Final: breast

Question 1

breast changes during cycle

Answer 1

estrogen: epithelial cell proliferation; ductal elongation and branching
also increase volume, elasticity of CT and ducts and increased deposition of adipose
progesterone: increased lobule formation

Question 2

1st trimester

Answer 2

proliferation of acinar cells w/ minimal change in secretory function

Question 3

3rd trimester

Answer 3

intense lobular proliferation

Question 4

amazia

Answer 4

mammary gland tissue absent but nipple and areola PRESENT

Question 5

Athenians

Answer 5

breast glandular tissue present but NO nipple/areola

Question 6

mastitis

Answer 6

• inflammation of parenchyma of mammary gland

-when lactating: puerperal mastitis
NOT harmful to keep breastfeeding; in fact mb helpful-

-Usually sterile but when infectious: s. Aureus or S. Epidermidis

Question 7

peri-ductal mastitis

Answer 7

painful mass in sub-areolar area w/ overlying skin erythema

micro: keratinizing squamous epithelium. Chronic granulomatous inflammatory response noted

Question 8

mammary duct ectasia

Answer 8

dilatation of sub-areolar

most common in 5th/6th decades of life. UNILATERAL but mb

breast pain, palpable yet poorly defined areola or peri-areolar mass, thick secretions from nipple mb noted

primary event: peri-ductal inflammation and duct ectasia; nipple inversion may occur as result of traction. Micro: see dilated ducts filled w/ granular debris and lipid laden m0 (foamy m0)

Question 9

fibrocystic breast dz

Answer 9

SINGLE MOST COMMON d/o of breast.
Fx’d by cycle
-Upper outer quadrant
- mammography of limited value, often requires bx or FNA

Question 10

Histology of Fibrocystic breast dz

Answer 10

histo: dense collagen fibers, cystic spaces filled w/ fluid and lined by cells resembling sweat glands

Question 11

Dx of Fibrocystic breast disease

Answer 11

depends on: MULTILAYERING of ductal cells or noting the in-growth of these cells towards center of the duct (net increase in number of ductal cells.

Question 12

fat necrosis

Answer 12

• d/t breast trauma or surgery
• released fat undergoes lipolysis and converted to FA and glycerol
• calcification and hemosiderin deposition occurs within affected area
• Usu painless

Question 13

lymphocytic mastopathy

Answer 13

single hard mass or multiple hard masses made of COLLAGENIZED STROMA surrounding Atrophic ducts and lobules

-micro: thickening and fibrosis of stromatolites tissue; lymphocytic infiltrates

-most commonly found in women w/ Type 1 DM and AI thyroiditis (Hashimoto’s)
theorized to be AI

Question 14

granulomatous mastopathy

Answer 14

occasionally seen w/ breast carcinoma. TB infxn will show caseating granulomas. Immunocompromised: may see granulomas outs disease d/t infection: mycobacterial or fungal

Question 15

adenosis

Answer 15

• increased number of gland components

- may become adenoma (more organized)

Question 16

fibroadenoma

Answer 16

• most common benign tumor of breast
• well circumscribed w/ prominent fibrotic capsule; firm on PE but FREELY moveable
• mb tender but usually non-tender
• well-encapsulated. Notable hyperplasia of intraductal epithelial cells. NO abnormalit in nuclear size or N:C ratio
• mb hormonally responsive: increase in size during pregnancy and late Luteal phase of menses

often regress post-menopause

benign but assoc. w minimally increased risk of carcinoma

Question 17

lactating adenoma

Answer 17

• localized focus of hyperplastic cells seen in breast tissue during pregnancy
• hyperplastic lobules w/ marked cytoplasmic vacuolization

Question 18

intraductal papilloma

Answer 18

• benign but small chance for malignant transformation
• micro: myoepithelial cells and multilayered ductal cells. These becomes flattened and nuclei appear next to luminal surface

Question 19

Breast CA

Answer 19

majority from glandular tissue (adenocarcinomas). Both lobular tissue and ductal tissue are considered glandular and both give rise to adenocarcinoma

Question 20

Risk Factors for Breast CA

Answer 20

FEMALE, age, personal hx, FHx (both mother and sister), high post-meno blood estrogen levels, high IGF, ETOH > 2 glasses/day, DES

Question 21

Moderate and minor risk factors for breast cancer

Answer 21

age at first pregnancy, any first-degree relative w/ hx of breast CA, tobacco use, ionizing radiation, hx of benign proliferative lesion

Question 22

What factors offer protection from breast cancer

Answer 22

menses >15, brastfeeding 1 year or more, minimal ETOH consumption, no tobacco, diet containing more MUFA

Question 23

Common denominator in breast cancer

Answer 23

level and duration of exposure to endogenous estrogen stimulation

Question 24

estrogen receptors and mutations

Answer 24

• bind estrogen, stimulate prolif of mammary cells. Over expressed in many breast CA (termed ER+)
• BRCA1 and BRCA2 30-40% of all inherited breast CA (bind and regulate RAD51 to fix DNA breaks)
• High prevalence of BRCA mutations in ashkenazi Jews

Question 25

HER2/neu

Answer 25

-proto-oncogene , increased risk of recurrence and worse prognosis

HER2/neu also seen w/ other malignancies (ovarian, ST, uterine) always suggests WORSE prognosis

Question 26

Breast cancer types

Answer 26

• ductal, lobular and nipple (Paget’s disease of the breast). Others: inflammatory
• Carcinoma in situ: low grade w/ basement membrane INTACT

Question 27

infiltrating ductal carcinoma

Answer 27

• MOST COMMON type of breast CA
• sandy, serrhous (?), surface
• more glandular tissue, less stromal/fat tissue
• signet ring=poor prognosis

Question 28

lobular carcinoma

Answer 28

• second most common
• high risk for MULTIPLE FOCI and increased risk for bilateral involvement
• CELLS LINE UP
• also may have signet ring

Question 29

Pagets dz of the breast

Answer 29

uncommon. Nipple and areolar complex.
ssx: change in sensation of nipple/areolar area and itching/burning. Eczema tours changes overlying nipple/areola. Late stages: ulceration and destruction of nipple/areola

Paget cells: large round cells w/ pale cytoplasm and pleomorphic nuclei

Question 30

Inflammatory breast CA

Answer 30

• distinguished from others by markedly inflamed appearance of affected breast
• ESPECIALLY aggressive
• often presents W/O palpable lump on breast examination