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Path III Final > Final Breast > Flashcards

Final Breast Flashcards

1
Q

what cells line lactiferous ducts and lobules?

A

luminal epithelial cells

myoepithelial cells

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2
Q

What do luminal epithelial cells do?

A

produce milk

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3
Q

What do myoepithelial cells do?

A
  • assist in milk ejection during lactation

- maintain normal structure/function of lobule and basement membrane

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4
Q

What are the top 3 infectious bacteria that enter through cracks and fissures in the nipple?

A 
#1 Staph aureus
#2 Staph epidermitis
#3 Strep epidermitis
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5
Q

Peri-ductal mastitis is associated with what RF?

A

Tobacco smoking

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6
Q

What is galactorrhea?

A

appearance of milk in non-pregnant, non-breastfeeding female or in a male.

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7
Q

Mammary duct ectasia is characterized by what histological finding?

A

Lipid laden macrophages in the lactiferous ducts

- foamy histiocytes also found in fat necrosis

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8
Q

Where are fibrocystic breast changes most commonly found?

A

Upper outer quadrant (just like malignancy)

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9
Q

Stromal fibrosis and peri-ductal lymph infiltrate indicate what?

A

lymphocytic mastopathy: WBC surrounded by fibrotic stromal tissue

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10
Q

hist of fibroadenoma

A

well encapsulated

no nuclear atypia

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11
Q

hist of lactating adenoma

A

hyperplastic lobules with marked cytoplasmic vacuolization

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12
Q

duct cells become flattened and nuclei appear next to luminal surface as flattened, dark staining nuclei, lining up in medial ductal facing surface in what lesions?

A

intraductal papilloma

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13
Q

What is the most common type of breast CA?

A

infiltrating ductal carcinoma (80% of all breast CA)

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14
Q

What are characteristics of infiltrating ductal carcinoma?

A

not movable on exam
irregular borders
hard

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15
Q

what type of breast cancer has signet ring appearance?

A

lobular carcinoma

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16
Q

What to Paget cells look like?

A

large, round cels with pale cytoplasm and pleomorphic nuclei seen in epidermis

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17
Q

What cells are affected by Paget cells?

A

Only nipple cells, the other cells are normal

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18
Q

What are the 3 main types of breast CA?

A

Ductal (intraductal is the same thing)
Lobular
Nipple (also called Paget’s disease)

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19
Q

What is hist of ductal cells compared to myoepithelial cells?

A

ductal cells: dark staining and concentric

myoepithelial cells: lighter staining and surround ductal epithelium

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20
Q

What is amastia?

A

congenital condition where breast tissue, nipple, and areola are absent

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21
Q

What is amazia?

A

congenital condition where mammary gland tissue is absent, but nipple and areola are present

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22
Q

What is athelia?

A

presence of glandular tissue with no nipple or areola

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23
Q

Where are supernumerary nipples usually found?

A

usually along milk line, but rarely can be found beyond mammary line

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24
Q

what are some causes of galactorrhea

A

excessive stimulation
hormonal dysregulation
medication side effect
underlying malignancy (30% of women > 60yo)

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25
Q

Mastitis

A

inflammation of parenchyma of mammary gland

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26
Q

etiology of mastitis?

A

inflammatory or infectious

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27
Q

What are top 3 bacteria that cause infectious mastitis?

A 
#1 staph areus
#2 staph epidermitis
#3 strep epidermitis
28
Q

puerperal mastitis

A

during pregnancy or right after

29
Q

what pt population is more likely to get peri-ductal mastitis?

A

Smokers (90% of pt are smokers)

30
Q

histology of periductal mastitis

A

keritinizing squamous epithelium in the duct system of the nipple that extends to abnormal depth

31
Q

what can lead to dilation and rupture of ducts involved in periductal mastitis?

A

chronic granulomatous inflammatory response

32
Q

Mammary duct ectasia

A

dilation of sub-areolar ducts

33
Q

what is pt pop for mammary duct ectasia?

A

multiparous women in 50s and 60s

34
Q

hist of mammary duct ectasia

A

dilated lactiferous ducts filled with granular debris including foamy lipid laden macrophages

35
Q

What is the #1 most common disorder of the breast?

