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patho II > female reproductive system- Breast > Flashcards

female reproductive system- Breast Flashcards

1
Q

list 3 Infectious/Inflammatory disroders of the breast

A

I. Acute Mastitis
II. Mammary Duct Ectasia (Plasma Cell Mastitis)
III. Fat Necrosis

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2
Q

Epi of Acute (Lactational) Mastitis

A

breast feedig women

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3
Q

Cause of Acute (Lactational) Mastitis

A

infection –> Staphylococcus aureus

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4
Q

Clinical presentation of Acute (Lactational) Mastitis

A

Pain and tenderness in the breast

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5
Q

Microscopic findings:
Acute inflammatory changes with the production of single or multiple abscesses

features of?

A

Acute (lactational) Mastitis

*Absecess–> fluid filled cysts caused by bacterial infections

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6
Q

Epi of Mammary Duct Ectasia
(Plasma Cell Mastitis)

A

40-60 yrs

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7
Q

Clinical presentations of Mammary Duct Ectasia
(Plasma Cell Mastitis)

A

Poorly defined peri-areolar mass with
nipple retraction

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8
Q

Microscopic findings:
1. Ducts are filled with granular debris, leukocytes and lipid-laden macrophages
2. Destruction of the lining epithelium
3. Prominent lympho-plasmacytic infiltration of the periductal stroma

features of?

A

Mammary Duct Ectasia
(Plasma Cell Mastitis)

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9
Q

Cause of Fat Necrosis of the breast?

A

Trauma (in most cases)

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10
Q

clinical presentation of Fat Necrosis?

A

Painless mass

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11
Q

Microscopic findings:
1. Early stage: Central focus of necrotic fat cells
surrounded by neutrophils, lipid-laden macrophages and sometimes giant cells
2. Advanced stage: Replacement by scar tissue or a cyst consisting of necrotic debris

features of?

A

Fat Necrosis

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12
Q

Epi of Fibrocystic changes

A

Most common breast abnormality seen in premenopausal women

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13
Q

cause of Fibrocystic changes

A

Consequence of the cyclic breast changes that
occur normally in the menstrual cycle

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14
Q

Microscopic findings:
* Cystic formation
* Fibrosis
* Apocrine Metaplasia
features of?

A

Fibrocystic changes cause by Non-proliferative lesions

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15
Q

Microscopic findings:
* Epithelial Hyperplasia (ductal & lobular)
* Adenosis
* Sclerosing Adenosis

feaures of?

A

Fibrocystic Changes caused by Proliferative lesions

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16
Q

microscopic features:
- Lining cells are large and polygonal with abundant granular, eosinophilic cytoplasm
- small, round, deeply chromatic nuclei
- Apocrine snouts

A

Apocrine Metaplasia (non-proliferating Fibrocystic changes)

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17
Q

where does Epithelial Hyperplasia occur in a patient w/ Proliferating fibrocystic changes in the breast?

A

Ductal or lobular epithelium

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18
Q

* Epithelial hyperplasia in Proliferating fibrocystic changes

Both atypical ductal and lobular hyperplasia are associated with an [increased/decreased] risk of invasive (infiltrating) carcinoma

A

Increased

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19
Q

microscopic features:
- Several elongated clefts are present at the periphery and within the cluster
- Oval and normo-chromatic nuclei

features of?

A

Epithelial Hyperplasia- in proliferating fibrocystic changes

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20
Q

What proliferative fibrocystic breast change is described as Stromal fibrosis and acini with proliferation of luminal spaces lined by epithelial and myopeithelial cells?

A

Sclerosing Adenosis

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21
Q

Histopatho:
- Proliferation of luminal spaces lined by
epithelial and myoepithelial cells

features of?

A

Adenosis (in proliferative fibrocystic changes)

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22
Q

List 3 benign neoplasms of the breast

A

1) Fibroadenoma
2) Phyllodes Tumour (benign)
3) Intra-ductal Papilloma

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23
Q

Cause of Fibroadenoma

A

Absolute or relative increase in Oestrogen

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24
Q

Epi of Fibroadenoma

A

Most common benign neoplasm; Young women (< 35yrs)

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25
Q

clinical presentations of Fibroadenoma

A

Solitary, discrete, mobile mass
(small masses )

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26
Q

Microscopic findings:
– Loose fibroblastic stroma containing duct-like, epithelium lined spaces of various shapes and sizes
– Lining of the spaces: Luminal and myoepithelial cells
– Well-defined intact basement membrane

features of?

