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Life Cycle > II: Breast > Flashcards

II: Breast Flashcards

1
Q

____ accounts for 5% of familial single gene breast cancers and is a tumor suppressor gene

A

CHEK2

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2
Q

_____ cells: assist in milk ejection during lactation and provide structural support to lobules

A

Myoepithelial

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3
Q

_____ stroma: dense fibrous connective tissue with adipose tissue

A

Interlobular

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4
Q

_____ stroma: envelops acini of lobules and consists of hormonally responsive fibroblast-like cells

A

Intralobular

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5
Q

______ are tumor suppressor genes involved in facilitating DNA repair (account for most single gene familial breast cancers).

A

BRCA1/BRCA2

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6
Q

20% of breast cancers are ______, involving amplification of a gene on chromosome 17q.

A

Her2 Positive

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7
Q

AAP guidelines: exclusive breastfeeding until ____, with continued breastfeeding until ______.

A

6 months; 1 year

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8
Q

Acute mastitis may be confused with ______.

A

Inflammatory carcinoma

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9
Q

At puberty, _______ stimulates side branching and TDLU development

A

Progesterone

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10
Q

At puberty, _____ stimulates proliferation of glandular tissue to form lactiferous ducts

A

Estrogen, Progesterone

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11
Q

At puberty, ________ stimulate elongation and branching of ductal network via _____.

A

Estrogen and GH; IGF-1

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12
Q

Branching and lobule formation during infancy is stimulated by ______.

A

Progesterone

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13
Q

BRCA__ cancers are typically triple negative.

A

1

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14
Q

BRCA__ mutations are associated with increased risk of male breast cancer

A

2

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15
Q

BRCA__ mutations are associated with increased risk of ovarian cancer.

A

1 or 2

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16
Q

Breastfeeding has been demonstrated to help prevent the following potential health complications in the infant: _____ (4)

A

Atopy, SIDS, diabetes, infant mortality

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17
Q

Ductal hyperplasia: increase in epithelial lining that distends the ______.

A

Terminal ducts

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18
Q

During pregnancy milk secretion is blocked by _______.

A

Progesterone

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19
Q

During pregnancy, extensive lobule formation is stimulated by ______.

A

Progesterone; PRL

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20
Q

During pregnancy, lobules increase in terms of ______.

A

Number, size

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21
Q

During pregnancy, milk production is stimulated by ______.

A

PRL; hPL

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22
Q

Hindmilk has higher ____ content.

A

lipid

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23
Q

Human milk has higher ______ content than cow milk

A

Oligosaccharide

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24
Q

In grading breast density, ___ represents breasts that are the most dense and may lower the sensitivity of mammography

A

D

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25
Q

Increase in _____ and decrease in _____ at parturition can stimulate milk secretion in neonates

A

PRL; Progesterone

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26
Q

Infants are expected to lose ___% of birthweight and reach minimum weight around day __ of life

A

5-7%; 5

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27
Q

Inner quadrant masses spread to _____ nodes first

A

Internal mammary

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28
Q

Insufficient milk syndrome results from inadequate _____,

A

Milk removal

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29
Q

Lobular hyperplasia: increase in number of cells within the ______.

A

Lobules/acini

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30
Q

Mammary mesenchyme stimulates ______ formation

A

Mammary gland and nipple

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31
Q

Milk excretion is stimulated by _____.

A

Oxytocin; suckling

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32
Q

Milk secretion is stimulated by _____.

A

PRL; milk removal

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33
Q

Name 2 breast diagnoses with moderate increase in the risk for cancer.

A

Ductal/Lobular Atypical Hyperplasia

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34
Q

Name 4 breast diagnoses with slight increase in the risk for cancer.

A

Papilloma, Moderate/Florid Hyperplasia, Sclerosing Adenosis, Fibroadenoma with complex features

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35
Q

Name three tumor types with more favorable prognosis

A

Tubular Carcinoma, Mucinous Carcinoma, Medullary Carcinoma

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36
Q

Name two problems that involve milk production.

A

Primary lactation failure; Insufficient milk syndrome

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37
Q

Obesity ______ the risk of breast cancer in post-menopausal women

A

increases

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38
Q

Obesity ______ the risk of breast cancer in young women

A

decreases

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39
Q

Outline the 2009 USPTF recommendations for mammgram screening.

