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UROGENITAL > [PATHO] BREAST > Flashcards

[PATHO] BREAST Flashcards

1
Q

types of fibrocystic changes

A

non proliferative
proliferative

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2
Q

non proliferative fibrocystic change features

A

cyst formation
fibrosis

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3
Q

proliferative fibrocystic change features

A

epithelial hyperplasia
adenosis

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4
Q

fibrocystic changes occur due to

A

cyclic breast changes during menstrual cycle (i.e estrogenic fluctuations)

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5
Q

palpable mass
serous/serosanguineous nipple discharge
reproductive age
possible risk of carcinoma
ill defined discrete nodularities
brown-blue cysts filled w watery turbid fluid

A

fibrocystic changes

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6
Q

does estrogenic therapy & OC increase risk of fibrocystic change

A

no

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7
Q

OC effect on fibrocystic change

A

decrease risk

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8
Q

gross appearance of fibrocystic changes (5)

A

1-multifocal, bilateral
2-ill defined
3-discrete nodularities
4-diffusely increased density
5-blue dome cysts filled w/ watery turbid fluid

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9
Q

microscopic features of fibrocystic changes (4)

A

1-cyst formation
2-epithelial hyperplasia
3-aprocrine metaplasia
4-stromal changes

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10
Q

microscopic features of fibrocystic changes IN DETAIL

A

1-cysts lined by columnar/cuboidal epithelial cells
2-epithelial hyperplasia results in
⤷stratification (epitheliosis)
⤷epithelium projects into lumen= papillomatosis
3-apocrine metaplasia= metaplastic cells line ducts
⤷polygonal, eosinophilic cyto, small deeply stained
nuclei
4-stroma formed of compressed fibrous tissue+ lymphocytic infiltrate

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11
Q

uncommon variant of fibrocystic change

A

sclerosing adenosis

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12
Q

hyperplasia of epithelium depends on

A

number of layers

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13
Q

blue dome cysts seen in

A

fibrocystic change

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14
Q

papillomatosis

A

projection of epithelium into intraluminal papillary infoldings

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15
Q

resembles breast carcinoma
hard rubbery mass
variant of fibrocystic change
ducts appear as cords
compressed lumina of ducts

A

sclerosing adenosis

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16
Q

sclerosing adenosis gross picture

A

hard rubbery mass
resembles carcinoma

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17
Q

sclerosing adenosis microscopic picture

A

stromal fibrosis compresses acini & ductal lumina—>solid cords

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18
Q

lesions clinically resembling breast carcinoma (3)

A

sclerosis adenosis
traumatic fat necrosis
mammary duct ectasia

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19
Q

fibrocystic changes posing minimal/low risk of carcinoma (4)

A

1-fibrosis
2-cystic change
3-apocrine metaplasia
4-mild hyperplasia

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20
Q

fibrocystic changes causing 2x increase of risk of carcinoma (3)

A

1-moderate-florid hyperplasia WITHOUT atypia
2-ductal papillomatosis
3-sclerosis adenosis

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21
Q

fibrocystic changes causing 5x increase in risk of carcinoma

A

atypical hyperplasia

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22
Q

increases risk of carcinoma in fibrocystic changes by 10x

A

familial history of breast carcinoma

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23
Q

gynecomastia causes (6)

A

1-liver cirrhosis
2-klinefelter $
3-estrogen secreting tumors
4-estrogen therapy
5-digitalis therapy
6-physiologic gynecomastia

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24
Q

gynecomastia gross picture (3)

A

1-button like
2-subareolar swelling
3-usually bilateral, occasionally unilateral

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25
Q

gynecomastia microscopic picture

A

ductal epithelial hyperplasia surrounded by hyalinized stroma

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26
Q

acute stages of inflammatory breast diseases cc by

A

pain & tenderness

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27
Q

acute mastitis caused by

A

bacterial entry into ducts via nipples
⤷nursing: skin around nipples becomes fissured
allowing bacterial entry

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28
Q

non bacterial
chronic inflammation
parous women 45-60yo
poorly defined areolar mass
nipple retraction
congealed secretions in ducts

A

mammary duct ectasia/periductal or plasma cell mastitis

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29
Q

mammary duct ectasia gross feature (3)

A

1-nipple retraction
2-poorly defined periareolar mass
3-congealed secretions in main excretory ducts

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30
Q

what induces reactive changes resembling carcinoma in mammary duct ectasia

A

ductal dilatation & rupture

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31
Q

mammary duct ectasia microscopic picture (3)

A

1-lymphoplasmotic infiltrate & granulomas in periductal stroma
2-ducts filled w/ granular debris, leukocytes & lipid laden MQ
3-lining epithelium destroyed

