Pathology of Breast

Question 1

Which layer is lost in cancer?

Answer 1

Normal Breast Tissue

The –Myoepithelial layer is lost

Question 2

What type of secretion?

Answer 2

apocrine secretion with snouting

Question 3

Type of Stain?

Answer 3

Immunoperoxidase stain with antibody to actin demonstrates the myoepithelial cell layer around the breast acinus. The myoepithelial cells are contractile and are very sensitive to oxytocin.

Question 4

dx?

Common etiology?

Treatment?

Answer 4

Acute mastitis

Staph (MRSA)

dicloxacillin

Question 5

dx?

What cells are here?

What happends if it ruptures?

Answer 5

Ectatic dilated ducts:

are filled with inspissated secretions and

lipid-laden macrophages.

When ruptured, a marked periductal and interstitial chronic inflammatory reaction ensues, consisting of lymphocytes, macrophages, and variable numbers of plasma cells

Question 6

•Gross appearance of ill-defined nodule with hemorrhage and chalky-white areas (calcifications)

What is expected microscopically?

Answer 6

Fat necrosis

•necrotic adipose tissue with foamy macrophages, multinucleated giant cells and chronic inflammatory cells; often hemosiderin deposits, fibrosis and calcification

Question 7

Type of necrosis in adipose tissue

What type of fibrosis?

What types of cells?

What process is occuring

Answer 7

Fat Necrois

1. foamy macrophages, multinucleated giant cells and chronic inflammatory cells;

often hemosiderin deposits, fibrosis and calcification

Soponification

Question 8

A painful erythematous subareolar mass that clinically appears to be a bacterial abscess

What difficiecy could be related to this?

Answer 8

Squamous metaplasia of the Lactiferous Ducts

AKA recurrent subareolar abscess, periductal mastitis, and Zuska disease

Note:

Many women have an inverted or retracted nipple, most likely as a secondary effect of the underlying inflammation

Vit A

Question 9

This Results in lumpy breast, often upper outer quadrant

Is this related to cancer?

Answer 9

Fibrocystic changes•

Involve cystic changes and fibrosis in TDLUs

No

Clinical:

• Menstrual variation
• Pain

Question 10

The following are evidence of what type of changes?

–“blue-domed”cysts

–Apocrine metaplasia

–Microcalcifications

–Adenosis

•increased number of acini per lobule

Answer 10

Non-proliferative fibrosis

Question 11

•Adenosis with fibrosis, often with calcifications, Hyperplasia and papillomas are ___ changes

Answer 11

Proliferation changes

Question 12

bloody nipple discharge

Answer 12

Intraductal Papilloma

Pre-Men. woman

Question 13

•Most common benign breast tumor

Answer 13

Fibroadenoma

Question 14

dx?

Answer 14

Fat Necrosis

Question 15

Answer 15

Apocrine Metaplasia

Question 16

Is there an increease risk of cancer?

Answer 16

Ductal epithelial hyperplasia

yes

Question 17

What hormone therapy puts a pt at risk for this?

What age group is at risk?

Answer 17

Fibroadenoma

Estrogen therapy

20’s

Question 18

How does this tumor differ from a Phyllodes Tumor

Answer 18

Fibroadenoma: There is less fibrosis then in the other tumor.

Pt age: 20 vs postmenapausal

Question 19

BRCA-1 vs BRCA-2

Answer 19

BRCA-2 leads to more male breast cancers than BRCA-1

•Males typically develop ductal and not lobular cancers

BRCA-1 associated with medullary carcinoma

Aut dominant

Question 20

polypoid tumor with a leaf-like pattern expands a duct

Answer 20

Phyllodes Tumor

Question 21

This can be used as a risk marker or the developement of invasive breast cancer

Answer 21

Lobular carcinoma in SITU

E-Cadherin negative

Question 22

dx

Answer 22

Comedo Ductal CIS

Question 23

Answer 23

Noncomedo DCIS

Question 24

dx

What marker can be used to differentiate ductal vs lobular?

Answer 24

–peau d’orange–> invasive breast cancer

IDC: + E-cadherin

ILC: -E-Cadherin

Question 25

What thpe of carcinoma?

Answer 25

**Invasive lobular carcinoma**

Question 26

Answer 26

Invasive ductal breast carcinoma low grade

Question 27

What other presentations must be present to confirm this dx?

Answer 27

–Red warm skin –Peau d’orange –Dermal lymphatic plugging with tumor –Need both clinical and pathologic findings to make diagnosis –Poor prognosis

Question 28

Red, itchy, swollen rash of nipple/areola What marker will be elevated? What is the MOA for the drug that would treat this dz?

Answer 28

Pagets ## Footnote **Marker**: Alkaline phosphatase **Bisphosphates:** Alendronate, ibandronate, risedronate, zoledronate. **MOA**: Pyrophosphate analogs; bind hydroxyapatite in bone, inhibiting osteoclast activity. Avoid using "Teriparatide" PTH analog

Question 29

What other cancer is this pt at high risk for developing? What cells have an increased function? What other clinical findings could you see? What type of bone formation will be present?

Answer 29

This is Pagets--\> increase Osteosarcoma Hearing Loss, hat size increased Endochondral ossification

Question 30

Drugs that can cause this include:

Answer 30

Gynecomastia Spironolactone digoxin ketoconozole cimetidine (h2 blockers) alcohol

Question 31

composed of widely dispersed, uniform-sized, oval to elongated dilated tubules

Answer 31

Tubular Carcinoma

Question 32

cells appear to be floating in the mucin.

Answer 32

Mucinous carcinoma * older women * slower growing * prognosis is better than for non-mucinous, invasive carcinomas

Question 33

Her-2 Prognosis if tumor is +/-

Answer 33

Oncogene negative is bad

Question 34

Green brown nipple discharge vs bloody discharge

Answer 34

Duct ectasia vs ntraductal papilloma