pathology 23- breast Flashcards
what is the functional unit of the breast
terminal duct lobular unit
what are the 2 layers that the lobules and ducts are lined with
luminal cell layer and myoepithelial layer
what cells line the luminal cell layer and what are the dependent on
columnar epithelial cells; highly dependent on vitamin A
where is the highest density of breast tissue
upper outer quadrant
what is the term for bacterial infection of the breast
acute mastitis
what is acute mastitis usually due to
S. aureus (associated with breast feeding)
what is the term for inflammation of subareolar ducts
periductal mastitis
who is periductal mastitis typically seen in
smokers
why is periductal mastitis typically seen in smokers
due to the relative vitamin A deficiency
what is the clinical presentation of periductal mastitis
subareolar mass with nipple retraction
what is the term for inflammation of the subareolar ducts with dilation
mammary duct ectasia
who does marry duct ectasia usually arise in
multiparous post-menopausal women
what is the presentation of mammary duct ectasia
periareolar mass with green-brown nipple discharge
what is seen on biopsy of mammary duct ectasia
chronic inflammation with plasma cells
what is fat necrosis usually due to
trauma
what is the most common change in premenopausal breast tissue
fibrocystic change
what is the appearance of the cysts in fibrocystic change
blue-domed appearance on gross exam
what is the clinical presentation in intraductal papilloma
bloody nipple discharge in premenopausal women
what is the major difference between papillary carcinoma and intraductal papilloma
intraductal is in pre-menopausal; papillary is in post-menopausal; also, papillary carcinoma lack myoepithelial cells that are seen in intraductal papilloma
what is the most common benign tumor of the breast
fibroadenoma
what is the term for fibroadenoma-like tumor with overgrowth of fibrous component
phyllodes tumor
how is DCIS Detected on mammography
calcification
what is the term for DCIS that extends up ducts to skin of nipple
paget disease
what is the presentation of paget disease of the breast
nipple ulceration and erythema
what might be the presentation of an advanced invasive ductal carcinoma of the breast
dimpling of skin and/or retraction of nipple
who does the mutinous type of invasive ductal carcinoma typically occur in
elderly
what can inflammatory invasive ductal carcinoma appear to be until it does not resolve with antibiotics
acute mastitis
what increases the propensity of medullary carcinoma of invasive ductal carcinomas
BRCA1 mutations
what are the cells lacking with LCIS
E-cadherin
what positivities are associated with response to anti-estrogenic agents
ER+ and PR+
what is the most common mutations in male breast cancer
BRCA2
What cells line the superficial portion of the breast
Keratinizing squamous cells
What lesions can occur in the lobular unit
Sclerosing adenosis, small duct papilloma, hyperplasia, atypical hyperplasia, carcinoma
What lesions can occur in the lobular stroma
Fibroadenoma, phyllodes tumor
What lesions can occur in the interlobular stroma
Fat necrosis, lipoma, fibrous tumor, fibromatosis, sarcom a
Where are 50% f breast carcinoma located
Upper outer quadrant
What happens to the nipples of many individuals with squamous metaplasia of lactiferous ducts
Inverted nipples secondary to infection
Describe the secretions that typically occur with duct ecstasies
Thick, white nipple secretions (and occasional skin retraction)
When does duct ectasia typically occur and in whom
5th or 6th decades of life in multiparous women
Who is lymphocytic mastopathy./ sclerosing lymphocytic lobulitis most common in
DM1 or autoimmune thyroid disease
Who does granulomatous mastitis occur in
Parous women
How is diagnosis of fibrocystic change made
Disappearance of mass after fine-needle aspiration of its contents
What is the term for increase in number of acini per lobule
Adenosis
What is flat adenosis associated with
Deletions of chromosome 16q
What is thought to be the earliest recognizable precursor of lowgrade breast cancers
Flat adenosis
Where do large papilloma typically occur
Lacteriferous sinuses and solitary
Where do small papilloma typically occur
Deeper in ductal system
How does gynecomastia present
Button-like subareolar enlargement
How is atypical ductal hyperplasia distinguished from DCIS
It only partially fills involved ducts
What is the spread seen in atypical lobular hyperplasia called
Pategoid intraepthielial spread
What are almost all breast malignancies
Adenocarcinomas
What chromosome is BRCA1 on
17
What chromosome is BRCA2 on
Chromosome 13
What are the comings for luminal cancers
ER positive, HER2 negative
What is the coding for basal like invasive cancer
ER negative HER2 negative
What is the most common mutation in ER positive HER2 negative
Mutations of BRCA2
What is the most common subtype of breast cancer in patients with germline mutations in TP53 (li-fraumeni syndrome)
HER2 positive cancers
What is a putative precursor lesion of HER2 positive cancers
Atypical apocrine adenosis
What is the most common mutation in ER negative HER2 negative cancers
BRCA1 mutations
What population of people have increased frequency of BRCA1 mutations
African Americans
What are the 2 main features required for comedo DCIS
Tumor cells with pleomorphic, high grade nuclei and areas of central necrosis
What does the cribriform type of non-come from DCIS look like
Rounded (cookie-cutter like) spaces within ducts or a solid DCIS pattern
What might paget disease of the breast be mistaken for
Eczema
What is lost in LCIS
E-cadherin
Which is Bilateral more often, DCIS or LCIS
LCIS
What should you think of when you see mucin positive signet ring cells
LCIS
What does LCIS almost always express
ER and PR
What overexpression is not observed with LCIS
HER2
What is the most common form of invasive breast cancer
ER positive, HER2 negative
Where is the metastasis most common for ER+ HER2-
Bone
What is the high proliferation ER positive HER2 negative associated with a mutation of
BRCA2
What receptor expression is often absent with HER2+
Progesterone receptor
Who is HER2+ more common in
Young women
Who is ER- HER2- most common in
Young premenopausal women as well as African Americans and hispanics
What is often mutated with ER- HER2-
BRCA1
Where does ER- HER2- typically metastasize
Viscera and brain
What type of carcinoma produces grating sound when cut
Invasive infiltrating carcinoma
What is lost with lobular carcinomas of the breast
CDH1 (encodes E-cadherin_
What is the histo hallmark of lobular carcinoma
Signet-ring cells; tubular formation absent
Describe mucinous carcinomas of the breast
Soft, rubbery, pale blue gelatin
What are medullary carcinoma associated with a mutation of
BRCA1
What carcinomas of the breast are the softest
Medullary
What is carcinoma of the male breast associated with
BRCA2 mutation and klinefelter
Where is the carcinoma of male breast cancer
Situated close to overlying skin and underlying thoracic wall
Where is distant metastasis of male breast cancer common to
Lungs, brain, bone and liver
What is the hallmark of inflammatory carcinoma
Peau d’ orange
What is the most common benign tumor of the breast
Fibroadenoma
Who do most fibroadenoma occur in
Women in 20s and 30s, frequently multiple and bilateral
What medication is associated with development of fibroadenomas that regress after sensation of treatment
Cyclosporine A
What tumors are “leaflike”
Phyllodes tumor
What are phyllodes tumors associated with gains in
Chromosome 1q
What is overexpressed in higher grade and more aggressive phyllodes tumors
HOXB13
