Lec 1/2 Breast Path Flashcards
1
Q
What are cooper’s ligaments?
A
bands that hold the breast in upright position
2
Q
What is the major lymphatic drainage of breast?
A
axillary lymph node
3
Q
How many lobes in breast?
A
15-25 lobes
4
Q
How do lobes connect to nipple?
A
lactiferous ducts
5
Q
What is terminal duct lbular unit?
A
terminal duct and associated terminal ductules or acini
6
Q
What composes a lobe?
A
- branching system of progressively smaller ducts ending in terminal duct lobular unit
- fibroadipose tissue
7
Q
What are 3 microscopic layers of a duct?
A
- columnar or cuboidal epithelial cells lining duct lumen
- underlying layer of myoeptihelial cels
- basement membrane
8
Q
What are lobules?
A
groups of acini [terminal ductules]
9
Q
What happens to breast after menopause?
A
TDLUs decrease in size and number; breast predominantly composed of fibroadipose tissue
10
Q
What are 5 drugs can can cause gynecomastia?
A
- digoxin
- tricyclic antidepressants
- alcohol
- marijuana
11
Q
What kind of tumor can cause gynecomastia?
A
testicular leydig cell tumor –> increases serum estrogen
12
Q
What are history findings of a breast mass that make you think its more likely benign?
A
- tender/painful mass
- mass changes during menstrual cycle
- history of breast cysts
- nipple discharge
13
Q
What are clinical exam findings of a breast mass that suggest benign?
A
- well defined border
- rubbery [vs hard in malignant]
- freely mobile
14
Q
What is mastitis?
A
inflammation of breast tissue
15
Q
What are symptoms of mastitis?
A
- tenderness
- redness
- induration = hardening
- occasionally abscess formation
16
Q
What are 2 basic types of mastitis?
A
- puerperal = lactational, associated with pregnancy
- non-puerperal = non-lactational
17
Q
What is pathogenesis of lactational mastitis?
A
duct obstruction–> milk stasis –> have increased pressure on duct and leakage of milk into surrounding breast tissue
18
Q
What are the 4 types of non-puerperal mastitis?
A
- duct ectasia
- fat necrosis
- granulomatous mastitis
- inflammatory carcinoma
19
Q
What are symptoms of lactational mastitis?
A
- pain, burning, redness, fever, swelling
- systemic symptoms of infection
20
Q
What 2 bugs are most likely to cause lactational mastitis?
A
- staph
- strep
21
Q
What is treatment for lactational mastitis?
A
- do ultrasound for abscess
- prescribe antibiotics
- if abscess –> drain
22
Q
What is the only type of cancer that can present as a mastitis?
A
inflammatory carcinoma
23
Q
What is duct ectasia?
A
- lactiferous duct beneath nipple becomes dilated; duct walls thicken and duct fills w/ fluid –> duct can become clogged or blocked
24
Q
What is the cause of duct ectasia?
A
unknown; occurs in premenopausal and elderly women
25
Who gets duct ectasia?
elderly women
26
What is pathogenesis of duct ectasia?
- dilation of large and intermediate breast ducts
| - periductal inflammation and fibrosis
27
What do you see histologically in duct ectasia?
periductal inflammation and fibrosis
28
What is treatment for duct ectasia?
treat with antibiotics if suspect infecction
29
What is fat necrosis of breast?
sterile inflmmatory process from aseptic digestion of fat by blood and tissue lipases
30
What is pathogensis of fat necrosis of breast?
trauma/surgery/radiation causes fat cell damage --> free fatty acids released, complex with calcium to form soap = white chalky deposits
31
What do you see clinically in fat necrosis? on mammography? biopsy?
breast lump = can look like cancer
shows abnormal calcification on mammography
necrotic fat and giant cells on biopsy
32
What is treatment for fat necrosis of breast?
if doesn't resolve after weeks; do biopsy to rule out cancer = diagnosis of exclusions
33
What is granulomatous mastitis?
inflammation caused by ruptured silicone breast implants or TB
34
How do you diagnose granulomatous mastitis?
see foreign material and foreign body giant cells on biopsy
35
What do you see in inflammatory carcinoma?
reddening + thickening of breast skin = simulates dermatitis w/ underlying breast cancer
36
What is pathological finding of inflammatory carcinoma
dermal lymphatic invasion by cancer leading to obstruction of lymphatics --> erythema + edema + peau d'orange
37
What is fibrocystic change?
benign breast lumps related to menstrual cycle; often multiple/ bilateral
38
Who gets fibrocystic change?
reproductive aged women; subsides after menopause
| starts in 30s
39
What are clinical manifesations of fibrocystic change?
breast and nipple itchiness
| cyclic bilateral breast pain peaks before menses
40
What are characteristics of fibrocystic change lumps?
