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Pathology III > Final - new material > Flashcards

Final - new material Flashcards

1
Q

Anytime a male or non-gravid female is producing breast discharge:

A

galactorrhea

MC from hormonal dysregulation or side-effect from several meds (OCPs)
excess prolactin expressed, mb from prolactinoma

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2
Q

The breasts are modified ___________:

A

sweat glands

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3
Q

The lactiferous duct system contains _________ ducts, which correspond to ____ openings at the nipple.

A

4-18

each duct opens to the nipple (equal #)

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4
Q

% of breast cancer found in each quadrant:

A

Upper Outer - 58%***

Upper Inner - 17%
Lower Outer - 12%
Lower Inner - 13%

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5
Q

The lactiferous ducts and lobules are lined by 2 cell types:

A

luminal epithelium cells - milk production

myoepithelial cells - assist lactation (ejection); normal structure/function

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6
Q

___% of lymph flow from breast travels to _____ node system:

A

75%

axillary [includes pectoral, sub-scap, humeral]

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7
Q

How are stroma & parenchyma different?

A

Stroma - non-functional, connective tissue, supportive framework.

Parenchyma - functional parts of an organ; in cancer, the mutant cells.

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8
Q

Amastia:

A

absent breast tissue/nipple/areola

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9
Q

Amazia:

A

absent mammary gland tissue

nipple/areola present

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10
Q

Athelia:

A

absent nipple or areola

glandular tissue present

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11
Q

In the ___ decade breast stromal tissues begin to involute, and at ________ diminish/disappear, replaced by adipose.

A

3rd decade

menopause

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12
Q

Estrogen stimulates what:

A

epithelial cell proliferation
ductal elongation/branching
increased volume & elasticity of CT/ducts
increased adipose tissue

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13
Q

Progesterone stimulates what:

A

increased lobule formation

increased size of acini/lumen/ducts

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14
Q

The glands on the areola are called _________ and function to:

A 
Montgomery tubercles (sebaceous glands)
lubricate nipple
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15
Q

Breast histology - 1st trimester:

3rd trimester:

A

1st - acinar proliferation
stromal involution
minimal secretory changes

3rd - lobular proliferation
cells enlarged, increased cytoplasm, lg nuclei
dramatic stromal involution

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16
Q

Inverted nipples are familial in ___% of cases,
bilateral in ____% of cases,
and present in ___% of the population.

A

familial - 50%
bilateral - 90%
incidence - 3%

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17
Q

When is an inverted nipple a red flag sign?

A

When it is a new onset in absence of a known cause

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18
Q

Galactorrhea is disconcerting when:

A

unilateral
bloody
assoc w/mass

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19
Q

Inflammation of the parenchyma of the mammary gland:

A

Mastitis

usu. when lactating -> puerperal

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20
Q

When found to be infectious in cause, mastitis is usu d/t:

A

staph aureus OR strep epidermitis

generally enters via cracks/fissures in nipple

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21
Q

Peri-ductal mastitis usu presents as:

A

painful mass in the sub-areolar area
overlying skin erythema
>90% are smokers
nipple inversion may occur

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22
Q

Peri-ductal mastitis - histology:

A

keratinizing squamous epithelium in the duct system
extends to abn depth
chronic granulomatous inflammatory response
dilation/rupture of ducts

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23
Q

Mammary duct ectasia is:

commonly seen in:

A

dilatation of the sub-areolar ducts
often unilateral, but mb bilateral

5th or 6th decade
multiparous women

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24
Q

Mammary duct ectasia - clinical presentation:

A 
breast pain
overlying erythema
palpable areolar or peri-areolar mass
poorly defined mass 
mb thick secretions from nipple
mb nipple inversion (30-40%)
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25
Q

Mammary duct ectasia - histology:

A

dilated lactiferous ducts
granular debris -> inc foamy (lipid) macrophages
infiltration of lymphs & macrophages
inc plasma cells

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26
Q

Condition characterized by fibrous lumps & cords in breast tissue that are non-cancerous:

A

Fibrocystic breast dz

30-60% of women
frequently dx’d at 20-40 yo
uncommon before adolescence/after menopause

