II: Breast Flashcards
1
Q
____ accounts for 5% of familial single gene breast cancers and is a tumor suppressor gene
A
CHEK2
2
Q
_____ cells: assist in milk ejection during lactation and provide structural support to lobules
A
Myoepithelial
3
Q
_____ stroma: dense fibrous connective tissue with adipose tissue
A
Interlobular
4
Q
_____ stroma: envelops acini of lobules and consists of hormonally responsive fibroblast-like cells
A
Intralobular
5
Q
______ are tumor suppressor genes involved in facilitating DNA repair (account for most single gene familial breast cancers).
A
BRCA1/BRCA2
6
Q
20% of breast cancers are ______, involving amplification of a gene on chromosome 17q.
A
Her2 Positive
7
Q
AAP guidelines: exclusive breastfeeding until ____, with continued breastfeeding until ______.
A
6 months; 1 year
8
Q
Acute mastitis may be confused with ______.
A
Inflammatory carcinoma
9
Q
At puberty, _______ stimulates side branching and TDLU development
A
Progesterone
10
Q
At puberty, _____ stimulates proliferation of glandular tissue to form lactiferous ducts
A
Estrogen, Progesterone
11
Q
At puberty, ________ stimulate elongation and branching of ductal network via _____.
A
Estrogen and GH; IGF-1
12
Q
Branching and lobule formation during infancy is stimulated by ______.
A
Progesterone
13
Q
BRCA__ cancers are typically triple negative.
A
1
14
Q
BRCA__ mutations are associated with increased risk of male breast cancer
A
2
15
Q
BRCA__ mutations are associated with increased risk of ovarian cancer.
A
1 or 2
16
Q
Breastfeeding has been demonstrated to help prevent the following potential health complications in the infant: _____ (4)
A
Atopy, SIDS, diabetes, infant mortality
17
Q
Ductal hyperplasia: increase in epithelial lining that distends the ______.
A
Terminal ducts
18
Q
During pregnancy milk secretion is blocked by _______.
A
Progesterone
19
Q
During pregnancy, extensive lobule formation is stimulated by ______.
A
Progesterone; PRL
20
Q
During pregnancy, lobules increase in terms of ______.
A
Number, size
21
Q
During pregnancy, milk production is stimulated by ______.
A
PRL; hPL
22
Q
Hindmilk has higher ____ content.
A
lipid
23
Q
Human milk has higher ______ content than cow milk
A
Oligosaccharide
24
Q
In grading breast density, ___ represents breasts that are the most dense and may lower the sensitivity of mammography
A
D
25
Increase in _____ and decrease in _____ at parturition can stimulate milk secretion in neonates
PRL; Progesterone
26
Infants are expected to lose ___% of birthweight and reach minimum weight around day __ of life
5-7%; 5
27
Inner quadrant masses spread to _____ nodes first
Internal mammary
28
Insufficient milk syndrome results from inadequate _____,
Milk removal
29
Lobular hyperplasia: increase in number of cells within the ______.
Lobules/acini
30
Mammary mesenchyme stimulates ______ formation
Mammary gland and nipple
31
Milk excretion is stimulated by _____.
Oxytocin; suckling
32
Milk secretion is stimulated by _____.
PRL; milk removal
33
Name 2 breast diagnoses with moderate increase in the risk for cancer.
Ductal/Lobular Atypical Hyperplasia
34
Name 4 breast diagnoses with slight increase in the risk for cancer.
Papilloma, Moderate/Florid Hyperplasia, Sclerosing Adenosis, Fibroadenoma with complex features
35
Name three tumor types with more favorable prognosis
Tubular Carcinoma, Mucinous Carcinoma, Medullary Carcinoma
36
Name two problems that involve milk production.
Primary lactation failure; Insufficient milk syndrome
37
Obesity ______ the risk of breast cancer in post-menopausal women
increases
38
Obesity ______ the risk of breast cancer in young women
decreases
39
Outline the 2009 USPTF recommendations for mammgram screening.
