Path Pt 1: Breast Flashcards
supernumerary nipples or breasts
persistence of epidermal thickenings along the milk line
normal ductal system may extend into the SQ tissue of the chest wall or axillary fossa (axillary tail of Spence)
- areas not clinically identified as breast tissue
- prophylactic mastectomies reduce, but do NOT eliminate the risk of breast cancer
- most breast tissue drains to axillary lymph nodes
accessory axillary breast tissue
congenitally inverted nipples are usually of little significance
- correct spontaneously during pregnancy or with simple traction
congenital nipple inversion
what is more of a concern than congenital nipple inversion?
acquired nipple inversion
- may indicate invasive cancer or inflammatory nipple disease
mastalgia, mastodynia
breast pain
- diffuse: usually due to premenstrual edema
- localized: often due to ruptured cysts, physical injury, infection
almost all painless masses are what?
benign
- only 10% of breast cancers present with pain
most commonly, masses are what?
cysts, fibroadenomas, or invasive carcinomas
- usually benign in premenopausal women
what are the likelihoods of malignancy with age?
- 10% < 40 years
- 60% > 50 years
NOTE: risk of malignancy in a woman with nipple discharge also increases with age
how are 1/3 of carcinomas detected?
palpable masses
why does screening have little effect on mortality?
because most palpable cancers have metastasized
what is considered the most worrisome for carcinoma if spontaneous, unilateral and the patient is >60?
nipple discharge
what is milky galactorrhea associated with?
increase in prolactin, hypothyroidism, endocrine anovulatory syndromes, methyldopa, phenothiazines
when is bloody or serous nipple discharge usually seen?
with a papilloma or cyst
- blood also seen during pregnancy due to rapid tissue remodeling
what should you think of in a patient >60 years old that presents with spontaneous unilateral discharge?
cancer
what is the most common site for breast carcinoma in females?
upper outer: 50%
20% central or sub-areolar (most common in males)
10% in remaining quadrants
what are the most common palpable masses in the breast?
cysts, fibroadenomas, and invasive carcinomas
benign lesions are more common with who?
premenopausal women
what are the principal signs of breast carcinoma?
densities and calcifications
what is the most common way to detect breast cancer?
mammogram
- increase sensitivity and specificity as patient ages: fibrous, radiodense tissue -> fatty radiolucent tissue
lesions that replease adipose tissue with radiodense tissue
- rounded = benign fibroadenoma or cyst
- irregular = invasive carcinoma
densities
- mammography identifies lesions 1cm in size vs 2-3cm by palpation
these form on sevretions, necrotic debris or hyalinized stroma
- usually benign lesion: clusters of apocrine glands, hyalinized fibroadenomas, sclerosing adenosis
calcifications
- if associated with malignancy: small, irregular, numerous and clustered -> ductal carcinoma in situ
rare, outside of lactational period
- caused by infections, autoimmune disease, or foreign body-type reactions to extravasated keratin secretions
inflammatory disorders of the breast
- “inflammatory breast cancer” mimics inflammation by obstruction dermal vasculature with tumor emboli
- ALWAYS consider in females with erythematous, swollen breast
- acute mastitis
- squamous metaplasia of lactiferous ducts
- duct ectasia
- fat necrosis
- lymphocytic mastopathy (diabetic mastopathy)
- granulomatous mastitis
types of inflammatory breast disorders
cracks and fissures of the nipple cause the breast to be vulnerable to bacteria during the first month of breast feeding
- erythematous and painful
acute bacterial mastitis