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27
Q

Fibrocystic breast changes are most often found:

Dx:

A

in the upper outer quadrant

mammography - limited value, mb too dense to visualize
bx or aspiration - definitive

28
Q

Fibrocystic breast - histology:

A

fibrosis - dense collagen
sclerosing ductal epithelial proliferation - round ducts inc in size
adenosis - full of glands
apocrine metaplasia - lg cystic spaces, fluid-filled

29
Q

MC occurs as result of prior breast trauma or 2° to breast surgery:

A

fat necrosis

adipocyte rupture -> lipolysis, converted to fatty acid + glycerol -> fibroblastic proliferation, inc vascularization -> calcification, hemosiderin deposition

presents as painless breast mass, skin thickening, mb tissue retraction -> looks like malignant neoplasm

30
Q

Fat necrosis - on mammogram:

A

central radiolucent area of fat w/inc density
calcifications at fat periphery

bx follows if mammo fails to r/o cancer

31
Q

Fat necrosis - histology:

A

irregular fatty spaces
foamy histiocytes surrounding
multinucleate giant cells

32
Q

Condition characterized by a single hard mass or multiple hard masses that are made up of collagenized stroma surrounding atrophic ducts and lobules:

A

lymphocytic mastopathy

33
Q

Lymphocytic mastopathy - histology:

A

thickening & fibrosis of stromal tissue

lymphocytic infiltrates surround epithelium & vessels

34
Q

Lymphocytic mastopathy MC found in:

A

women w/ DM 1
women w/ AI thyroiditis

-> mb LM is also AI dz…? (theory)

35
Q

Uncommon form of mastitis characterized by the presence of granulomas, formed by epithelioid cells & giant cells:

A

Granulomatous mastopathy

etio - idiopathic
mb d/t TB, sarcoidosis, Wegener’s granulomatosis
mb seen w/ breast carcinoma, mb draining lymph nodes

36
Q

What confirms the granulomatous mastopathy dx?

A

positive cultures for/demonstration of acid-fast bacilli

37
Q

Adenosis refers to:

A

increased number of glandular components

grows/organizes -> adenoma (benign)

38
Q

MC benign tumor of the breast:

A 
fibroadenoma
well-circumscribed mass w/fibrotic capsule
firm
freely movable
NTTP MC
39
Q

Fibroadenoma - histology:

A

low mag - well-encapsulated

high mag - notable hyperplasia of intraductal epithelial cells, normal nuclei, normal nucleus/cytoplasm ratio

40
Q

T/F - fibroadenomas commonly increase in size during pregnancy.

A

True
they are hormonally responsive
also inc during luteal phase of menses
regress after menopause

41
Q

A localized focus of hyperplastic cells seen in breast tissue during pregnancy:

A

Lactating adenoma

solitary or multiple
histo - hyperplastic lobules, cytoplasmic vacuolization

42
Q

Intraductal papillomas are identified in ___% of all breast biopsies.

A

1-3%

benign, but definite potential for malignant transformation (very small liklihood): solitary ductal papilloma / multiple

43
Q

Intraductal papilloma - histology:

A 
myoepithelial cells
multilayered ductal cells
* flattened
* nuclei near lumenal surface
* long axes align in same direction
44
Q

Vast majority of breast cancers arise in _______ tissue and are classified as _______________.

A

Glandular (lobular & ductal)

adenocarcinoma

45
Q

Risk factors for breast cancer - HIGH:

A

female
advancing age
PMHx of cancer in one breast
FHx of both mother & sister w/breast cancer
>2 alcoholic bevs/day
high premenopause IGF-1 levels
high post-menopause blood estrogen levels

46
Q

Risk factors for breast cancer - MOD:

A 
>30 yrs at first pregnancy 
nulliparity
early menarche
late menopause
post-menopause obesity
caucasian, >45yo
African-American, <45yo
any 1st deg relative w/Hx of breast cancer
Hx of endometrial / ovarian cancer
tobacco use
high fat/sat fat rich diet
Hx of benign proliferative lesion, dysplastic mammography changes, & high dose of ionizing radiation to chest
47
Q

