & gritty when sectioned)
6) What is the common etiology of fat necrosis of breast and likewise what breast conditions can mimic a carcinoma because of the fibrous scarring?
- # 1 cause of fat necrosis of the breast is TRAUMA
- Tends to occur as a solitary, sharply localized process in one breast, & almost all patients give a history of previous trauma, prior surgical intervention, or radiation therapy.
-Grossly, there is hemorrhage w/ CENTRAL FAT NECROSIS, later forms a nodule of gray-white firm tissue w/ foci of chalk-white debris
Possible confusion w/ cancer when fibrotic
Conditions that can mimic carcinoma: a) Chronic Mastitis -produces small lumps, w/ necrosis tissue replaced by fibrous scar & "nipple retraction" b) Central Fat necrosis of the breast (white firm tissue w/ foci is fibrotic)
7) What are the major features of gynecomastia?
- What does the male breast not have?
- What are some of the causes of gynecomastia?
- Gynecomastia is male breast enlargement associated w/ hormonal changes in puberty
- Enlargement is caused by proliferation of excretory ducts that surround connective tissue
- Occurs in adulthood owing to an EXCESS of ESTROGEN, as from cirrhosis or tumors
- Fibrous cap of tissue directly under the areola
- ductal(no lobules) in origin & invades more rapidly because of less adipose tissue
- Male breast has NO lobules but does still have DUCTS
8) Directly and indirectly related to risk factors for breast cancers (two questions)
- Sex?
- Age?
- Race?
- The most important risk factor points to hormonal & genetic etiologies which may act concomitantly, they are paired w/ some additional unidentified carcinogenic substances in environment, or w/ carcinogenic viruses.
1. Sex: Females are affected 100 times more
2. Age: RARE BEFORE puberty and quite unusual in young women. Incidence slowly rises after age of 35 years & peaks in postmenopausal women who are 60 yrs old.
3. Race: Uncommon in Japanese, and Chinese, and MOST common in Caucasians, spec. Jews.
8) Directly and indirectly related to risk factors for breast cancers (two questions)
- Genetics?
- Hormonal factors ?
- Genetics: If a mother had/ has breast cancer all daughters have increased risk. (Also for sisters of a patient with breast cancer.) A history of familial cancer increases the risk for relatives be 5-10 fold & possibly higher in some.
- Hormonal Factors: Women exposed to estrogens for prolonged periods tend to develop breast cancer. More common in early menarche & late menopause (influence of ovarian sex hormones).
Nulliparous women @ greater risk, than those who have multiple children, b/c pregnancy interrupts the cyclic secretion of ovarian estrogens.
-Breast cancers have estrogen receptors, & growth of these cells can be inhibited/slowed down by synthetic anti-estrogen drugs—> important role of hormones in breast cancer.
8) Directly and indirectly related to risk factors for breast cancers (two questions)
- Presence of other cancers?
- Premaligant Fibrocystic Changes & Multiple intraductal papillomatosis ?
- Other causes?
- Presence of other cancers: Incidence increased in women who have cancer in other breast, as well as those who have ovarian or endometrial cancer, b/c these tumors are hormonally induced, occurring in women in whom there is hyperestrinism.
- Premalignant Fibrocystic Changes and Multiple Intraductal Papillomatosis:
* *Atypical Epithelial Hyperplasia, along w/ multiple intraductal papillomas can progress to invasive carcinoma, if not removed. - Other causes:
Obesity, high fat diets, & moderate alcohol consumption can all increase the risk.
-The more severe & atypical hyperplasia, greater the risk.
9) What is the most common location for breast cancer to occur?
-Upper outer quadrant (45%), central under the areola (25%)
10) The main difference from invasive and in situ is preachment of?
**When it reaches the BASEMENT MEMBRANE
-Noninvasive/ in situ – a malignant population of cells that lack the capacity to invade through the basement membrane and therefore no distant spread
-Invasive/ infiltrating – tumors that infiltrate the tissue are surrounding with CT which is produced by the host in response to the tumor
o This dense CT pulls on the adjacent tissue, causing puckering of the skin and retraction of the nipple
11) What is the difference between FNA vs a surgical biopsy or incisional biopsy?
- *FNA (fine needle aspiration)
- sample may be too small to establish definitive diagnosis & procedure must be repeated
- done @ initial screening
- *Surgical biopsy requires incision of skin & is performed under general anesthesia
- confirms diagnosis of cancer
12) What does the mammogram look for?
- Specialized X-ray technique, allows detailed examination of breast w/ low density radiographs
- Tumor masses can be detected in early stages of development even before they are palpable seen as increased density w/ frequent calcification
- Smallest tumor can be less than 0.5 cm
13) Know the difference from modified radical mastectomy and lumpectomy
- Lumpectomy: most conservative surgical procedure as it is limited to resection of the tumor with surrounding fat tissue
- Modified radical MASTECTOMY: removal of breast tissue, skin, areola, nipple, pectoralis(except), and most of underarm lymph nodes (EVERYTHING)
Modified means that the pectoralis is not remove
14) What route do breast cancers metastasize via?
Lymphatics- b/c most lymph ducts drain into axillary lymph nodes, most metastases are found in the axillary area.
- As focal lesions, cancer extends in all directions & adhere to deep fascia of chest wall–> become fixed
- Medially or centrally located tumors spread into internal mammary lymph nodes
- **Distant metastases: in lungs, liver, bones, brain, and adrenals
- **Local: Internal mammary lymph nodes & axillary lymph nodes
15) What is the function and other name for Sertoli (Sustenticular) cells?
- For support & nutrition of the spermatozoa, located between the germ cells
- “inside” seminal vesicles while the Leydig cells are “outside”
16) Which of the following 3 accessory male glands produces the largest amount of seminal fluid?
1) Seminal Vesicles 60%
2) Prostate 13-33%
3) Cowpers (Bulbourethral) Gland 7-10%
17) What is the lining epithelium of the Vas deferens (Ductus deferens) and Epididymis?
- Epididymis: Lined w/ Ciliated Pseudo-stratified Columnar Epithelium & walls contain smooth muscle
- Vas Deferens: lined by Pseudo-stratified Epithelium w/ a heavy coat of 3 muscle layers that propel sperm towards urethra by peristalsis
18) What is the definition of cryptorchidism and what is the most common malignant and nonmalignant complications?
- A congenital malpositioning of the testes outside of their nomal scrotal location-it is the MOST important of the congenital abnormalities.
- The descent of the testes may be arrested at any point from the abdomen to the upper scrotum.
- Mostly commonly unilateral, one quarter it is bilateral, and the cause for the maldescent is unknown.
- Adult men with untreated bilateral cryptorchidism are ***INFERTILE, but orchiopexy before the age of 2 years generally prevents this complication
- The RISK of developing germ cell tumors in untreated Crytorchidism, most commonly ***Seminomas and Embryonal Carcinomas (BOTH malignant), is increased 10-35 times.
19) When do the testes descend down into the scrotum. At what week?
-Fetal testes are originally located in the abdominal cavity
-During intrauterine life- the testes slowly descend towards the inguinal canal and
through it, reaching the scrotum by “33 weeks “
-They lie in the pelvic cavity and at about 2 months prior to birth they descend into the scrotum
20) What testicular tumor is commonly seen in Crytorchidism?
- The risk of developing germ cell tumors in untreated cryptorchidism, most commonly Seminomas and Embryonal Carcinomas, is increased 10-35 times
- Germ cell tumors aren’t reported in patients who had an orchiopexy before age 5 – it’s crucial to treat this disorder early