A

fibrocystic breast disease

36
Q

fibrocystic breast disease

A

fibrous lumps and cords in breast tissue that are non-cancerous

37
Q

what percentage of women are affected by fibrocystic breast disease?

A

30-60%

usually 20-40 yo

38
Q

hist of fibrocystic breast disease?

A

fibrocystic changes: broad areas of pink dense CT fibers
increased size of ducts
exhibit adenosis (full of apocrine glands on surface)
multilayering of ductal cells

39
Q

What is hist diagnosis of fibrocystic breast disease?

A

multilayering of ductal cells or in-growth of ductal cells towards center of duct
*may require biopsy or aspiration to dx from CA

40
Q

pathophysiology of fat necrosis

A

rupture of adipocytes and hemorrhage from broken blood vessels into traumatized area

  • fat undergoes lipolysis -> FA -> glycerol
  • fibroblastic proliferation walls off area from surrounding tissue
41
Q

hist of fat necrosis

A
  • calcification and hemosiderin deposition occur in affected area
  • irregular fatty spaces surrounded by foamy histiocytes and multinucleate giant cells
42
Q

gross morphology of fat necrosis

A 
mass
painless
overlying skin thickening
tissue retraction
may look like neoplasm
43
Q

What does mammography reveal in fat necrosis?

A

central radiolucent area of fat with increased density, calcifications, and hemosiderin deposition

44
Q

what would be a better and worse prognosis found on mammography in fat necrosis?

A

smooth calcifications = better

spicules/pop corn shape = worse

45
Q

lymphocytic mastopathy

A

single or multiple hard masses composed of collagenized stroma surrounding atrophic ducts and lobules

46
Q

what pt gets lymphocytic mastopathy?

A

women with DM1 or autoimmune thyroiditis

47
Q

hist of lymphocytic mastopathy?

A
  • thickening and fibrosis of stromal tissue

- lymph infiltrates that surround epithelium of blood vessels

48
Q

How do you dx lymphocytic mastopathy?

A

core needle biopsy reveals dense stromal fibrosis and peri-ductal lymphocytic infiltration
*nests of cells around ducts

49
Q

Granulomatous mastopathy

A

uncommon form of mastitis characterized by presence of granulomas formed by epithelia cells and giant cells

50
Q

What is etiology of granulomatous mastopathy?

A

idiopathic but possibly TB, sarcoidosis, Wegeners granulomatosis

51
Q

Adenosis

A
  • increased number of glands

- no cancerous changes

52
Q

what is most common benign tumor of breast?

A

fibroadenoma

53
Q

hist of fibroadenoma?

A

well encapsulated at low magnification
hyperplasia of intraductal epithelial cells
increase in number of glands

54
Q

seq of fibroadenoma?

A

benign mass, but slight increase in risk for carcinoma

55
Q

hist of lactating adenoma

A

hyperplastic lobules with marked cytoplasmic vacuolization

56
Q

hist of intraductal papilloma

A

myoepithelial cells and multi-layered duct cells

duct cells become flattened and nuclei line up

57
Q

where do majority of breast CA originate?

A 
glandular tissue (adenocarcinoma)
- this includes lobular and ductal tissue
58
Q

What pop has higher prevalence of BRCA1 mutation?

A

Ashkenazi Jews

59
Q

What proto-oncogene is amplified in 30% of breast cancers?

A

HER2/neu gene

60
Q

What is number one type of breast cancer

A

infiltrating ductal carcinoma (80%)

61
Q

2 type of breast CA?

A

lobular carcinoma (5-10%)

62
Q

hist of lobular carcinoma

A

signet ring: nuclei pushed to side
affects only lobular portion
increased vacuolated area

63
Q

Pagets disease of the breast

A

uncommon

eczematous changes overlying nipple and areola

64
Q

hist of pagets disease

A

paget cells: large, round cells with pale cytoplasm and pleomorphic nuclei in epidermis
- only nipple cells affected

65
Q

Inflammatory breast cancer

A

form of ductal carcinoma distinguished by inflamed appearance of breast

  • very aggressive and highly recurrent
  • can present with no lump
  • feels warm
  • peau de orange

Path III Final (6 decks)

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