[PATHO] BREAST Flashcards
1
Q
types of fibrocystic changes
A
non proliferative
proliferative
2
Q
non proliferative fibrocystic change features
A
cyst formation
fibrosis
3
Q
proliferative fibrocystic change features
A
epithelial hyperplasia
adenosis
4
Q
fibrocystic changes occur due to
A
cyclic breast changes during menstrual cycle (i.e estrogenic fluctuations)
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
6
Q
does estrogenic therapy & OC increase risk of fibrocystic change
A
no
7
Q
OC effect on fibrocystic change
A
decrease risk
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
9
Q
microscopic features of fibrocystic changes (4)
A
1-cyst formation
2-epithelial hyperplasia
3-aprocrine metaplasia
4-stromal changes
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
11
Q
uncommon variant of fibrocystic change
A
sclerosing adenosis
12
Q
hyperplasia of epithelium depends on
A
number of layers
13
Q
blue dome cysts seen in
A
fibrocystic change
14
Q
papillomatosis
A
projection of epithelium into intraluminal papillary infoldings
15
Q
resembles breast carcinoma
hard rubbery mass
variant of fibrocystic change
ducts appear as cords
compressed lumina of ducts
A
sclerosing adenosis
16
Q
sclerosing adenosis gross picture
A
hard rubbery mass
resembles carcinoma
17
Q
sclerosing adenosis microscopic picture
A
stromal fibrosis compresses acini & ductal lumina—>solid cords
18
Q
lesions clinically resembling breast carcinoma (3)
A
sclerosis adenosis
traumatic fat necrosis
mammary duct ectasia
19
Q
fibrocystic changes posing minimal/low risk of carcinoma (4)
A
1-fibrosis
2-cystic change
3-apocrine metaplasia
4-mild hyperplasia
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
21
Q
fibrocystic changes causing 5x increase in risk of carcinoma
A
atypical hyperplasia
22
Q
increases risk of carcinoma in fibrocystic changes by 10x
A
familial history of breast carcinoma
23
Q
gynecomastia causes (6)
A
1-liver cirrhosis
2-klinefelter $
3-estrogen secreting tumors
4-estrogen therapy
5-digitalis therapy
6-physiologic gynecomastia
24
Q
gynecomastia gross picture (3)
A
1-button like
2-subareolar swelling
3-usually bilateral, occasionally unilateral
25
gynecomastia microscopic picture
ductal epithelial hyperplasia surrounded by hyalinized stroma
26
acute stages of inflammatory breast diseases cc by
pain & tenderness
27
acute mastitis caused by
bacterial entry into ducts via nipples
⤷nursing: skin around nipples becomes fissured
allowing bacterial entry
28
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
29
mammary duct ectasia gross feature (3)
1-nipple retraction
2-poorly defined periareolar mass
3-congealed secretions in main excretory ducts
30
what induces reactive changes resembling carcinoma in mammary duct ectasia
ductal dilatation & rupture
31
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
32
hard mass
resembles carcinoma
follows trauma
traumatic fat necrosis
33
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
34
traumatic fat necrosis resolution
scar tissue formation + calcifications
35
lymphedema seen in (2)
1-inflammatory carcinoma
2-tubular carcinoma
36
MC benign neoplasm
fibroadenoma
37
fibroadenoma pathogenesis (2)
1-arises from intralobular stroma
2-neoplastic stromal fibroblasts--> GF secretion-->(+)epithelial cells proliferation
38
fibroadenoma gross picture (3)
1-solitary nodules 1-10cm diameter
2-encapsulated, firm
3-uniform gray-tan cut surface
39
fibroadenoma malignancy risk
zero
40
fibroadenoma occurs due to
estrogen increase
41
30-39yo
solitary movable mass
increased levels of estrogen
gray tan nodule
biphasic lesion
fibroadenoma
42
fibroadenoma microscopic picture
1-biphasic
2-loose fibroblastic stroma
3-duct like epithelium lined spaces
might be pericanalicular/intracanalicular
43
spaces in fibroadenoma are lined by
luminal & myoepithelial cells
44
pericanalicular fibroadenoma
spaces are regular oval/ round shaped
45
intracanalicular fibroadenoma
spaces are compressed by proliferating stroma into slit/star shaped structures
46
fibroadenoma Cl/P
1-solitary freely movable mass
2-enlarges w/ menstrual cycle & pregnancy
3-regress & calcify after menopause
47
phyllodes tumor arises from
intralobular stroma
but NOT fibroadenoma
48
fibroadenoma arises from
intralobular stroma
49
45yo
solid fleshy mass with leaf like clefts
