Path: Breast (high yield)

Question 1

When does acute mastitis commonly occur and what is the main cause?

Answer 1

Occurs in the first few months of breast feeding. Nipples and areola become irritated and infection can occur. Staph aureus is most common (localized lesion) Strep is second most common (diffuse lesions)

Question 2

What is periductal mastitis and its biggest risk factor?

Answer 2

Inflammation of the subareolar lactiferous ducts. Commonly seen in smokers. (smoking leads to a vit. A deficiency which alters the ductal epithelium)

Question 3

What is the morphology of periductal mastitis?

Answer 3

Cells along the lactiferous duct change from cuboidal to keratinized squamous.

Question 4

What is mammary duct ectasia?

Answer 4

Palpable periaroalr mass caused by inflammation and dilation of the subareolar ducts. Not associated with smoking.

Question 5

What is the morphology of mammary duct ectasia?

Answer 5

Tons of lipid-laden macrophages and cholesterol deposits. Granulomatous inflammation surrounds the cholesterol deposits.

Question 6

What are the 3 fibrocystic changes that occur in the breast?

Answer 6

1. Fibrosis
2. Cyst Formation
3. Adenosis (increase in the number of acini per lobule)

Question 7

What is the difference between proliferative breast disease without atypia vs. disease with atypia?

Answer 7

Without atypia means proliferation of ductal epithelium and stroma without cytologic or architectural changes that might indicate carcinoma in situ. Includes: epithelial hyperplasia, slerosing adenosis, complex sclerosing lesions, and papillomas.

With atypia resembles ductal carcinoma in situ. Includes atypical ductal hyperplasia and atypical lobular hyperplasia.

Question 8

What is Ductal carcinoma in situ of the breast?

Answer 8

Malignant ductal cells of the lactiferous ducts. Can spread thru the lobules and create calcifications.

Question 9

What is Paget Disease?

Answer 9

Occurs when a patient has Ductal Carcinoma In situ of the breast. The malignant cancer cells spread along the ductal epithelium and out onto the skin of the nipple creating “scale crust”.

Question 10

Major differences between lobular and ductal carcinoma in situ.

Answer 10

Lobular has no calcifications and is usually bilateral.

Ductal has calcifications and is more unilateral.

Question 11

Most common invasive breast carcinoma in women.

Answer 11

Medullary Carcinoma

Question 12

Morhology of the 3 major types of invasive breast carcinoma:

Medullary

Mucinous

Tubular

Answer 12

Medullary: syncytium like sheets of cells, mitotic figures, lymphoplasmocytic infiltrate

Mucinous: small islands of cells with lakes of mucin

Tubular: well formed tubules, possible calcifications in tubules

Question 13

Name the type of invasive breast carcinoma

Answer 13

Mucinous: lots of mucin and islands of cells

Question 14

Name the type of invasive breast carcinoma.

Answer 14

Tubular: well formed tubules

Question 15

Name the type of invasive breast carcinoma.

Answer 15

Medullary: Sheets of syncytial cells

Question 16

Main prognostic factor for breast cancers.

Answer 16

Axillary lymph node status

Question 17

Most common benign breast tumor and its morphology.

Answer 17

Fibroadenoma: mammographic densities and calcifications. More common in women age 15-30 and in pregnancy.

Question 18

Describe a Phyllodes Tumor and its morphology.

Answer 18

Similar to a fribroadenoma only the fibrous tissue expands even more in this type of tumor. Arises in the intralobular stroma in post menopausal women.

Question 19

What is gynecomastia?

Answer 19

Enlargement of the male breast. Presents as a button-like subareolar enlargement.