female reproductive system- Breast Flashcards by Elyaa Saleh

list 3 Infectious/Inflammatory disroders of the breast

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

How well did you know this?

Not at all

Perfectly

Epi of Acute (Lactational) Mastitis

breast feedig women

How well did you know this?

Not at all

Perfectly

Cause of Acute (Lactational) Mastitis

infection –> Staphylococcus aureus

How well did you know this?

Not at all

Perfectly

Clinical presentation of Acute (Lactational) Mastitis

Pain and tenderness in the breast

How well did you know this?

Not at all

Perfectly

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

features of?

Acute (lactational) Mastitis

*Absecess–> fluid filled cysts caused by bacterial infections

How well did you know this?

Not at all

Perfectly

Epi of Mammary Duct Ectasia
(Plasma Cell Mastitis)

40-60 yrs

How well did you know this?

Not at all

Perfectly

Clinical presentations of Mammary Duct Ectasia
(Plasma Cell Mastitis)

Poorly defined peri-areolar mass with
nipple retraction

How well did you know this?

Not at all

Perfectly

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?

Mammary Duct Ectasia
(Plasma Cell Mastitis)

How well did you know this?

Not at all

Perfectly

Cause of Fat Necrosis of the breast?

Trauma (in most cases)

How well did you know this?

Not at all

Perfectly

clinical presentation of Fat Necrosis?

Painless mass

How well did you know this?

Not at all

Perfectly

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?

Fat Necrosis

How well did you know this?

Not at all

Perfectly

Epi of Fibrocystic changes

Most common breast abnormality seen in premenopausal women

How well did you know this?

Not at all

Perfectly

cause of Fibrocystic changes

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

How well did you know this?

Not at all

Perfectly

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

Fibrocystic changes cause by Non-proliferative lesions

How well did you know this?

Not at all

Perfectly

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

feaures of?

Fibrocystic Changes caused by Proliferative lesions

How well did you know this?

Not at all

Perfectly

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

Apocrine Metaplasia (non-proliferating Fibrocystic changes)

How well did you know this?

Not at all

Perfectly

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

Ductal or lobular epithelium

How well did you know this?

Not at all

Perfectly

* Epithelial hyperplasia in Proliferating fibrocystic changes

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

Increased

How well did you know this?

Not at all

Perfectly

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

features of?

Epithelial Hyperplasia- in proliferating fibrocystic changes

How well did you know this?

Not at all

Perfectly

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

Sclerosing Adenosis

How well did you know this?

Not at all

Perfectly

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

features of?

Adenosis (in proliferative fibrocystic changes)

How well did you know this?

Not at all

Perfectly

List 3 benign neoplasms of the breast

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

How well did you know this?

Not at all

Perfectly

Cause of Fibroadenoma

Absolute or relative increase in Oestrogen

How well did you know this?

Not at all

Perfectly

Epi of Fibroadenoma

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

How well did you know this?

Not at all

Perfectly

clinical presentations of Fibroadenoma

Solitary, discrete, mobile mass (small masses )

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?

Fibroadenoma

Fibrocystic Changes vs. Fibroadenoma

----------- : Benign neoplastic papillary growth in ductals

Intra-Ductal Papilloma

epi of Intra-Ductal Papilloma

Premenopausal women

Clinical presentations of Intra-Ductal Papilloma

Serous or bloody nipple discharge

Loc of Intra-Ductal Papillomas

Mass found beneath the Areola and within the lactiferous ducts

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?

Intra-Ductal Papilloma

Clinical presentations of Phyllodes Tumour (benign)

Solitary, discrete, mobile mass (large masses)

Clinical behaviour of Phyllodes Tumour

benign or malignant

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

Phyllodes Tumour (Benign)

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

Phyllodes Tumour (malignant) | * Anaplasia--> hallmark of cancer

Risk factors of breast carcinoma

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**

Pathogenesis/Genetic changes of breast carcinoma

* **Overexpression of the HER2/NEU proto-oncogene** * **Mutations in BRCA1 or BRCA2 tumour suppressor genes**

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

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

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

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

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

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

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

**Triple negative** ER [-], PR [-], HER2/NEU [-] | e.g., meduallary carcinoma

Triple-Negative breast Cancer ?

**Meudullary Breast Carcinomas** (ER [-], PR [-], HER2/NEU [-]) | * Rare <1%

# *prognosis Overexpression of HER2/Neu --> **[Poorer/good]** prognosis;

**Poorer**

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

* Tubular, Medullary and Mucinous Carcinomas --> **Good** prognosis; * Ductal and Inflammatory Carcinomas --> **Poor** prognosis

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

**Present**

Carcinoma in situ vs Invasive (infiltrating) Carcinoma

* **Carcinoma in situ**: Neoplastic cells **do not penetrate** the limiting basement membrane * **Invasive (Infiltrating) Carcinoma**: Neoplastic cells **penetrate** the limiting basement membrane

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

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

Histologic Variations of DCIS | *DCIS: ductal carcinoma in situ

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

What type of DCIS is this?

**Comedo** (characterised by the presence of calcification)

What type of DCIS is this?

**Cribriform**

What type of DCIS is this?

**Micro-papillary**

prognosis of DCIS?

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

Cause of Paget Disease of the Nipple

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

Prognosis of Paget disease of the Nipple

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

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?

**Paget Disease of the Nipple**

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?

**Lobular Carcinoma in situ (LCIS)**

Epi of Invasive Ductal Carcinoma (NOS):

70% to 80% of breast cancer

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?

Invasive Ductal Carcinoma (NOS)

Immunohistochemistry of Invasive Ductal Carcinoma (NOS)

* E-Cadherin: [+]; Membranous staining * P120 Catenin: [+]; Membranous staining

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?

Invasive Lobular Carcinoma

# ** Immunohistochemistry of Invasive Lobular Carcinoma

* E-Cadherin: [-] * P120 Catenin: [+]; Cytoplasmic staining

Clinical presentation of Inflammatory Carcinoma

Enlarged, **swollen erythematous** breast, **no palpable mass**

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

Inflammatory breast carcinoma

Epi of Medullary breast carcinoma

<1%, RARE

Clinical presentation of Medullary breast carcinoma

resemblance to fibroadenomas

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

Medullary breast carcinoma

Immunohistochemistry of Medullary Breast Carcinoma

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

Clinical presentation of Colloid (Mucinous) Carcinoma

Well-circumscribed masses;

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

Colloid (Mucinous) Carcinoma

Immunohistochemistry of Colloid (Mucinous) Carcinoma

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

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

Tubular Carcinoma

Immunohistochemistry of Tubular Carcinoma

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

prognosis of Tubular carcinoma

Excellent

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

Tubular carcinoma

Clinical presentations of invasive breast carcinomas

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

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

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