female reproductive system- Breast Flashcards
list 3 Infectious/Inflammatory disroders of the breast
I. Acute Mastitis
II. Mammary Duct Ectasia (Plasma Cell Mastitis)
III. Fat Necrosis
Epi of Acute (Lactational) Mastitis
breast feedig women
Cause of Acute (Lactational) Mastitis
infection –> Staphylococcus aureus
Clinical presentation of Acute (Lactational) Mastitis
Pain and tenderness in the breast
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
Epi of Mammary Duct Ectasia
(Plasma Cell Mastitis)
40-60 yrs
Clinical presentations of Mammary Duct Ectasia
(Plasma Cell Mastitis)
Poorly defined peri-areolar mass with
nipple retraction
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)
Cause of Fat Necrosis of the breast?
Trauma (in most cases)
clinical presentation of Fat Necrosis?
Painless mass
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
Epi of Fibrocystic changes
Most common breast abnormality seen in premenopausal women
cause of Fibrocystic changes
Consequence of the cyclic breast changes that
occur normally in the menstrual cycle
Microscopic findings:
* Cystic formation
* Fibrosis
* Apocrine Metaplasia
features of?
Fibrocystic changes cause by Non-proliferative lesions
Microscopic findings:
* Epithelial Hyperplasia (ductal & lobular)
* Adenosis
* Sclerosing Adenosis
feaures of?
Fibrocystic Changes caused by Proliferative lesions
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)
where does Epithelial Hyperplasia occur in a patient w/ Proliferating fibrocystic changes in the breast?
Ductal or lobular epithelium
* Epithelial hyperplasia in Proliferating fibrocystic changes
Both atypical ductal and lobular hyperplasia are associated with an [increased/decreased] risk of invasive (infiltrating) carcinoma
Increased
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
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
Histopatho:
- Proliferation of luminal spaces lined by
epithelial and myoepithelial cells
features of?
Adenosis (in proliferative fibrocystic changes)
List 3 benign neoplasms of the breast
1) Fibroadenoma
2) Phyllodes Tumour (benign)
3) Intra-ductal Papilloma
Cause of Fibroadenoma
Absolute or relative increase in Oestrogen
Epi of Fibroadenoma
Most common benign neoplasm; Young women (< 35yrs)
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)
- Ductal Carcinoma in situ (DCIS)
- Lobular Carcinoma in situ (LCIS)
Histologic Variations of DCIS
*DCIS: ductal carcinoma in situ
- Solid
- Comedo
- Cribriform
- Papillary
- Micro-papillary
- 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