- smooth defined edges
| - freely mobile
41
How do you diagnose fibrocystic change?
H&P
if indeterminate --> mammography or ultrasonography
if cyst has solid compnent --> perform biospy
42
What do you see histologically in fibrocystic change?
- cystic dilation of ducts
- increase in fibrous stroma
- may have apocrine metaplasia of ductal epithelium
43
What are 3 classifications of fibrocystic change? prognosis?
- non-proliferative --> absent/mild epithelial hyperplasia, no increased risk of cancer
- proliferative moderate --> moderate/severe duct hyperplasia; some increase risk cancer
- proliferative atypical --> severe duct hyperplasia with cytologic abnormalities= duct pretty much filled in w/ proliferating epithelium
44
What is treatment for fibrocystic change?
- fitted bra for support
- pain killers
- decreased caffeine + chocolate
45
What is phyllodes tumor?
large bulky mass of connective tissue and cysts = has leaf-like projections
firm, mobile, circumscribed
can be benign or malignant
46
Who gets phyllodes tumor?
appears in 6th decade
47
What does thick greenish nipple discharge in perimenopasual woman suggest about etiology?
suggests due to mammary duct ectasia
48
What does bloody or sticky nipple discharge suggest?
intraductal papilloma
49
What should pus-like nipple discharged and red, sore, warm breasts make you think?
infection, mastitis
50
What is most common benign breast tumor?
fibroadenoma
51
What is most common breast tumor in young women < 30?
fibroadenoma
52
What is presentation of fibroadenoma?
- small mobile firm mass with sharp edges
- painless freely mobile, well circumscribed, firm/rubbery
- may grow in pregnancy
53
What histologic findings in fibroadenoma?
- benign fibroblastic stroma and benign ductal epithelium
| - can be intracanalicular or pericanalicular
54
What tests should you do to diagnose fibroadenoma?
mammography
| in older pt --> do biopsy to perform definitive diagnosis
55
What is treatment for fibroadenoma?
remove if --> abnormal cells in biopsy, concern for cancer, or for visual reason
56
What # rank is breast cancer of most common cancers in women?
2nd most common
57
What # rank is breast cancer of most common causes of cancer death?
breast
58
What is mean age of breast cancer diagnosis?
60 yo
59
What is prognosis of fibroadenoma?
have slightly higher risk of breast carcinoma later in life
60
Who gets phylloides tumor?
mean age 45 = looks like fibroadenoma but 10 years older
61
What is core biospy vs open excisional breat biopsy for phyllodes tumor?
core biospy = more reliable; difficult to distinguish from fibroadenoma
open excisional breast biopsy = for smaller lesion = definitive method for diagnosis phyllodes tumor
62
What is treatment for phyllodes tumor?
excise = can become malignant
63
What is prognosis for phyllodes tumor?
can recur or lead to breast cancer
64
What are 9 non-genetic risk factors for breast cancer?
- menstrual cycle: early menarche, late menopause
- nulliparity or low parity
- no breast feeding
- long duration postmenopasual hormone replacement therapy
- obesity
- alcohol consumption [1 drink/day]
- ionizing radiation at young age
- proliferative fibrocystic change
- family history
65
What is risk factor for breast cancer in pts with BRCA1? ovarian cancer?
56-90% risk breast cancer
| 45% risk ovarian cancer
66
What is risk factor for breast cancer in pts with BRCA2? ovarian cancer?
37-84% risk breast cancer
| 15% risk ovarian cancer
67
What 4 cancers assocaited wtih Li fraumeni syndrome and P53?
- soft sisue and bone sarcoma
- brain tumor
- leukemia
- adrenocortical cancer
68
What % of breast cancers are genetic?