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32
Q

hard mass
resembles carcinoma
follows trauma

A

traumatic fat necrosis

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33
Q

traumatic fat necrosis microscopic picture (4)

A

1-central foci of necrotic fat
2-surrounded by neutrophils, lipid laden MQ, giant cells
3-compressed by fibrous tissue & mononuclear lymphocytes
4-replaced by scar tissue & calcifications

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34
Q

traumatic fat necrosis resolution

A

scar tissue formation + calcifications

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35
Q

lymphedema seen in (2)

A

1-inflammatory carcinoma
2-tubular carcinoma

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36
Q

MC benign neoplasm

A

fibroadenoma

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37
Q

fibroadenoma pathogenesis (2)

A

1-arises from intralobular stroma
2-neoplastic stromal fibroblasts–> GF secretion–>(+)epithelial cells proliferation

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38
Q

fibroadenoma gross picture (3)

A

1-solitary nodules 1-10cm diameter
2-encapsulated, firm
3-uniform gray-tan cut surface

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39
Q

fibroadenoma malignancy risk

A

zero

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40
Q

fibroadenoma occurs due to

A

estrogen increase

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41
Q

30-39yo
solitary movable mass
increased levels of estrogen
gray tan nodule
biphasic lesion

A

fibroadenoma

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42
Q

fibroadenoma microscopic picture

A

1-biphasic
2-loose fibroblastic stroma
3-duct like epithelium lined spaces
might be pericanalicular/intracanalicular

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43
Q

spaces in fibroadenoma are lined by

A

luminal & myoepithelial cells

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44
Q

pericanalicular fibroadenoma

A

spaces are regular oval/ round shaped

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45
Q

intracanalicular fibroadenoma

A

spaces are compressed by proliferating stroma into slit/star shaped structures

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46
Q

fibroadenoma Cl/P

A

1-solitary freely movable mass
2-enlarges w/ menstrual cycle & pregnancy
3-regress & calcify after menopause

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47
Q

phyllodes tumor arises from

A

intralobular stroma
but NOT fibroadenoma

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48
Q

fibroadenoma arises from

A

intralobular stroma

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49
Q

45yo
solid fleshy mass with leaf like clefts
patient health improved follow surgical excision

A

phyllodes tumor

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50
Q

phyllodes tumor gross picture

A

large 1-45cm solid fleshy mass w/ cystic areas & leaf like clefts & slits

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51
Q

phyllodes tumor micro picture(3)

A

1-epithelial component covers hypercellular stroma
2-leaf like processes protruding into cystic spaces
3-malignant changes

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52
Q

malignant changes in phyllodes tumor (3)

A

1-increased stromal cellularity w/ anaplasia
2-high mitotic activity
3-increase in size & infiltrative margins

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53
Q

serous/bloody nipple discharge

A

intraductal papilloma

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54
Q

subareolar mass
solitary mass
nipple retraction
bloody nipple discharge

A

intraductal papilloma

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55
Q

intraductal papilloma pathogenesis

A

papillary growth in lactiferous ducts

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56
Q

intraductal papilloma micro picture (2)

A

1-delicate branching growths within dilated ducts/cysts
2-papillae have CT core covered by double epithelium
⤷ outer luminal epithelial layer overlying
⤷myoepithelial layer

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57
Q

RF of breast carcinoma (10)

A

1-North american/ Europena
2- 50+ yo
3-age at menarche <!2
4-age at menopause >55
5-family history of the 1st degree (2x risk)
6-null parity & pregnancy
7-alcohol & smoking
8-obesity & high fat diet
9-exogenous estrogen & OCs
10-benign breast disease

58
Q

proliferative lesion WITHOUT atypia increases risk of breast carcinoma by

59
Q

proliferative lesion WITH atypical hyperplasia increases risk of breast carcinoma by

60
Q

genetic RF of breast carcinoma (2)

A

1-overexpression of HER/2NEU proto-oncogene
2-mutation of BRACA 1& BRACA2 suppressor genes

61
Q

DCIS micro picture(2)

A

1-cells w/ high grade nuclei distending spaces w/ central necrosis
2-calcifications

62
Q

DCIS prognosis

A

excellent 97% survival after mastectomy
1/3 develop invasive ductal carcinoma

63
Q

lesions affecting lactiferous ducts (2)

A

intraductal papilloma
paget’s disease of nipple

64
Q

due to extension of DCIS
underlying invasive carcinoma present
unilateral crusting exudate over nipple & areolar skin

A

paget’s disease of nipples

65
Q

paget’s disease micro picture

A

large cells w/ atypical nuclei within epidermis, along basal layer & permeating the malphigian layer

