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Reproductive > Lec 1/2 Breast Path > Flashcards

Lec 1/2 Breast Path Flashcards

1
Q

What are cooper’s ligaments?

A

bands that hold the breast in upright position

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2
Q

What is the major lymphatic drainage of breast?

A

axillary lymph node

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3
Q

How many lobes in breast?

A

15-25 lobes

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4
Q

How do lobes connect to nipple?

A

lactiferous ducts

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5
Q

What is terminal duct lbular unit?

A

terminal duct and associated terminal ductules or acini

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6
Q

What composes a lobe?

A
  • branching system of progressively smaller ducts ending in terminal duct lobular unit
  • fibroadipose tissue
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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
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8
Q

What are lobules?

A

groups of acini [terminal ductules]

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9
Q

What happens to breast after menopause?

A

TDLUs decrease in size and number; breast predominantly composed of fibroadipose tissue

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10
Q

What are 5 drugs can can cause gynecomastia?

A
  • digoxin
  • tricyclic antidepressants
  • alcohol
  • marijuana
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11
Q

What kind of tumor can cause gynecomastia?

A

testicular leydig cell tumor –> increases serum estrogen

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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
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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
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14
Q

What is mastitis?

A

inflammation of breast tissue

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15
Q

What are symptoms of mastitis?

A
  • tenderness
  • redness
  • induration = hardening
  • occasionally abscess formation
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16
Q

What are 2 basic types of mastitis?

A
  • puerperal = lactational, associated with pregnancy

- non-puerperal = non-lactational

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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

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18
Q

What are the 4 types of non-puerperal mastitis?

A
  • duct ectasia
  • fat necrosis
  • granulomatous mastitis
  • inflammatory carcinoma
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19
Q

What are symptoms of lactational mastitis?

A
  • pain, burning, redness, fever, swelling

- systemic symptoms of infection

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20
Q

What 2 bugs are most likely to cause lactational mastitis?

A
  • staph

- strep

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21
Q

What is treatment for lactational mastitis?

A
  • do ultrasound for abscess
  • prescribe antibiotics
  • if abscess –> drain
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22
Q

What is the only type of cancer that can present as a mastitis?

A

inflammatory carcinoma

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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
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24
Q

What is the cause of duct ectasia?

A

unknown; occurs in premenopausal and elderly women

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25
Q

Who gets duct ectasia?

A

elderly women

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26
Q

What is pathogenesis of duct ectasia?

A
  • dilation of large and intermediate breast ducts

- periductal inflammation and fibrosis

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27
Q

What do you see histologically in duct ectasia?

A

periductal inflammation and fibrosis

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28
Q

What is treatment for duct ectasia?

A

treat with antibiotics if suspect infecction

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29
Q

What is fat necrosis of breast?

A

sterile inflmmatory process from aseptic digestion of fat by blood and tissue lipases

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30
Q

What is pathogensis of fat necrosis of breast?

A

trauma/surgery/radiation causes fat cell damage –> free fatty acids released, complex with calcium to form soap = white chalky deposits

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31
Q

What do you see clinically in fat necrosis? on mammography? biopsy?

A

breast lump = can look like cancer
shows abnormal calcification on mammography
necrotic fat and giant cells on biopsy

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32
Q

What is treatment for fat necrosis of breast?

A

if doesn’t resolve after weeks; do biopsy to rule out cancer = diagnosis of exclusions

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33
Q

What is granulomatous mastitis?

A

inflammation caused by ruptured silicone breast implants or TB

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34
Q

How do you diagnose granulomatous mastitis?

A

see foreign material and foreign body giant cells on biopsy

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35
Q

What do you see in inflammatory carcinoma?

A

reddening + thickening of breast skin = simulates dermatitis w/ underlying breast cancer

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36
Q

What is pathological finding of inflammatory carcinoma

A

dermal lymphatic invasion by cancer leading to obstruction of lymphatics –> erythema + edema + peau d’orange

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37
Q

What is fibrocystic change?

A

benign breast lumps related to menstrual cycle; often multiple/ bilateral

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38
Q

Who gets fibrocystic change?

