Path: Breast & Pregnancy

Question 1

What are inflammatory disorders of the breast?

Answer 1

acute mastitis
duct ectasia - may mimic cancer
traumatic fat necrosis - may mimic cancer

Question 2

What is acute mastitis?

Answer 2

bacterial, complicates nursing

red, tender, maybe abscesses

Question 3

What is duct ectasia?

Answer 3

unknown etiology, unilateral thickening of breast tissue

dilated ducts filled w necrotic debris and surrounded by inflammation

Question 4

What is traumatic fat necrosis?

Answer 4

often forgotten or unnoticed trauma

unilateral irregular nodule

Question 5

What is fibrocystic dz?

Answer 5

common, 20-40 yrs old, presents as lumpy breasts

separated into non-proliferative and proliferative

Question 6

What is non-proliferative FCD?

Answer 6

no increased risk of carcinoma
fibrosis and cysts apocrine metaplasia
blue domed cysts

Question 7

What is proliferative FCD?

Answer 7

has all the features of non-proliferative and:
epithelial hyperplasia (varying degrees)
sclerosing adenosis - lobular proliferation of small tubules

Question 8

What are the benign breast tumors?

Answer 8

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

Question 9

What are some risk factors for invasive breast carcinoma?

Answer 9

increased length of reproductive life, obesity, exogenous estrogens (higher doses than OCPs)

Question 10

What are the features of familial breast carcinomas?

Answer 10

mutations in BRCA1, BRCA2, p53 (Li-Fraumeni syndrome)

younger and bilateral tumors

Question 11

What constitutes areas of concern on mammography?

Answer 11

irregular radiodensities and microcalcifications

Question 12

What is the breast carcinoma category breakdown?

Answer 12

noninvasive: ductal CIS, lobular CIS
invasive: invasive ductal or lobular
ductal always more common

Question 13

What is ductal CIS?

Answer 13

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

Question 14

What is Paget’s dz of the breast?

Answer 14

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

Question 15

What is lobular CIS?

Answer 15

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

Question 16

What are the 3 forms of LCIS that behave more like DCIS and should thus be treated as exceptions?

Answer 16

cells w pleomorphic nuclei
signet ring cells
ducts showing central necrosis

Question 17

What are the features of invasive ductal carcinoma?

Answer 17

desmoplastic, fixed to adjacent structures, skin dimpling
scar like grossly
infiltrating malignant ductal epithelial cells w variable gland formation

Question 18

What are the features of invasive lobular carcinoma?

Answer 18

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

Question 19

Where do all invasive breast carcinomas spread to?

Answer 19

axillary nodes, internal mammary nodes, lungs, bone and liver

Question 20

What size of breast tumor indicates potential for good prognosis?

Answer 20

<2 cm

Question 21

What are molecular prognostic markers of invasive breast carcinoma?

Answer 21

ER and PR + –> tamoxifen
Her 2 + –> herceptin
Ki-67 = proliferation marker

Question 22

What are the molecular subtypes of invasive breast carcinoma?

Answer 22

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

Question 23

What is Phyllodes tumors?

Answer 23

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

Question 24

What is gynecomastia?

Answer 24

enlargement of male breasts - ducts, but no lobules
associated w hormone imbalance –> hyperestrogenism
puberty, very aged, Klinefelters, leydig cell tumors, cirrhosis

Question 25

What is toxemia?

Answer 25

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

Question 26

What is the most common site of ectopic pregnancy?

Answer 26

fallopian tubes, endometrium lacks villi

Question 27

What are predisposing factors to ectopic pregnancy?

Answer 27

PID

Question 28

What are the outcomes of ectopic pregnancy?

Answer 28

hemorrhage, rupture, spontaneous regression

Question 29

What comprises gestational trophoblastic dz?

Answer 29

hydatidiform moles: complete, partial, invasive
choriocarcinoma
placental site trophoblastic tumor: rare

Question 30

What is a complete mole?

Answer 30

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

Question 31

What is a partial mole?

Answer 31

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

Question 32

What are precursor lesions to gestational choriocarcinoma?

Answer 32

hydatidiform mole
abortion
normal pregnancy
ectopic pregnancy

Question 33

What is gestational choriocarcinoma?

Answer 33

malignant syncytial and cytotrophoblasts (no villi), hemorrhagic
direct spread and hematogenous spread
very curable