Protective factors against breast cancer:

A 
>15 at menarche (anovulation, early menopause)
>1 yr breast feeding
physical activity
minimal EtOH consumption
no tobacco use
monounsat fat rich diet
48
Q

Hereditary breast cancers represent ____% of total:

A

27%

of inherited -> mutated BRCA 1 & 2 account for 30-40%

49
Q

BRCA in gen population: ____%

in Ashkenazi Jew population: ____%

A

0.1%

20%

50
Q

By their cell proliferating effects on breast epithelium, _________ increase the chance of DNA replication errors leading to greater chance for mutations.

A

Estrogens

51
Q

Women in what country have the highest incidence rate of breast cancer?

A

USA

MC cancer, 2nd MC cause of death - women in USA

52
Q

What does “ER positive” suggest:

A

Over-expression of estrogen receptors
found in 70% of breast cancer cases

two kinds - alpha & beta, encoded by ESR1 & ESR2 genes

53
Q

______ preferentially binds to the alpha ER.
______ preferentially bind to the beta ER.
______ binds to both ERs equally well.

A

Estrone

Estriol, Raloxifene, Genistein

17-beta-estradiol

54
Q

BRCA1 & BRCA2 are both _________ genes.

A

Tumor suppressor genes, involved in DNA repair of double-strand breaks.

BRCA2 also binds/regulates RAD51 to fix DNA breaks.

Heterozygous germ-line mutations in either BRCA1 or BRCA2 gene show inc rates of breast & ovarian cancer.

55
Q

_____% of women with mutated BRCA1 gene will develop breast cancer during their lifetime.

A

50-85%

reduced risk with:
prophylactic mastectomy
salpingo-oophrectomy (age 40)

For BRCA2 -> advantage shown only w/concurrent procedures

56
Q

A genetic risk factor for breast cancer is presence of the proto-oncogene _________, present in _____% of breast cancers.
Also seen in:

A

HER2/neu (human epidermal growth factor receptor 2)
30%

ovarian cancer
stomach cancer
uterine cancer
assoc w/ worse prognosis, inc recurrence (in all types)

57
Q

PE findings assoc w/breast cancer:

A 
firm/hard breast mass
painless mass (TTP only 10-15%)
irregular borders to mass
mb fixed to chest wall or skin
skin dimpling
nipple retraction
bloody dc from nipple
58
Q

PE findings assoc w/benign mass:

A 
firm, rubbery
frequently TTP
regular margins
mobile
no dimpling/skin retraction/bloody dc
59
Q

The 3 main types of breast cancer are:

A

Ductal
Lobular
Nipple (Paget’s dz of breast/nipple)

60
Q

MC type of breast cancer:

A

infiltrating ductal carcinoma [80%]

usu. single hard mass
irreg borders
not easily movable

61
Q

Infiltrating ductal carcinoma - histology:

A

cords & nests of neoplastic cells
intervening collagen
dystrophic calcifications
pleomorphic cells strewn through stroma

62
Q

2nd MC type of breast cancer:

A

Lobular [5-10%]

high risk for multiple loci
inc risk for BL involvement

63
Q

Lobular carcinoma is characterized by presence of small homogenous cells that invade the stroma, often seen in a ___________ pattern.
Worse prognosis is assoc w/ presence of ______ appearance.

A

Single-file pattern

Signet ring appearance

64
Q

Relatively uncommon dz of the breast involving the nipple & areolar area, presenting w/persistent change in sensation of that area (itching, burning):

A

Paget’s dz of the breast

classic finding: eczematous changes over nipple/areola
later stage: ulceration/destruction of nipple/areolar complex

65
Q

Paget’s dz of the breast - histology:

A

large round cells
pale cytoplasm
pleomorphic nuclei
derived from glandular epithelium

66
Q

Form of ductal carcinoma distinguished by the markedly inflammed appearance of the affected breast:

A

Inflammatory breast cancer (IBC)

especially aggressive
presents w/o palpable lump

Pathology III (5 decks)

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