66
Q

paget’s disease pathogenesis

A

extension of DCIS to lactiferous ducts & contiguous skin of nipple

67
Q

paget’s disease prognosis

A

depends on underlying carcinoma
not worsened by presence of paget’s disease

68
Q

paget’s disease Cl/P (2)

A

1-unilateral crusting exudate over nipple & areolar skin
2-presence of underlying carcinoma

69
Q

expands but doesnt affect underlying lobular structure
associated w/ increased risk of carcinoma in contralateral breast
can progress to invasive lobular carcinoma

70
Q

LCIS micro picture (4)

A

1-monomorphic cells w bland rounded nuclei
2-intracellular mucin vacuoles
3-occur in loosely cohesive lusters in lobules
4-calcifications & necrosis are rare

71
Q

LCIS prognosis

A

1-1/3= progress to invasive lobular carcinoma
2-↑ risk of carcinoma in contralateral breast

72
Q

invasive duct carcinoma is assoc w/

73
Q

DCIS patterns (5)

A

1-comedo
2-cribriform
3-micropapillary
4-papillary
5-clinging

74
Q

most duct carcinomas produce

A

1-desmoplastic reaction resulting in mammographic densities
2-hard masses

75
Q

invasive ductal carcinoma gross picture (5)

A

1-firm, poorly circumscribed
2-irregular tumor margins
3-gritty on cutting
4-grayish yellow cut surface
5-infiltrates adjacent fat giving crab like pattern

76
Q

invasive ductal carcinoma micro picture

A

heterogenous, ranges from
1-tumors w/well-developed tubular formation & low-grade nuclei to
2-tumors w/ sheets of anaplastic cells

77
Q

invasive ductal carcinoma immunophenotype

A

2/3= estrogen & progesterone receptors
1/3= HER/2NEU

78
Q

invasive lobular carcinoma gross picture

A

multicentric
bilateral

79
Q

invasive lobular carcinoma associated w/

A

adjacent LCIS

80
Q

invasive lobular carcinoma micro picture (6)

A

1-monomorphic cells w/ bland rounded nuclei
2-intracellular mucin vacuoles
3-occur in loosely cohesive clusters in lobules
4-calcifications & necrosis are rare
5-invades stroma
6-cells surround cancerous or normal looking acini/ducts giving targetoid/bull’s eye pattern

81
Q

invasive lobular carcinoma immunophenotype

A

hormone receptors

82
Q

inflammatory carcinoma gross/ Cl/P

A

enlarged erythematous edematous breast
WITHOUT palpable mass

83
Q

inflammatory carcinoma micro picture (5)

A

1-poorly differentiated
2-diffusely enlarged
3-aggressive
4-lymphedema (tumor emboli block skin drainage)
5-peaud d’ orange (skin thickening)

84
Q

inflammatory carcinoma prognosis

85
Q

medullary carcinoma pathological features (4)

A

1-well circumscribed pushing tumor margins
2-BRACA1 mutation
3-lymphoplasmacytic infiltrate
4-sheets of anaplastic cells

86
Q

medullary carcinoma micro picture

A

1-sheets of anaplastic cells
2-lymphoplasmacytic infiltrate

87
Q

medullary carcinoma immunophenotype

A

lack both hormone receptors & HERN/2NEU

88
Q

colloid mucinous carcinoma micro picture

A

cells produce abundance of extracellular mucin dissecting surrounding stroma

89
Q

colloid mucinous carcinoma gross picture

A

1-well circumscribed
2-soft gelatinous

90
Q

colloid mucinous carcinoma immunophenotype

A

hormone receptors

91
Q

lesions producing intracellular mucin

A

LCIS
invasive lobular carcinoma

92
Q

lesions producing extracellular mucin

A

colloid mucinous carcinoma

93
Q

tubular carcinomas are found by

A

mammographic screening

94
Q

tubular carcinoma micro picture

A

well formed tubules w/ low grade nuclei

95
Q

tubular carcinoma immunophenotype

A

hormone receptos

96
Q

tubular carcinoma immunophenotype

A

hormone receptors

97
Q

lesions showing hormone receptors expression

A

1- 2/3 of invasive ductal carcinomas
2-invasive lobular carcinoma
3-colloid mucinous carcinoma
4-tubular carcinoma

98
Q

lesions cc by masses (9)

A

1-fibrocystic change
2-sclerosis adenosis
3-mammary duct ectasia
4-traumatic fat necrosis
5-fibroadenoma
6-phyllodes tumor
7-intraductal papilloma
8-invasive ductal carcinoma
9-tubular carcinoma

