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Lecom pathology year 2 > pathology 23- breast > Flashcards

pathology 23- breast Flashcards

1
Q

what is the functional unit of the breast

A

terminal duct lobular unit

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2
Q

what are the 2 layers that the lobules and ducts are lined with

A

luminal cell layer and myoepithelial layer

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3
Q

what cells line the luminal cell layer and what are the dependent on

A

columnar epithelial cells; highly dependent on vitamin A

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4
Q

where is the highest density of breast tissue

A

upper outer quadrant

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5
Q

what is the term for bacterial infection of the breast

A

acute mastitis

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6
Q

what is acute mastitis usually due to

A

S. aureus (associated with breast feeding)

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7
Q

what is the term for inflammation of subareolar ducts

A

periductal mastitis

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8
Q

who is periductal mastitis typically seen in

A

smokers

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9
Q

why is periductal mastitis typically seen in smokers

A

due to the relative vitamin A deficiency

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10
Q

what is the clinical presentation of periductal mastitis

A

subareolar mass with nipple retraction

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11
Q

what is the term for inflammation of the subareolar ducts with dilation

A

mammary duct ectasia

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12
Q

who does marry duct ectasia usually arise in

A

multiparous post-menopausal women

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13
Q

what is the presentation of mammary duct ectasia

A

periareolar mass with green-brown nipple discharge

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14
Q

what is seen on biopsy of mammary duct ectasia

A

chronic inflammation with plasma cells

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15
Q

what is fat necrosis usually due to

A

trauma

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16
Q

what is the most common change in premenopausal breast tissue

A

fibrocystic change

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17
Q

what is the appearance of the cysts in fibrocystic change

A

blue-domed appearance on gross exam

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18
Q

what is the clinical presentation in intraductal papilloma

A

bloody nipple discharge in premenopausal women

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19
Q

what is the major difference between papillary carcinoma and intraductal papilloma

A

intraductal is in pre-menopausal; papillary is in post-menopausal; also, papillary carcinoma lack myoepithelial cells that are seen in intraductal papilloma

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20
Q

what is the most common benign tumor of the breast

A

fibroadenoma

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21
Q

what is the term for fibroadenoma-like tumor with overgrowth of fibrous component

A

phyllodes tumor

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22
Q

how is DCIS Detected on mammography

A

calcification

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23
Q

what is the term for DCIS that extends up ducts to skin of nipple

A

paget disease

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24
Q

what is the presentation of paget disease of the breast

A

nipple ulceration and erythema

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25
Q

what might be the presentation of an advanced invasive ductal carcinoma of the breast

A

dimpling of skin and/or retraction of nipple

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26
Q

who does the mutinous type of invasive ductal carcinoma typically occur in

A

elderly

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27
Q

what can inflammatory invasive ductal carcinoma appear to be until it does not resolve with antibiotics

A

acute mastitis

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28
Q

what increases the propensity of medullary carcinoma of invasive ductal carcinomas

A

BRCA1 mutations

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29
Q

what are the cells lacking with LCIS

A

E-cadherin

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30
Q

what positivities are associated with response to anti-estrogenic agents

A

ER+ and PR+

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31
Q

what is the most common mutations in male breast cancer

A

BRCA2

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32
Q

What cells line the superficial portion of the breast

A

Keratinizing squamous cells

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33
Q

What lesions can occur in the lobular unit

A

Sclerosing adenosis, small duct papilloma, hyperplasia, atypical hyperplasia, carcinoma

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34
Q

What lesions can occur in the lobular stroma

A

Fibroadenoma, phyllodes tumor

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35
Q

What lesions can occur in the interlobular stroma

A

Fat necrosis, lipoma, fibrous tumor, fibromatosis, sarcom a

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36
Q

Where are 50% f breast carcinoma located

A

Upper outer quadrant

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37
Q

What happens to the nipples of many individuals with squamous metaplasia of lactiferous ducts

A

Inverted nipples secondary to infection

38
Q

Describe the secretions that typically occur with duct ecstasies

A

Thick, white nipple secretions (and occasional skin retraction)

39
Q

When does duct ectasia typically occur and in whom

A

5th or 6th decades of life in multiparous women

40
Q

Who is lymphocytic mastopathy./ sclerosing lymphocytic lobulitis most common in

A

DM1 or autoimmune thyroid disease

41
Q

Who does granulomatous mastitis occur in

A

Parous women

42
Q

How is diagnosis of fibrocystic change made

A

Disappearance of mass after fine-needle aspiration of its contents

43
Q

What is the term for increase in number of acini per lobule

A

Adenosis

44
Q

What is flat adenosis associated with

A

Deletions of chromosome 16q

45
Q

What is thought to be the earliest recognizable precursor of lowgrade breast cancers