Under 50 individualized decision; 50-74 biennial screening
40
Outline the 2015 ACS recommendations for mammogram screening.
40-44 Optional; 45-54 annual; 55+ biennial until life expectancy is less than 10 years
41
Suckling induces release of hypothalamic-regulated release of _____.
PRL; oxytocin
42
The majority of cancers are ER/PR _____ and Her2 _____.
Positive; Negative
43
US/CDC growth charts are based on growth of infants that were ____fed
formula
44
Use of ___ growth charts is recommended for age 0-2
WHO
45
What differentiates LCIS from atypical lobular hyperlasia?
>50% of lobules filled with epithelial proliferation
46
What differentiates proliferative fibrocystic changes from non-proliferative fibrocystic changes?
Epithelial hyperplasia
47
What feature is missing in male breast tissue?
Acini
48
What is the effect of maternal malnutrition on milk content?
None
49
What is the effect of maternal malnutrition on milk volume produced?
Decreased
50
What is the inheritance pattern for BRCA genes?
Autosomal Dominant
51
What is the most common etiology in acute mastitis?
S. aureus
52
When should breastfeeding be initiated?
Within 1 hour of birth
53
Which breast diagnosis markedly increases the risk for cancer in BOTH breasts?
LCIS
54
Which diagnosis? 2-4 cm mass; epithelial layer maintained with two-cell pattern; various ratio of fibrous and glandular tissue
Fibroadenoma
55
Which diagnosis? Adolescent girls with marked enlargement of breasts due to hormonal stimulation; may be associated with pain, embarrassment, discomfort
Juvenile Hypertrophy
56
Which diagnosis? Associated with a fistula tract opening to the skin around the areola
Periductal mastitis
57
Which diagnosis? Associated with mutations in E-cadherin
LCIS
58
Which diagnosis? Carcinoma with non-glandular growth
Metaplastic Carcinoma
59
Which diagnosis? Cells grow in single file, dispersed through fibrous tissue; Small, uniform, round cells with minimal pleomorphism; generally fewer mitoses and no necrosis
LDC
60
Which diagnosis? Cells may grow in targetoid pattern
LDC
61
Which diagnosis? Clonal proliferation of epithelial cells within ducts with myoepithelial layer and basement membrane intact; generally asymptomatic/non-palpable; may form calcifications on mammogram
DICS
62
Which diagnosis? Cystic changes with cells appearing to protrude into the lumen of ducts; basally placed nuclei with cytoplasmic blebs on the apical surface
Apocrine Metaplasia
63
Which diagnosis? Does not form masses calcifications; often multicentric, bilateral; increases risk for developing invasive carcinoma in both breasts
LCIS
64
Which diagnosis? Failure of differentiation of mammary glands due to absence of PTHrP signaling
Blomstrands Chondroplasia/Amastia
65
Which diagnosis? Irregular mass with induration; plasma cell infiltrate
Chronic mastitis
66
Which diagnosis? Male with ductal epithelial hyperlasia, stromal edema, and loose fibrosis around ducts
Gynecomastia
67
Which diagnosis? Malignant; well-differentiated cells in a sea of lightly staining stroma
Mucinous Carcinoma
68
Which diagnosis? May present as hard mass; neutrophils and histiocytes early followed by fibrosis/calcification and giant cells later
Fat necrosis
69
Which diagnosis? Most common type of carcinoma; range of histologic features; tend to have more pleomorphic cells
IDC
70
Which diagnosis? Neoplastic cells from ducts on the skin; no invasion of basement membrane of ducts or skin
Paget's Disease
71
Which diagnosis? Obstruction of lactiferous tubules leading to duct ectasia in a perimenopausal woman
Chronic mastitis
72
Which diagnosis? Originates from major lactiferous duct near the nipple, small (~1cm); ductal proliferation with numerous papillae with a fibrovascular core
Intraductal papilloma
73
Which diagnosis? Painful, erythematous subareolar mass associated with smoking
Periductal mastitis
74