A

reproductive aged women; subsides after menopause

starts in 30s

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39
Q

What are clinical manifesations of fibrocystic change?

A

breast and nipple itchiness

cyclic bilateral breast pain peaks before menses

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40
Q

What are characteristics of fibrocystic change lumps?

A
  • smooth defined edges

- freely mobile

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41
Q

How do you diagnose fibrocystic change?

A

H&P
if indeterminate –> mammography or ultrasonography

if cyst has solid compnent –> perform biospy

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42
Q

What do you see histologically in fibrocystic change?

A
  • cystic dilation of ducts
  • increase in fibrous stroma
  • may have apocrine metaplasia of ductal epithelium
43
Q

What are 3 classifications of fibrocystic change? prognosis?

A
  • 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
Q

What is treatment for fibrocystic change?

A
  • fitted bra for support
  • pain killers
  • decreased caffeine + chocolate
45
Q

What is phyllodes tumor?

A

large bulky mass of connective tissue and cysts = has leaf-like projections
firm, mobile, circumscribed
can be benign or malignant

46
Q

Who gets phyllodes tumor?

A

appears in 6th decade

47
Q

What does thick greenish nipple discharge in perimenopasual woman suggest about etiology?

A

suggests due to mammary duct ectasia

48
Q

What does bloody or sticky nipple discharge suggest?

A

intraductal papilloma

49
Q

What should pus-like nipple discharged and red, sore, warm breasts make you think?

A

infection, mastitis

50
Q

What is most common benign breast tumor?

A

fibroadenoma

51
Q

What is most common breast tumor in young women < 30?

A

fibroadenoma

52
Q

What is presentation of fibroadenoma?

A
  • small mobile firm mass with sharp edges
  • painless freely mobile, well circumscribed, firm/rubbery
  • may grow in pregnancy
53
Q

What histologic findings in fibroadenoma?

A
  • benign fibroblastic stroma and benign ductal epithelium

- can be intracanalicular or pericanalicular

54
Q

What tests should you do to diagnose fibroadenoma?

A

mammography

in older pt –> do biopsy to perform definitive diagnosis

55
Q

What is treatment for fibroadenoma?

A

remove if –> abnormal cells in biopsy, concern for cancer, or for visual reason

56
Q

What # rank is breast cancer of most common cancers in women?

A

2nd most common

57
Q

What # rank is breast cancer of most common causes of cancer death?

A

breast

58
Q

What is mean age of breast cancer diagnosis?

A

60 yo

59
Q

What is prognosis of fibroadenoma?

A

have slightly higher risk of breast carcinoma later in life

60
Q

Who gets phylloides tumor?

A

mean age 45 = looks like fibroadenoma but 10 years older

61
Q

What is core biospy vs open excisional breat biopsy for phyllodes tumor?

A

core biospy = more reliable; difficult to distinguish from fibroadenoma

open excisional breast biopsy = for smaller lesion = definitive method for diagnosis phyllodes tumor

62
Q

What is treatment for phyllodes tumor?

A

excise = can become malignant

63
Q

What is prognosis for phyllodes tumor?

A

can recur or lead to breast cancer

64
Q

What are 9 non-genetic risk factors for breast cancer?

A
  • 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
Q

What is risk factor for breast cancer in pts with BRCA1? ovarian cancer?

A

56-90% risk breast cancer

45% risk ovarian cancer

66
Q

What is risk factor for breast cancer in pts with BRCA2? ovarian cancer?

A

37-84% risk breast cancer

15% risk ovarian cancer

67
Q

What 4 cancers assocaited wtih Li fraumeni syndrome and P53?

A
  • soft sisue and bone sarcoma
  • brain tumor
  • leukemia
  • adrenocortical cancer
68
Q

What % of breast cancers are genetic?

A

5-10%

69
Q

Where is BRCA1 on genome?

A

chr 17q21

70
Q

Where is BRCA2 on genome?

A

13q12-13

71
Q

How does breast cancer typically present?

A
  • hard nontender breast lump with irregular borders

- OR detected by screening mammography

72
Q

What is most common location of breast cancer?

A

upper outer quadrant

73
Q

What are other presenting signs of breast cancer besides lump?