patient health improved follow surgical excision
phyllodes tumor
50
phyllodes tumor gross picture
large 1-45cm solid fleshy mass w/ cystic areas & leaf like clefts & slits
51
phyllodes tumor micro picture(3)
1-epithelial component covers hypercellular stroma
2-leaf like processes protruding into cystic spaces
3-malignant changes
52
malignant changes in phyllodes tumor (3)
1-increased stromal cellularity w/ anaplasia
2-high mitotic activity
3-increase in size & infiltrative margins
53
serous/bloody nipple discharge
intraductal papilloma
54
subareolar mass
solitary mass
nipple retraction
bloody nipple discharge
intraductal papilloma
55
intraductal papilloma pathogenesis
papillary growth in lactiferous ducts
56
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
57
RF of breast carcinoma (10)
1-North american/ Europena
2- 50+ yo
3-age at menarche 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
proliferative lesion WITHOUT atypia increases risk of breast carcinoma by
1.6 folds
59
proliferative lesion WITH atypical hyperplasia increases risk of breast carcinoma by
>2 folds
60
genetic RF of breast carcinoma (2)
1-overexpression of HER/2NEU proto-oncogene
2-mutation of BRACA 1& BRACA2 suppressor genes
61
DCIS micro picture(2)
1-cells w/ high grade nuclei distending spaces w/ central necrosis
2-calcifications
62
DCIS prognosis
excellent 97% survival after mastectomy
1/3 develop invasive ductal carcinoma
63
lesions affecting lactiferous ducts (2)
intraductal papilloma
paget's disease of nipple
64
due to extension of DCIS
underlying invasive carcinoma present
unilateral crusting exudate over nipple & areolar skin
paget's disease of nipples
65
paget's disease micro picture
large cells w/ atypical nuclei within epidermis, along basal layer & permeating the malphigian layer
66
paget's disease pathogenesis
extension of DCIS to lactiferous ducts & contiguous skin of nipple
67
paget's disease prognosis
depends on underlying carcinoma
not worsened by presence of paget's disease
68
paget's disease Cl/P (2)
1-unilateral crusting exudate over nipple & areolar skin
2-presence of underlying carcinoma
69
expands but doesnt affect underlying lobular structure
associated w/ increased risk of carcinoma in contralateral breast
can progress to invasive lobular carcinoma
LCIS
70
LCIS micro picture (4)
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
LCIS prognosis
1-1/3= progress to invasive lobular carcinoma
2-↑ risk of carcinoma in contralateral breast
72
invasive duct carcinoma is assoc w/
DCIS
73
DCIS patterns (5)
1-comedo
2-cribriform
3-micropapillary
4-papillary
5-clinging
74
most duct carcinomas produce
1-desmoplastic reaction resulting in mammographic densities
2-hard masses
75
invasive ductal carcinoma gross picture (5)
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
invasive ductal carcinoma micro picture
heterogenous, ranges from
1-tumors w/well-developed tubular formation & low-grade nuclei to
2-tumors w/ sheets of anaplastic cells
77
invasive ductal carcinoma immunophenotype
2/3= estrogen & progesterone receptors
1/3= HER/2NEU
78
invasive lobular carcinoma gross picture
multicentric
bilateral
79
invasive lobular carcinoma associated w/
adjacent LCIS
80
invasive lobular carcinoma micro picture (6)
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
invasive lobular carcinoma immunophenotype
hormone receptors
82
inflammatory carcinoma gross/ Cl/P
enlarged erythematous edematous breast
**WITHOUT** palpable mass
83
inflammatory carcinoma micro picture (5)
1-poorly differentiated
2-diffusely enlarged
3-aggressive
4-lymphedema (tumor emboli block skin drainage)
5-**peaud d' orange** (skin thickening)
84
inflammatory carcinoma prognosis
POOR
85
medullary carcinoma pathological features (4)
1-well circumscribed pushing tumor margins
2-BRACA1 mutation
3-lymphoplasmacytic infiltrate
4-sheets of anaplastic cells
86
medullary carcinoma micro picture
1-sheets of anaplastic cells
2-lymphoplasmacytic infiltrate
87
medullary carcinoma immunophenotype
lack both hormone receptors & HERN/2NEU
88
colloid mucinous carcinoma micro picture
cells produce abundance of extracellular mucin dissecting surrounding stroma
89
colloid mucinous carcinoma gross picture
1-well circumscribed
2-soft gelatinous
90
colloid mucinous carcinoma immunophenotype
