Final: breast Flashcards
breast changes during cycle
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
1st trimester
proliferation of acinar cells w/ minimal change in secretory function
3rd trimester
intense lobular proliferation
amazia
mammary gland tissue absent but nipple and areola PRESENT
Athenians
breast glandular tissue present but NO nipple/areola
mastitis
- 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
peri-ductal mastitis
painful mass in sub-areolar area w/ overlying skin erythema
micro: keratinizing squamous epithelium. Chronic granulomatous inflammatory response noted
mammary duct ectasia
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)
fibrocystic breast dz
SINGLE MOST COMMON d/o of breast.
Fx’d by cycle
-Upper outer quadrant
- mammography of limited value, often requires bx or FNA
Histology of Fibrocystic breast dz
histo: dense collagen fibers, cystic spaces filled w/ fluid and lined by cells resembling sweat glands
Dx of Fibrocystic breast disease
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.
fat necrosis
- 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
lymphocytic mastopathy
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
granulomatous mastopathy
occasionally seen w/ breast carcinoma. TB infxn will show caseating granulomas. Immunocompromised: may see granulomas outs disease d/t infection: mycobacterial or fungal
adenosis
- increased number of gland components
- may become adenoma (more organized)
fibroadenoma
- 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
lactating adenoma
- localized focus of hyperplastic cells seen in breast tissue during pregnancy
- hyperplastic lobules w/ marked cytoplasmic vacuolization
intraductal papilloma
- benign but small chance for malignant transformation
- micro: myoepithelial cells and multilayered ductal cells. These becomes flattened and nuclei appear next to luminal surface
Breast CA
majority from glandular tissue (adenocarcinomas). Both lobular tissue and ductal tissue are considered glandular and both give rise to adenocarcinoma
Risk Factors for Breast CA
FEMALE, age, personal hx, FHx (both mother and sister), high post-meno blood estrogen levels, high IGF, ETOH > 2 glasses/day, DES
Moderate and minor risk factors for breast cancer
age at first pregnancy, any first-degree relative w/ hx of breast CA, tobacco use, ionizing radiation, hx of benign proliferative lesion
What factors offer protection from breast cancer
menses >15, brastfeeding 1 year or more, minimal ETOH consumption, no tobacco, diet containing more MUFA
Common denominator in breast cancer
level and duration of exposure to endogenous estrogen stimulation
estrogen receptors and mutations
- 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