A
  • red + warm
  • edema
  • pain
  • skin or nipple retraction
  • peau d’orange
  • nipple discharge
  • axillary lymphadenopathy
74
Q

What are 3 signs of advanced breast cancer?

A
  • bone pain
  • jaundice
  • weight loss
75
Q

What do you see on mammogram in breast cancer?

A

irregularly shaped white lesion = see spiculated contours

76
Q

What are the 4 main types of breast cancer?

A
  • ductal carcinoma in situ [DCIS]
  • invasive ductal carcinoma
  • lobular carcinoma in situ
  • invasive lobular carcinoma
77
Q

What is duct carcinoma?

A

most common type of breast cancer = start in ducts

78
Q

What is lobular carcinoma?

A

thought to arise from breast lobules

79
Q

What is clinical picture of duct carcinoma in situ?

A
  • does not form palpable mass –> discovered on screening mammography
  • precursor to invasive duct carcinoma
  • can be multifocal, multicentric, bilateral
80
Q

What do you see on mamography with DCIS?

A

suspicious calcifications

81
Q

What is treatment for duct carcinoma in situ?

A

resect suspicious area

82
Q

What do you see on histology of DCIS?

A

carcinoma cells within ducts; do not penetrate basement membrane

83
Q

What is clinical picture of infiltrating duct carcinoma?

A
  • firm rock-hard mass with sharp margins

- irregular borders +/- calcification

84
Q

What do you see histologically on infiltrating duct carcinoma?

A
  • irregular nests of malignant ductal epithelial cells breaking through duct basement membrane into stroma
85
Q

What are characteristics of lobular carcinoma in situ [LCIS]?

A
  • 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
Q

How does invasive lobular carcinoma present?

A
  • bilateral
  • similar to invasive duct on mammography
  • histologically –> small uniform malignant cells invading stroma in linear single file pattern
87
Q

What is paget disease? presentation?

A

see cancer cells in epidermis; associated with underlying DCIS
eczematous patches on nipple

88
Q

What is presentation of medullary carcinoma?

A

younger patients, well circumscribed
lack calcifications on mammography
mimic fibroadenoma = fleshy, cellular, lymphocytic infiltrate
good prognosis

89
Q

What is presentation of mucinous carcinoma?

A

older than general breast cancer
invasive tumor cells floating in extracellular mucus
favorable prognsosis

90
Q

What is presentation of tubular carcinoma?

A

small tubular formation
stellate, firm tumor, neoplastic glands composed of single cell layer
favorable prognosis

91
Q

What is presentation of papillary carcinoma?

A 
older than breast cancer in general
usually in central portion of breast
may cause nipple discharge
well circumscribed
finger-like projections
good prognosis
92
Q

What are tests for breast cancer?

A

mammography = screening not diagnostic

if you do multiple views can be diagnostic

93
Q

What does negative mammogram tell you?

A

does not exclude breast cancer –> need to do bbiopsy if suspicious

94
Q

When is ultrasonography used?

A

dense breast tissue; to determine whether lesion is solid or cystic

95
Q

When is MRI useful?

A

high sensitivity and low specificity = high false pos

used to screen women who are high risk

96
Q

What is treatment for breast cancer?

A
  • excise tumor
  • dissect sentinel lymph node
  • chemo/radiation/hormone
97
Q

Where does breast cancer usually metastasize?

A

bone
lung
brain
liver

98
Q

What are 5 prognostic markers for breast cancer?

A
  • axillary lymph node status
  • tumor size [big = higher risk]
  • type [tubular = good prognosis]
  • histologic grade [low = good]
  • proliferation index
99
Q

What is proliferation index?

A

% of cells that express Ki67

100
Q

What is the single most important prognostic factor for breast cancer?

A

axillary lymph node status

101
Q

What does HER2/neu expression tell you about prognosis?

A

negative prognostic marker w/ increased risk of recurrence

102
Q

What drug can you use with pts who have HER2/neu?

A

herceptin

103
Q

What drug can you use wtih patients who have estrogen/progesterone receptor + tumors?

A

tamoxifen

Reproductive (14 decks)

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