Path: Breast & Pregnancy Flashcards
What are inflammatory disorders of the breast?
acute mastitis
duct ectasia - may mimic cancer
traumatic fat necrosis - may mimic cancer
What is acute mastitis?
bacterial, complicates nursing
red, tender, maybe abscesses
What is duct ectasia?
unknown etiology, unilateral thickening of breast tissue
dilated ducts filled w necrotic debris and surrounded by inflammation
What is traumatic fat necrosis?
often forgotten or unnoticed trauma
unilateral irregular nodule
What is fibrocystic dz?
common, 20-40 yrs old, presents as lumpy breasts
separated into non-proliferative and proliferative
What is non-proliferative FCD?
no increased risk of carcinoma
fibrosis and cysts apocrine metaplasia
blue domed cysts
What is proliferative FCD?
has all the features of non-proliferative and:
epithelial hyperplasia (varying degrees)
sclerosing adenosis - lobular proliferation of small tubules
What are the benign breast tumors?
fibroadenoma: most common, <30, well circumscribed, mobile, firm nodule of benign glands and fibrous stroma
intraductal papiloma: papillary lesion in lactiferous ducts, may have serous or bloody discharge, may feel small subareolar tumor
What are some risk factors for invasive breast carcinoma?
increased length of reproductive life, obesity, exogenous estrogens (higher doses than OCPs)
What are the features of familial breast carcinomas?
mutations in BRCA1, BRCA2, p53 (Li-Fraumeni syndrome)
younger and bilateral tumors
What constitutes areas of concern on mammography?
irregular radiodensities and microcalcifications
What is the breast carcinoma category breakdown?
noninvasive: ductal CIS, lobular CIS
invasive: invasive ductal or lobular
ductal always more common
What is ductal CIS?
high grade DCIS: high grade nuclei, often with comedonecrosis (looks like pimple popping)
low grade DCIS: low grade nuclei, cribiform, solid, or papillary pattern
precursor for carcinoma
What is Paget’s dz of the breast?
DCIS which has spread to the skin of the nipple
ulcerated, fissured, oozing nipple, mimics eczema, underlying mass in some
malignant ductal cells invading epidermis - stays in epidermis, not invasive
What is lobular CIS?
most premenopausal, often multifocal and bilateral
expansion and filling of acini of lobular unit w uniform, bland cells
MARKER, not precursor, of increased risk for invasive carcinoma
What are the 3 forms of LCIS that behave more like DCIS and should thus be treated as exceptions?
cells w pleomorphic nuclei
signet ring cells
ducts showing central necrosis
What are the features of invasive ductal carcinoma?
desmoplastic, fixed to adjacent structures, skin dimpling
scar like grossly
infiltrating malignant ductal epithelial cells w variable gland formation
What are the features of invasive lobular carcinoma?
more often multicentric and bilateral
similar to invasive ductal, but metastases more to peritoneum, ovary, endometrium, meninges, and GI
infiltrating, individual, low grade malignant cells often in single file
Where do all invasive breast carcinomas spread to?
axillary nodes, internal mammary nodes, lungs, bone and liver
What size of breast tumor indicates potential for good prognosis?
<2 cm
What are molecular prognostic markers of invasive breast carcinoma?
ER and PR + –> tamoxifen
Her 2 + –> herceptin
Ki-67 = proliferation marker
What are the molecular subtypes of invasive breast carcinoma?
luminal A: ER and/or PR +, Her 2-, low Ki-67 = better prognosis luminal B: ER and/or PR +, Her 2 + or -, hi Ki-67 = poorer prognosis triple negative (+ck 5/6 or EGFR) = basal like - poorer than A or B only Her 2 + = poorer prognosis
What is Phyllodes tumors?
benign or malignant, based on stromal component
micro: stroma and glands, similar to fibroadenoma, but w hypercellular stroma and leaf-like pattern
benign and low grade malignant may recur
high grade malignant may recur and metastasize
What is gynecomastia?
enlargement of male breasts - ducts, but no lobules
associated w hormone imbalance –> hyperestrogenism
puberty, very aged, Klinefelters, leydig cell tumors, cirrhosis
What is toxemia?
pre-eclampsia: HTN, proteinuria, edema
eclampsia: more severe, convulsions, DIC and subsequent lesions
due to abnormal placentation or placental ischemia
primiparas or last tri typically
What is the most common site of ectopic pregnancy?
fallopian tubes, endometrium lacks villi
What are predisposing factors to ectopic pregnancy?
PID
What are the outcomes of ectopic pregnancy?
hemorrhage, rupture, spontaneous regression
What comprises gestational trophoblastic dz?
hydatidiform moles: complete, partial, invasive
choriocarcinoma
placental site trophoblastic tumor: rare
What is a complete mole?
bleeding, uterus large for dates, HCG elevated, vesicles on US, mass of grape like clusters
all villi show hydropic swelling w trophoblastic proliferation
*cytogenetics: 46XX or XY, empty egg fertilized by 1 or 2 sperm, DIPLOID
sometimes followed by choriocarcinoma
What is a partial mole?
uterus not enlarged, HCG less elevated, clinical dx by missed or spontaneous abortion
some villi enlarged w proliferation
*cytogenetics: TRIPLOID egg fertilized by two haploid or 1 diploid sperm
rarely followed by choriocarcinoma
What are precursor lesions to gestational choriocarcinoma?
hydatidiform mole
abortion
normal pregnancy
ectopic pregnancy
What is gestational choriocarcinoma?
malignant syncytial and cytotrophoblasts (no villi), hemorrhagic
direct spread and hematogenous spread
very curable