hormone receptors
91
lesions producing intracellular mucin
LCIS
invasive lobular carcinoma
92
lesions producing extracellular mucin
colloid mucinous carcinoma
93
tubular carcinomas are found by
mammographic screening
94
tubular carcinoma micro picture
well formed tubules w/ low grade nuclei
95
tubular carcinoma immunophenotype
hormone receptos
96
tubular carcinoma immunophenotype
hormone receptors
97
lesions showing hormone receptors expression
1- 2/3 of invasive ductal carcinomas
2-invasive lobular carcinoma
3-colloid mucinous carcinoma
4-tubular carcinoma
98
lesions cc by masses (9)
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
tumors NOT showing palpable mass
inflammatory carcinoma
100
advanced cases of tubular carcinoma show (3)
1-skin dimpling
2-nipple retraction
3-fixation to chest wall
101
tubular carcinoma Cl/P(3)
1-painless palpable mass/mammographic densities/clinically occult
2-lymphedema
3-advanced cases: skin dimpling, nipple retraction, fixation to chest wall
102
outer quadrant tumors extend to
axillary LNs
103
inner quadrant tumors extend to
internal mammary LNs
104
survival rate when ≥16 LNs involved
less than 50%
105
5-year survival rate when no axillary LNs are involved
90%
106
hematogenous spread curability
rare
107
survival is prolonged in cases of hematogenous spread by
chemotherapy
108
prognosis of carcinomas <2cm in size
EXCELLENT
109
LN metastasis at time of detection of cancer 2-3cm in size
50%
110
distant hematogenous spread (4)
1-lungs
2-skeleton
3-liver
4-adrenals
111
TNM staging criteria (3)
1-invasion & size (T)
2- LN metastasis (N)
3-distant metastasis (M)
112
tubular, medullary, cribriform, mucinous tumors prognosis
GOOD
113
ductal carcinomas prognosis
POOR
114
proliferative rate of cancers measured by (3)
1-mitotic activity
2-flow cytometry
3-cell cycle proteins (Ki-67) markers
115
prognosis of cancers showing estrogen & progesterone receptors
GOOD
116
prognosis of cancers showing HER/2NEU overexpressipn
POOR
117
overexpression of HER/2NEU associated w/
aggressive tumors
118
importance of evaluating HER/2NEU overexpression
predicts tumor response to Herceptin therapy
119
importance of evaluating estrogen & progesterone receptors presence
predicts tumor response to therapy
120
prognosis of invasive lobular carcinoma
GOOD
121
prognosis of tubular carcinoma
GOOD
122
prognosis of colloid carcinoma
GOOD
123
prognosis of invasive ductal carcinoma
2/3= GOOD (estro&progest)
1/3=POOR (HER/2NEU)
124
tumors with WORST prognosis
Triple negative Basal like tumors
125
molecular classification of breast carcinomas
1-Luminal A
2-Lumina B
3- HER2-enriched
4-Basal-like
126
luminal A cancers
lower grade ER/PR +ve
HER2 -ve
127
Luminal B cancers
higher grade ER/PR +ve
HER2 +ve
128
HER2 enriched cancers
over express HER2
🚫 ER/PR
129
basal-like cancers
resemble basally located myoepithelial cells
ER/PR -ve
HER2 -ve
**TRIPLE NEGATIVE**
130
ratio of breast carcinomas in M:F
1:125
131
carcinoma of male breast resembles
invasive carcinomas of female breast
132
♂: spread at time of discovery
regional LNs + Distant metastasis
133
male breast carcinomas rapidly infiltrate...
overlying skin & underlying thoracic wall due to scant breast susbtance in male
134
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
invasive ductal carcinoma
135
good prognosis
multicentric & bilateral
express ER/PR
monomorphic cells
intracellular mucin vacuoles
rounded bland nuclei
targetoid pattern/bull's eye pattern
Invasive lobular carcinoma
136
poor prognosis
aggressive
diffusely infiltrative
NO palpable mass
poorly differentiated
enlarged edematous erythematous breast
lymphedema
peaud d'orange
inflammatory carcinoma
137
good prognosis
well circumscribed
BRACA 1 mutation
lack ER/PR & HER/2NEU
pushing tumor borders
sheets of large anaplastic cells
lymphoplasmacytic infiltrate
medullary carcinoma
138
good prognosis
well-circumscribed
soft gelatinous
express ER/PR receptors
produces extracellular mucin that dissects into surrounding stroma
colloid mucinous carcinoma
139
good prognosis
small <1cm
well formed tubules & low grade nuclei
painless palpable mass
lymphedema
dimpling of skin
nipple retraction
fixation of chest wall
tubular carcinoma
140
infiltrates overlying skin & underlying thoracic wall
Male breast carcinoma