99
Q

tumors NOT showing palpable mass

A

inflammatory carcinoma

100
Q

advanced cases of tubular carcinoma show (3)

A

1-skin dimpling
2-nipple retraction
3-fixation to chest wall

101
Q

tubular carcinoma Cl/P(3)

A

1-painless palpable mass/mammographic densities/clinically occult
2-lymphedema
3-advanced cases: skin dimpling, nipple retraction, fixation to chest wall

102
Q

outer quadrant tumors extend to

A

axillary LNs

103
Q

inner quadrant tumors extend to

A

internal mammary LNs

104
Q

survival rate when ≥16 LNs involved

A

less than 50%

105
Q

5-year survival rate when no axillary LNs are involved

106
Q

hematogenous spread curability

107
Q

survival is prolonged in cases of hematogenous spread by

A

chemotherapy

108
Q

prognosis of carcinomas <2cm in size

109
Q

LN metastasis at time of detection of cancer 2-3cm in size

110
Q

distant hematogenous spread (4)

A

1-lungs
2-skeleton
3-liver
4-adrenals

111
Q

TNM staging criteria (3)

A

1-invasion & size (T)
2- LN metastasis (N)
3-distant metastasis (M)

112
Q

tubular, medullary, cribriform, mucinous tumors prognosis

113
Q

ductal carcinomas prognosis

114
Q

proliferative rate of cancers measured by (3)

A

1-mitotic activity
2-flow cytometry
3-cell cycle proteins (Ki-67) markers

115
Q

prognosis of cancers showing estrogen & progesterone receptors

116
Q

prognosis of cancers showing HER/2NEU overexpressipn

117
Q

overexpression of HER/2NEU associated w/

A

aggressive tumors

118
Q

importance of evaluating HER/2NEU overexpression

A

predicts tumor response to Herceptin therapy

119
Q

importance of evaluating estrogen & progesterone receptors presence

A

predicts tumor response to therapy

120
Q

prognosis of invasive lobular carcinoma

121
Q

prognosis of tubular carcinoma

122
Q

prognosis of colloid carcinoma

123
Q

prognosis of invasive ductal carcinoma

A

2/3= GOOD (estro&progest)
1/3=POOR (HER/2NEU)

124
Q

tumors with WORST prognosis

A

Triple negative Basal like tumors

125
Q

molecular classification of breast carcinomas

A

1-Luminal A
2-Lumina B
3- HER2-enriched
4-Basal-like

126
Q

luminal A cancers

A

lower grade ER/PR +ve
HER2 -ve

127
Q

Luminal B cancers

A

higher grade ER/PR +ve
HER2 +ve

128
Q

HER2 enriched cancers

A

over express HER2
🚫 ER/PR

129
Q

basal-like cancers

A

resemble basally located myoepithelial cells
ER/PR -ve
HER2 -ve
TRIPLE NEGATIVE

130
Q

ratio of breast carcinomas in M:F

131
Q

carcinoma of male breast resembles

A

invasive carcinomas of female breast

132
Q

♂: spread at time of discovery

A

regional LNs + Distant metastasis

133
Q

male breast carcinomas rapidly infiltrate…

A

overlying skin & underlying thoracic wall due to scant breast susbtance in male

134
Q

poor prognosis
desmoplastic reaction
hard mass
poorly differentiated
grayish-yellow
gritty
express ER/PR & HER/2NEU
well developed tubular formation w/ low grade nuclei/ sheets of anaplastic cells

A

invasive ductal carcinoma

135
Q

good prognosis
multicentric & bilateral
express ER/PR
monomorphic cells
intracellular mucin vacuoles
rounded bland nuclei
targetoid pattern/bull’s eye pattern

A

Invasive lobular carcinoma

136
Q

poor prognosis
aggressive
diffusely infiltrative
NO palpable mass
poorly differentiated
enlarged edematous erythematous breast
lymphedema
peaud d’orange

A

inflammatory carcinoma

137
Q

good prognosis
well circumscribed
BRACA 1 mutation
lack ER/PR & HER/2NEU
pushing tumor borders
sheets of large anaplastic cells
lymphoplasmacytic infiltrate

A

medullary carcinoma

138
Q

good prognosis
well-circumscribed
soft gelatinous
express ER/PR receptors
produces extracellular mucin that dissects into surrounding stroma

A

colloid mucinous carcinoma

139
Q

good prognosis
small <1cm
well formed tubules & low grade nuclei
painless palpable mass
lymphedema
dimpling of skin
nipple retraction
fixation of chest wall

A

tubular carcinoma

140
Q

infiltrates overlying skin & underlying thoracic wall

A

Male breast carcinoma

UROGENITAL (22 decks)

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