[PATHO] BREAST Flashcards
types of fibrocystic changes
non proliferative
proliferative
non proliferative fibrocystic change features
cyst formation
fibrosis
proliferative fibrocystic change features
epithelial hyperplasia
adenosis
fibrocystic changes occur due to
cyclic breast changes during menstrual cycle (i.e estrogenic fluctuations)
palpable mass
serous/serosanguineous nipple discharge
reproductive age
possible risk of carcinoma
ill defined discrete nodularities
brown-blue cysts filled w watery turbid fluid
fibrocystic changes
does estrogenic therapy & OC increase risk of fibrocystic change
no
OC effect on fibrocystic change
decrease risk
gross appearance of fibrocystic changes (5)
1-multifocal, bilateral
2-ill defined
3-discrete nodularities
4-diffusely increased density
5-blue dome cysts filled w/ watery turbid fluid
microscopic features of fibrocystic changes (4)
1-cyst formation
2-epithelial hyperplasia
3-aprocrine metaplasia
4-stromal changes
microscopic features of fibrocystic changes IN DETAIL
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
uncommon variant of fibrocystic change
sclerosing adenosis
hyperplasia of epithelium depends on
number of layers
blue dome cysts seen in
fibrocystic change
papillomatosis
projection of epithelium into intraluminal papillary infoldings
resembles breast carcinoma
hard rubbery mass
variant of fibrocystic change
ducts appear as cords
compressed lumina of ducts
sclerosing adenosis
sclerosing adenosis gross picture
hard rubbery mass
resembles carcinoma
sclerosing adenosis microscopic picture
stromal fibrosis compresses acini & ductal lumina—>solid cords
lesions clinically resembling breast carcinoma (3)
sclerosis adenosis
traumatic fat necrosis
mammary duct ectasia
fibrocystic changes posing minimal/low risk of carcinoma (4)
1-fibrosis
2-cystic change
3-apocrine metaplasia
4-mild hyperplasia
fibrocystic changes causing 2x increase of risk of carcinoma (3)
1-moderate-florid hyperplasia WITHOUT atypia
2-ductal papillomatosis
3-sclerosis adenosis
fibrocystic changes causing 5x increase in risk of carcinoma
atypical hyperplasia
increases risk of carcinoma in fibrocystic changes by 10x
familial history of breast carcinoma
gynecomastia causes (6)
1-liver cirrhosis
2-klinefelter $
3-estrogen secreting tumors
4-estrogen therapy
5-digitalis therapy
6-physiologic gynecomastia
gynecomastia gross picture (3)
1-button like
2-subareolar swelling
3-usually bilateral, occasionally unilateral
gynecomastia microscopic picture
ductal epithelial hyperplasia surrounded by hyalinized stroma
acute stages of inflammatory breast diseases cc by
pain & tenderness
acute mastitis caused by
bacterial entry into ducts via nipples
⤷nursing: skin around nipples becomes fissured
allowing bacterial entry
non bacterial
chronic inflammation
parous women 45-60yo
poorly defined areolar mass
nipple retraction
congealed secretions in ducts
mammary duct ectasia/periductal or plasma cell mastitis
mammary duct ectasia gross feature (3)
1-nipple retraction
2-poorly defined periareolar mass
3-congealed secretions in main excretory ducts
what induces reactive changes resembling carcinoma in mammary duct ectasia
ductal dilatation & rupture
mammary duct ectasia microscopic picture (3)
1-lymphoplasmotic infiltrate & granulomas in periductal stroma
2-ducts filled w/ granular debris, leukocytes & lipid laden MQ
3-lining epithelium destroyed
hard mass
resembles carcinoma
follows trauma
traumatic fat necrosis
traumatic fat necrosis microscopic picture (4)
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
traumatic fat necrosis resolution
scar tissue formation + calcifications
lymphedema seen in (2)
1-inflammatory carcinoma
2-tubular carcinoma
MC benign neoplasm
fibroadenoma
fibroadenoma pathogenesis (2)
1-arises from intralobular stroma
2-neoplastic stromal fibroblasts–> GF secretion–>(+)epithelial cells proliferation
fibroadenoma gross picture (3)
1-solitary nodules 1-10cm diameter
2-encapsulated, firm
3-uniform gray-tan cut surface
fibroadenoma malignancy risk
zero
fibroadenoma occurs due to
estrogen increase
30-39yo
solitary movable mass
increased levels of estrogen
gray tan nodule
biphasic lesion
fibroadenoma
fibroadenoma microscopic picture
1-biphasic
2-loose fibroblastic stroma
3-duct like epithelium lined spaces
might be pericanalicular/intracanalicular
spaces in fibroadenoma are lined by
luminal & myoepithelial cells
pericanalicular fibroadenoma
spaces are regular oval/ round shaped
intracanalicular fibroadenoma
spaces are compressed by proliferating stroma into slit/star shaped structures
fibroadenoma Cl/P
1-solitary freely movable mass
2-enlarges w/ menstrual cycle & pregnancy
3-regress & calcify after menopause
phyllodes tumor arises from
intralobular stroma
but NOT fibroadenoma
fibroadenoma arises from
intralobular stroma
45yo
solid fleshy mass with leaf like clefts
patient health improved follow surgical excision
phyllodes tumor
phyllodes tumor gross picture
large 1-45cm solid fleshy mass w/ cystic areas & leaf like clefts & slits
phyllodes tumor micro picture(3)
1-epithelial component covers hypercellular stroma
2-leaf like processes protruding into cystic spaces
3-malignant changes
malignant changes in phyllodes tumor (3)
1-increased stromal cellularity w/ anaplasia
2-high mitotic activity
3-increase in size & infiltrative margins
serous/bloody nipple discharge
intraductal papilloma
subareolar mass
solitary mass
nipple retraction
bloody nipple discharge
intraductal papilloma
intraductal papilloma pathogenesis
papillary growth in lactiferous ducts
intraductal papilloma micro picture (2)
1-delicate branching growths within dilated ducts/cysts
2-papillae have CT core covered by double epithelium
⤷ outer luminal epithelial layer overlying
⤷myoepithelial layer