A

Under 50 individualized decision; 50-74 biennial screening

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40
Q

Outline the 2015 ACS recommendations for mammogram screening.

A

40-44 Optional; 45-54 annual; 55+ biennial until life expectancy is less than 10 years

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41
Q

Suckling induces release of hypothalamic-regulated release of _____.

A

PRL; oxytocin

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42
Q

The majority of cancers are ER/PR _____ and Her2 _____.

A

Positive; Negative

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43
Q

US/CDC growth charts are based on growth of infants that were ____fed

A

formula

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44
Q

Use of ___ growth charts is recommended for age 0-2

A

WHO

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45
Q

What differentiates LCIS from atypical lobular hyperlasia?

A

> 50% of lobules filled with epithelial proliferation

46
Q

What differentiates proliferative fibrocystic changes from non-proliferative fibrocystic changes?

A

Epithelial hyperplasia

47
Q

What feature is missing in male breast tissue?

48
Q

What is the effect of maternal malnutrition on milk content?

49
Q

What is the effect of maternal malnutrition on milk volume produced?

50
Q

What is the inheritance pattern for BRCA genes?

A

Autosomal Dominant

51
Q

What is the most common etiology in acute mastitis?

52
Q

When should breastfeeding be initiated?

A

Within 1 hour of birth

53
Q

Which breast diagnosis markedly increases the risk for cancer in BOTH breasts?

54
Q

Which diagnosis? 2-4 cm mass; epithelial layer maintained with two-cell pattern; various ratio of fibrous and glandular tissue

A

Fibroadenoma

55
Q

Which diagnosis? Adolescent girls with marked enlargement of breasts due to hormonal stimulation; may be associated with pain, embarrassment, discomfort

A

Juvenile Hypertrophy

56
Q

Which diagnosis? Associated with a fistula tract opening to the skin around the areola

A

Periductal mastitis

57
Q

Which diagnosis? Associated with mutations in E-cadherin

58
Q

Which diagnosis? Carcinoma with non-glandular growth

A

Metaplastic Carcinoma

59
Q

Which diagnosis? Cells grow in single file, dispersed through fibrous tissue; Small, uniform, round cells with minimal pleomorphism; generally fewer mitoses and no necrosis

60
Q

Which diagnosis? Cells may grow in targetoid pattern

61
Q

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

62
Q

Which diagnosis? Cystic changes with cells appearing to protrude into the lumen of ducts; basally placed nuclei with cytoplasmic blebs on the apical surface

A

Apocrine Metaplasia

63
Q

Which diagnosis? Does not form masses calcifications; often multicentric, bilateral; increases risk for developing invasive carcinoma in both breasts

64
Q

Which diagnosis? Failure of differentiation of mammary glands due to absence of PTHrP signaling

A

Blomstrands Chondroplasia/Amastia

65
Q

Which diagnosis? Irregular mass with induration; plasma cell infiltrate

A

Chronic mastitis

66
Q

Which diagnosis? Male with ductal epithelial hyperlasia, stromal edema, and loose fibrosis around ducts

A

Gynecomastia

67
Q

Which diagnosis? Malignant; well-differentiated cells in a sea of lightly staining stroma

A

Mucinous Carcinoma

68
Q

Which diagnosis? May present as hard mass; neutrophils and histiocytes early followed by fibrosis/calcification and giant cells later

A

Fat necrosis

69
Q

Which diagnosis? Most common type of carcinoma; range of histologic features; tend to have more pleomorphic cells

70
Q

Which diagnosis? Neoplastic cells from ducts on the skin; no invasion of basement membrane of ducts or skin

A

Paget’s Disease

71
Q

Which diagnosis? Obstruction of lactiferous tubules leading to duct ectasia in a perimenopausal woman

A

Chronic mastitis

72
Q

Which diagnosis? Originates from major lactiferous duct near the nipple, small (~1cm); ductal proliferation with numerous papillae with a fibrovascular core