5-10%
69
Where is BRCA1 on genome?
chr 17q21
70
Where is BRCA2 on genome?
13q12-13
71
How does breast cancer typically present?
- hard nontender breast lump with irregular borders
| - OR detected by screening mammography
72
What is most common location of breast cancer?
upper outer quadrant
73
What are other presenting signs of breast cancer besides lump?
- red + warm
- edema
- pain
- skin or nipple retraction
- peau d'orange
- nipple discharge
- axillary lymphadenopathy
74
What are 3 signs of advanced breast cancer?
- bone pain
- jaundice
- weight loss
75
What do you see on mammogram in breast cancer?
irregularly shaped white lesion = see spiculated contours
76
What are the 4 main types of breast cancer?
- ductal carcinoma in situ [DCIS]
- invasive ductal carcinoma
- lobular carcinoma in situ
- invasive lobular carcinoma
77
What is duct carcinoma?
most common type of breast cancer = start in ducts
78
What is lobular carcinoma?
thought to arise from breast lobules
79
What is clinical picture of duct carcinoma in situ?
- does not form palpable mass --> discovered on screening mammography
- precursor to invasive duct carcinoma
- can be multifocal, multicentric, bilateral
80
What do you see on mamography with DCIS?
suspicious calcifications
81
What is treatment for duct carcinoma in situ?
resect suspicious area
82
What do you see on histology of DCIS?
carcinoma cells within ducts; do not penetrate basement membrane
83
What is clinical picture of infiltrating duct carcinoma?
- firm rock-hard mass with sharp margins
| - irregular borders +/- calcification
84
What do you see histologically on infiltrating duct carcinoma?
- irregular nests of malignant ductal epithelial cells breaking through duct basement membrane into stroma
85
What are characteristics of lobular carcinoma in situ [LCIS]?
- does not form palpable mass
- does not have calcifications
- usually incidental finding on breast biopsy
- may be multicentric or bilateral
no gross lesion --> neoplastic cells replace normal epithelium of terminal duct lobular unit
86
How does invasive lobular carcinoma present?
- bilateral
- similar to invasive duct on mammography
- histologically --> small uniform malignant cells invading stroma in linear single file pattern
87
What is paget disease? presentation?
see cancer cells in epidermis; associated with underlying DCIS
eczematous patches on nipple
88
What is presentation of medullary carcinoma?
younger patients, well circumscribed
lack calcifications on mammography
mimic fibroadenoma = fleshy, cellular, lymphocytic infiltrate
good prognosis
89
What is presentation of mucinous carcinoma?
older than general breast cancer
invasive tumor cells floating in extracellular mucus
favorable prognsosis
90
What is presentation of tubular carcinoma?
small tubular formation
stellate, firm tumor, neoplastic glands composed of single cell layer
favorable prognosis
91
What is presentation of papillary carcinoma?
```
older than breast cancer in general
usually in central portion of breast
may cause nipple discharge
well circumscribed
finger-like projections
good prognosis
```
92
What are tests for breast cancer?
mammography = screening not diagnostic
| if you do multiple views can be diagnostic
93
What does negative mammogram tell you?
does not exclude breast cancer --> need to do bbiopsy if suspicious
94
When is ultrasonography used?
dense breast tissue; to determine whether lesion is solid or cystic
95
When is MRI useful?
high sensitivity and low specificity = high false pos
| used to screen women who are high risk
96
What is treatment for breast cancer?
- excise tumor
- dissect sentinel lymph node
- chemo/radiation/hormone
97
Where does breast cancer usually metastasize?
bone
lung
brain
liver
98
What are 5 prognostic markers for breast cancer?
- axillary lymph node status
- tumor size [big = higher risk]
- type [tubular = good prognosis]
- histologic grade [low = good]
- proliferation index
99
What is proliferation index?
% of cells that express Ki67
100
What is the single most important prognostic factor for breast cancer?
axillary lymph node status
101
What does HER2/neu expression tell you about prognosis?
negative prognostic marker w/ increased risk of recurrence
102
What drug can you use with pts who have HER2/neu?
herceptin
103
What drug can you use wtih patients who have estrogen/progesterone receptor + tumors?
tamoxifen