A

Flat adenosis

46
Q

Where do large papilloma typically occur

A

Lacteriferous sinuses and solitary

47
Q

Where do small papilloma typically occur

A

Deeper in ductal system

48
Q

How does gynecomastia present

A

Button-like subareolar enlargement

49
Q

How is atypical ductal hyperplasia distinguished from DCIS

A

It only partially fills involved ducts

50
Q

What is the spread seen in atypical lobular hyperplasia called

A

Pategoid intraepthielial spread

51
Q

What are almost all breast malignancies

A

Adenocarcinomas

52
Q

What chromosome is BRCA1 on

A

17

53
Q

What chromosome is BRCA2 on

A

Chromosome 13

54
Q

What are the comings for luminal cancers

A

ER positive, HER2 negative

55
Q

What is the coding for basal like invasive cancer

A

ER negative HER2 negative

56
Q

What is the most common mutation in ER positive HER2 negative

A

Mutations of BRCA2

57
Q

What is the most common subtype of breast cancer in patients with germline mutations in TP53 (li-fraumeni syndrome)

A

HER2 positive cancers

58
Q

What is a putative precursor lesion of HER2 positive cancers

A

Atypical apocrine adenosis

59
Q

What is the most common mutation in ER negative HER2 negative cancers

A

BRCA1 mutations

60
Q

What population of people have increased frequency of BRCA1 mutations

A

African Americans

61
Q

What are the 2 main features required for comedo DCIS

A

Tumor cells with pleomorphic, high grade nuclei and areas of central necrosis

62
Q

What does the cribriform type of non-come from DCIS look like

A

Rounded (cookie-cutter like) spaces within ducts or a solid DCIS pattern

63
Q

What might paget disease of the breast be mistaken for

A

Eczema

64
Q

What is lost in LCIS

A

E-cadherin

65
Q

Which is Bilateral more often, DCIS or LCIS

A

LCIS

66
Q

What should you think of when you see mucin positive signet ring cells

A

LCIS

67
Q

What does LCIS almost always express

A

ER and PR

68
Q

What overexpression is not observed with LCIS

A

HER2

69
Q

What is the most common form of invasive breast cancer

A

ER positive, HER2 negative

70
Q

Where is the metastasis most common for ER+ HER2-

A

Bone

71
Q

What is the high proliferation ER positive HER2 negative associated with a mutation of

A

BRCA2

72
Q

What receptor expression is often absent with HER2+

A

Progesterone receptor

73
Q

Who is HER2+ more common in

A

Young women

74
Q

Who is ER- HER2- most common in

A

Young premenopausal women as well as African Americans and hispanics

75
Q

What is often mutated with ER- HER2-

A

BRCA1

76
Q

Where does ER- HER2- typically metastasize

A

Viscera and brain

77
Q

What type of carcinoma produces grating sound when cut

A

Invasive infiltrating carcinoma

78
Q

What is lost with lobular carcinomas of the breast

A

CDH1 (encodes E-cadherin_

79
Q

What is the histo hallmark of lobular carcinoma

A

Signet-ring cells; tubular formation absent

80
Q

Describe mucinous carcinomas of the breast

A

Soft, rubbery, pale blue gelatin

81
Q

What are medullary carcinoma associated with a mutation of

A

BRCA1

82
Q

What carcinomas of the breast are the softest

A

Medullary

83
Q

What is carcinoma of the male breast associated with

A

BRCA2 mutation and klinefelter

84
Q

Where is the carcinoma of male breast cancer

A

Situated close to overlying skin and underlying thoracic wall

85
Q

Where is distant metastasis of male breast cancer common to

A

Lungs, brain, bone and liver

86
Q

What is the hallmark of inflammatory carcinoma

A

Peau d’ orange

87
Q

What is the most common benign tumor of the breast

A

Fibroadenoma

88
Q

Who do most fibroadenoma occur in

A

Women in 20s and 30s, frequently multiple and bilateral

89
Q

What medication is associated with development of fibroadenomas that regress after sensation of treatment

A

Cyclosporine A

90
Q

What tumors are “leaflike”

A

Phyllodes tumor

91
Q

What are phyllodes tumors associated with gains in

A

Chromosome 1q

92
Q

What is overexpressed in higher grade and more aggressive phyllodes tumors

A

HOXB13

Lecom pathology year 2 (18 decks)

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