A

Fibroadenoma

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27
Q

Fibrocystic Changes
vs. Fibroadenoma

A
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28
Q

———– : Benign neoplastic papillary growth in ductals

A

Intra-Ductal Papilloma

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29
Q

epi of Intra-Ductal Papilloma

A

Premenopausal women

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30
Q

Clinical presentations of Intra-Ductal Papilloma

A

Serous or bloody nipple discharge

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31
Q

Loc of Intra-Ductal Papillomas

A

Mass found beneath the Areola and within the lactiferous ducts

32
Q

Microscopic findings:
* Multiple papillae, each having a
connective tissue core covered by epithelial cells that are double-layered, with an outer luminal layer overlying a myoepithelial layer

features of?

A

Intra-Ductal Papilloma

33
Q

Clinical presentations of Phyllodes Tumour (benign)

A

Solitary, discrete, mobile mass
(large masses)

34
Q

Clinical behaviour of Phyllodes Tumour

A

benign or malignant

35
Q

Microscopic findings:
* Biphasic tumour, composed of neoplastic stromal cells and epithelium-lined glands.
Stromal element is more cellular and abundant (compared to Fibroadenoma), forming epithelium-lined, leaf-like projections

Features of?

* Bipashic –> composed of 2 different cellualr elements

A

Phyllodes Tumour (Benign)

36
Q

Microscopic features:
1. Marked Stromal Hypercellualarity
2. Anaplasia (lack of celluar Differentiation)
3. High mitotic activity
4. Infiltrative margins

features of?

A

Phyllodes Tumour (malignant)

* Anaplasia–> hallmark of cancer

37
Q

Risk factors of breast carcinoma

A

1) ↑ Age –> menopause
2) Prolonged exposure to oestrogens (hormonal imbalance): Hormone replacement therapy, late age at birth of first child, nulliparous, long duration between menarche and menopause
2) History of atypical hyperplasia and Lobular and ductal carcinoma in situ
4) Ionising Radiation, Obesity, High-fat diet
7) Alcohol consumption and Cigarette smoking
8) Ethnicity: highest rate in non-Hispanic white women

38
Q

Pathogenesis/Genetic changes of breast carcinoma

A
  • Overexpression of the HER2/NEU proto-oncogene
  • Mutations in BRCA1 or BRCA2 tumour suppressor genes
39
Q

HER2/NEU proto-oncogene:
Gene expression profiling can separate breast cancer
into four molecular subtypes:
Luminal A is?

A

ER [+], PR [+], HER2/NEU [-]

40
Q

HER2/NEU proto-oncogene:
Gene expression profiling can separate breast cancer
into four molecular subtypes:
Luminal B is?

A

ER [+], PR [-], HER2/NEU [+]

41
Q

HER2/NEU proto-oncogene:
Gene expression profiling can separate breast cancer
into four molecular subtypes:
HER2/NEU positive is?

A

HER2/NEU [+], ER [-], PR [-]

42
Q

HER2/NEU proto-oncogene:
Gene expression profiling can separate breast cancer
into four molecular subtypes:
Basal-like is?

A

Triple negative
ER [-], PR [-], HER2/NEU [-]

e.g., meduallary carcinoma

43
Q

Triple-Negative breast Cancer ?

A

Meudullary Breast Carcinomas
(ER [-], PR [-], HER2/NEU [-])

* Rare <1%

44
Q

*prognosis

Overexpression of HER2/Neu –> [Poorer/good] prognosis;

A

Poorer

44
Q

* prognosis

Histologic type of Cancer
(Tubular, Medullary and Mucinous Carcinomas –> [Good/Poor] prognosis;
Ductal and Inflammatory Carcinomas –> [Good/Poor]prognosis

A
  • Tubular, Medullary and Mucinous Carcinomas –> Good prognosis;
  • Ductal and Inflammatory Carcinomas –> Poor prognosis
45
Q

prognosis

[present/Absent] ER or PR -> Good response to therapy

A

Present

46
Q

Carcinoma in situ vs Invasive (infiltrating) Carcinoma

A
  • Carcinoma in situ: Neoplastic cells do not penetrate the limiting basement membrane
  • Invasive (Infiltrating) Carcinoma: Neoplastic cells penetrate the limiting basement membrane
47
Q

Examples of Non-invasive Breast Carcinoams (Carcinoma in situ)

A
  1. Ductal Carcinoma in situ (DCIS)
  2. Lobular Carcinoma in situ (LCIS)
48
Q

Histologic Variations of DCIS

*DCIS: ductal carcinoma in situ

A
  1. Solid
  2. Comedo
  3. Cribriform
  4. Papillary
  5. Micro-papillary
  6. Mixed types
49
Q

What type of DCIS is this?

A

Comedo (characterised by the presence of calcification)

50
Q

What type of DCIS is this?

A

Cribriform

51
Q

What type of DCIS is this?