A

Intraductal papilloma

73
Q

Which diagnosis? Painful, erythematous subareolar mass associated with smoking

A

Periductal mastitis

74
Q

Which diagnosis? Proliferation of ductules and stroma with distortion of TDLU; diffuse microcalcifications mimicking carcinoma on mammogram

A

Sclerosing Adenosis

75
Q

Which diagnosis? Proliferation of fibroblastic stroma in a young woman; Originates from TDLU; benign

A

Fibroadenoma

76
Q

Which diagnosis? Redness, swelling, pain, and tenderness of the breast in a young lactating female; associated with cracks in the nipple

A

Acute mastitis

77
Q

Which diagnosis? Scaly rash on the nipple with pruritis; may present with underlying associated carcinoma

A

Paget’s Disease

78
Q

Which diagnosis? Second most commony type of carcinoma; associated with loss of e-cadherin; generally express ER/PR (not Her2/neu)

79
Q

Which diagnosis? Small cells with round nuclei filling lobules and poorly adhering to adjacent cells; no invasion

80
Q

Which diagnosis? Soft palpable mass in pregnant/lactating woman; normal appearing breast tissue with adenosis and physiologic changes

A

Lactating Adenoma

81
Q

Which diagnosis? Squamous metaplasia extending deep into ducts with keratin plugs and abscess formation

A

Periductal mastitis

82
Q

Which diagnosis? Stromal tissue with overlying epithelium in a leaflike pattern

A

Phyllodes Tumor

83
Q

Which diagnosis? Stromal tumor associated with previous radiation therapy or chronic edema

A

Angiosarcoma

84
Q

Which diagnosis? Tumor intralobular stroma and ductal epithelium; most are benign and well localized; large (>5cm) with fleshy leafy clefts and slits

A

Phyllodes Tumor

85
Q

Which diagnosis? Well circumscribed mass with indistinct cell borders; pushing rounded border; prominent lymphoplasmacytic infiltrate at periphery

A

Medullary Carcinoma

86
Q

Which diagnosis? Well-differentiated tumor with bland cells; irregular angulated contours of glands; no myoepithelial cell layer or basement membrane present

A

Tubular Carcinoma

87
Q

Which factor induces differentiation of dermal mesenchyme into mammary mesenchyme?

88
Q

Which mammogram assessment rating? Benign; proceed with routine screening

89
Q

Which mammogram assessment rating? Highly suggestive of malignancy

90
Q

Which mammogram assessment rating? Incomplete, need additional info or scans

91
Q

Which mammogram assessment rating? Known biopsy proven malignancy

92
Q

Which mammogram assessment rating? Negative; proceed with routine screening

93
Q

Which mammogram assessment rating? Probably benign; continued surveillance +/- short interval follow-up

94
Q

Which mammogram assessment rating? Suspicious; requires tissue diagnosis; 2-95% chance of malignancy

95
Q

Which milk type? Higher in protein; lower in fat and sucrose

96
Q

Which milk type? Increased calories; higher in protein/lower in fat; lower in immunoglobulins

A

Transitional

97
Q

Which milk type? Water is primary constituent; lipids account for 50% of calories; contains lactose, casein, whey, lactoferrin

98
Q

Which milk type? Yellow; high in IgA and lactoferrin

99
Q

Which pattern of DCIS? Central necrosis; high grade

100
Q

Which pattern of DCIS? Ducts appear punched-out or perforated

A

Cribriform

101
Q

Which pattern of DCIS? Ducts filled with cells

102
Q

Which pattern of DCIS? Projections into duct lumen with vascular core

103
Q

Which pattern of DCIS? Projections into duct lumen without a vascular core (smaller)

A

Micropapillary

104
Q

Which race has the highest risk for breast cancer?

105
Q

Which type of typical hyperplasia? Epithelial cell bridging to form arcades

106
Q

Which type of typical hyperplasia? Formation of solid masses that distend the lumen

107
Q

Which type of typical hyperplasia? Papillary tufts projecting into the lumen

108
Q

WHO growth charts are based on growth of infants that were ____fed

109
Q

WHO guidelines: exclusive breastfeeding until ____, with continued breastfeeding until ______.

A

6 months; 2 years

110
Q

Younger age at time of first child birth _____ risk of breast cancer

Life Cycle (24 decks)

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