Which diagnosis? Proliferation of ductules and stroma with distortion of TDLU; diffuse microcalcifications mimicking carcinoma on mammogram
Sclerosing Adenosis
75
Which diagnosis? Proliferation of fibroblastic stroma in a young woman; Originates from TDLU; benign
Fibroadenoma
76
Which diagnosis? Redness, swelling, pain, and tenderness of the breast in a young lactating female; associated with cracks in the nipple
Acute mastitis
77
Which diagnosis? Scaly rash on the nipple with pruritis; may present with underlying associated carcinoma
Paget's Disease
78
Which diagnosis? Second most commony type of carcinoma; associated with loss of e-cadherin; generally express ER/PR (not Her2/neu)
LDC
79
Which diagnosis? Small cells with round nuclei filling lobules and poorly adhering to adjacent cells; no invasion
LCIS
80
Which diagnosis? Soft palpable mass in pregnant/lactating woman; normal appearing breast tissue with adenosis and physiologic changes
Lactating Adenoma
81
Which diagnosis? Squamous metaplasia extending deep into ducts with keratin plugs and abscess formation
Periductal mastitis
82
Which diagnosis? Stromal tissue with overlying epithelium in a leaflike pattern
Phyllodes Tumor
83
Which diagnosis? Stromal tumor associated with previous radiation therapy or chronic edema
Angiosarcoma
84
Which diagnosis? Tumor intralobular stroma and ductal epithelium; most are benign and well localized; large (>5cm) with fleshy leafy clefts and slits
Phyllodes Tumor
85
Which diagnosis? Well circumscribed mass with indistinct cell borders; pushing rounded border; prominent lymphoplasmacytic infiltrate at periphery
Medullary Carcinoma
86
Which diagnosis? Well-differentiated tumor with bland cells; irregular angulated contours of glands; no myoepithelial cell layer or basement membrane present
Tubular Carcinoma
87
Which factor induces differentiation of dermal mesenchyme into mammary mesenchyme?
PTHrP
88
Which mammogram assessment rating? Benign; proceed with routine screening
2
89
Which mammogram assessment rating? Highly suggestive of malignancy
5
90
Which mammogram assessment rating? Incomplete, need additional info or scans
0
91
Which mammogram assessment rating? Known biopsy proven malignancy
6
92
Which mammogram assessment rating? Negative; proceed with routine screening
1
93
Which mammogram assessment rating? Probably benign; continued surveillance +/- short interval follow-up
3
94
Which mammogram assessment rating? Suspicious; requires tissue diagnosis; 2-95% chance of malignancy
4
95
Which milk type? Higher in protein; lower in fat and sucrose
Colostrum
96
Which milk type? Increased calories; higher in protein/lower in fat; lower in immunoglobulins
Transitional
97
Which milk type? Water is primary constituent; lipids account for 50% of calories; contains lactose, casein, whey, lactoferrin
Mature
98
Which milk type? Yellow; high in IgA and lactoferrin
Colostrum
99
Which pattern of DCIS? Central necrosis; high grade
Comedo
100
Which pattern of DCIS? Ducts appear punched-out or perforated
Cribriform
101
Which pattern of DCIS? Ducts filled with cells
Solid
102
Which pattern of DCIS? Projections into duct lumen with vascular core
Papillary
103
Which pattern of DCIS? Projections into duct lumen without a vascular core (smaller)
Micropapillary
104
Which race has the highest risk for breast cancer?
White
105
Which type of typical hyperplasia? Epithelial cell bridging to form arcades
Moderate
106
Which type of typical hyperplasia? Formation of solid masses that distend the lumen
Florid
107
Which type of typical hyperplasia? Papillary tufts projecting into the lumen
Mild
108
WHO growth charts are based on growth of infants that were ____fed
breast
109
WHO guidelines: exclusive breastfeeding until ____, with continued breastfeeding until ______.
6 months; 2 years
110
Younger age at time of first child birth _____ risk of breast cancer
Decreases