A

Micro-papillary

52
Q

prognosis of DCIS?

A

Excellent prognosis, with > 97% long-term
survival after simple mastectomy

53
Q

Cause of Paget Disease of the Nipple

A

Underlying DCIS or invasive breast cancer extends up the lactiferous ducts and into the adjacent skin of the nipple

54
Q

Prognosis of Paget disease of the Nipple

A

Prognosis is based on the underlying carcinoma, and is not affected by the presence of Paget Disease

55
Q

Macroscopic features:
Nipple and Aerola show:
* Eczematous patches over the nipple and areolar skin
* Ulceration
* Oozing (Discharge)
* Crusting
* Fissuring

Microscopic findings:
* Intra-epidermal spread of tumour cells
* Cells occur singly or in groups within the epidermis
* Presence of a clear halo surrounding the nucleus (Pale cytoplasm)

features of?

A

Paget Disease of the Nipple

56
Q

Microscopic features:
- Uniform appearance: Monomorphic cells with bland, round nuclei in loosely cohesive clusters within the lobules
- Intra-cellular mucin vacuoles (“signet ring” cells) are common
(- No calcification)

features of?

A

Lobular Carcinoma in situ (LCIS)

57
Q

Epi of Invasive Ductal Carcinoma (NOS):

A

70% to 80% of breast cancer

58
Q

Microscopic findings:
Heterogeneous appearance, ranging from tumours with well-developed tubule formation and low-grade nuclei to tumours consisting of sheets of anaplastic cells

features of?

A

Invasive Ductal Carcinoma (NOS)

59
Q

Immunohistochemistry of Invasive Ductal Carcinoma (NOS)

A
  • E-Cadherin: [+]; Membranous staining
  • P120 Catenin: [+]; Membranous staining
60
Q

Microscopic findings:
* Consists of cells morphologically identical to the cells of LCIS
* Cells invade individually into stroma; often aligned in
“single-file” strands or chains (“indian file” appearance)

features of?

A

Invasive Lobular Carcinoma

61
Q

**

Immunohistochemistry of Invasive Lobular Carcinoma

A
  • E-Cadherin: [-]
  • P120 Catenin: [+]; Cytoplasmic staining
62
Q

Clinical presentation of Inflammatory Carcinoma

A

Enlarged, swollen erythematous
breast, no palpable mass

63
Q

Microscopic findings:
* Poorly differentiated and diffusely infiltrative
* Involvement of dermal lymphatic spaces
* No true inflammation

features of?

A

Inflammatory breast carcinoma

64
Q

Epi of Medullary breast carcinoma

A

<1%, RARE

65
Q

Clinical presentation of Medullary breast carcinoma

A

resemblance to fibroadenomas

66
Q

Microscopic findings:
Large, anaplastic cells
 Well-circumscribed, “pushing” borders
 Marked lympho-plasmacytic infiltrate

Features of?

A

Medullary breast carcinoma

67
Q

Immunohistochemistry of Medullary Breast Carcinoma

A

ER [-], PR [-] and HER2/Neu [-]
(Triple-Negative Tumours)

68
Q

Clinical presentation of Colloid (Mucinous) Carcinoma

A

Well-circumscribed masses;

69
Q

Macroscopic features: Soft and gelatinous masses
Microscopic findings: Abundant quantities of extracellular mucin in the stroma

features of?

A

Colloid (Mucinous) Carcinoma

70
Q

Immunohistochemistry of Colloid (Mucinous) Carcinoma

A

ER & PR [+], in the majority of cases;
NO overexpression of HER2/Neu

71
Q

– Microscopic findings:
* Well-formed tubules
* Low-grade nuclei
* Calcifications
* Apocrine snouts

features of?

A

Tubular Carcinoma

72
Q

Immunohistochemistry of Tubular Carcinoma

A

ER & PR [+] (almost all cases); NO
HER2/Neu overexpression

73
Q

prognosis of Tubular carcinoma

A

Excellent

74
Q

what type of Breast Carcinomas has the following observations on
Imaging studies : Irregular mammographic densities (percentage of dense tissue of an entire breast)

A

Tubular carcinoma

75
Q

Clinical presentations of invasive breast carcinomas

A

1) Retraction or dimpling of the skin or nipple
2) involvement of the lymphatic pathways –> Localised
lymphoedema –> Peau d’orange appearance (“orange
peel”)
3) Lymphogenous and haematogenous dissemination;
Favoured locations: lungs, skeleton, liver, adrenals,
brain

76
Q

**

Which breast carcinoma can arise in both breasts, [DCIS/LCIS]

A

LCIS

*DCIS arises in the same breast (single) and quadrant

patho II (29 decks)

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