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RGU 2 > Pathology of Precursor Breast Lesions > Flashcards

Pathology of Precursor Breast Lesions Flashcards

1
Q

What is the breast?

A
  • a modified sweat gland embryologically derived from the skin.
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2
Q

Where can breast tissue develop?

A
  • anywhere along the MILK LINE, from the axilla to the vulva.
  • more common on the left side.
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3
Q

What is the functional unit of the breast?

A
  • terminal duct lobules
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4
Q

*** What lines the lobules and ducts of the breast?

A
  • 2 layers of epithelium:
    1. LUMINAL layer= inner layer lining the ducts and lobules responsible for milk production.
    2. MYOEPITHELIAL layer= outer layer lining ducts and lobules; contractile function that propels milk towards the nipple.
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5
Q

What hormone receptors does breast tissue contain?

A
  1. progesterone receptors

2. estrogen receptors

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6
Q

** Where is the highest density of breast tissue in females after menarche?

A
  • UPPER OUTER QUADRANT
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7
Q

Is breast tenderness a common complaint prior to menstruation?

A

YES

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8
Q

What happens to breast lobules during pregnancy?

A
  • undergo HYPERPLASIA driven by estrogen and progesterone produced by the corpus luteum (early first trimester), fetus, and placenta (later in pregnancy).
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9
Q

What happens to breast tissue after menopause?

A
  • ATROPHY
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10
Q

What is GALACTORRHEA?

A
  • milk production outside of lactation caused by nipple stimulation (physiologic), prolactinoma of the anterior pituitary (common pathologic cause) and drugs.
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11
Q

*** Is the abnormal production of milk (galactorrhea) a symptom of breast cancer?

A

NO

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12
Q

***What is acute mastitis?

A
  • bacterial infection of the breast, usually due to Staph aureus that presents as a warm erythematous breast with purulent nipple discharge (may progress to abscess).
  • associated with BREAST-FEEDING causing FISSURES/CRACKS in the nipple and entry for microbes.
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13
Q

How do you treat acute mastitis?

A
  • drainage (e.g. feeding) and antibiotics (dicloxacillin).
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14
Q

*** What is periductal mastitis?

A
  • inflammation of the SUBAREOLAR DUCTS (usually seen in smokers).
  • presents as a mass with nipple retraction.
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15
Q

** What causes periductal mastitis?

A
  • relative VITAMIN A deficiency (caused from smoking), which results in SQUAMOUS METAPLASIA of lactiferous ducts (normal columnar epithelium), producing duct blockage and inflammation.
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16
Q

** What is mammary duct ectasia?

A
  • inflammation with DILATION (ECTASIA) of the wall of the SUBAREOLAR DUCTS.
  • presents as a periareolar mass with GREEN-BROWN nipple DISCHARGE in MULTIPARoUS POSTmenopausal women.
17
Q

What would a biopsy of mammary duct ectasia show?

A
  • chronic inflammation with PLASMA cells.
18
Q

*** What causes breast fat necrosis?

A
  • usually related to TRAUMA, however a history of trauma may not always be evident.
  • presents as a mass or abnormal CALCIFICATION on mammography (due to saponification).
19
Q

What would a biopsy show on breast fat necrosis?

A
  • necrotic fat with associated calcifications and GIANT cells.
20
Q

** What is FIBROCYSTIC CHANGE of breast tissue?

A
  • BENIGN development of FIBROSIS and CYSTS in the breast.
  • presents as vague irregularity of the breast tissue (LUMPY BREAST), usually in the upper outer quadrant.
  • most common change in PREmenopausal breast (thought to be hormone mediated). Oral contraceptives help by balancing hormones.
21
Q

How do the cysts of fibrocystic breast change look on gross exam?

A
  • BLUE-DOME appearance with histological eosinophilic cytoplasm.
22
Q

*** Are some fibrocystic-related changes associated with an increased risk for invasive carcinoma?

A

YES (increased risk applies to BOTH BREASTS).

23
Q

** If a woman has fibrosis, cysts, and apocrine metaplasia, is she at an increased risk for invasive carcinoma?

A
  • NO

* this is unusual bc normally metaplasia increases your risk.

24
Q

** If a woman has DUCTAL HYPERPLASIA or SCLEROSING ADENOSIS (both types of fibrocystic changes), is she at an increased risk for invasive carcinoma?

A

YES (2x increased risk).

*sclerosing adenosis is often calcified!

25
Q

** Does ATYPICAL HYPERPLASIA increase a woman’s risk for invasive carcinoma?

A

YES (5x increased risk).

*look for ROMAN BRIDGES on histology.

26
Q

*** What is INTRADUCTAL PAPILLOMA?

A
  • papillary growth (usually into a LARGE DUCT) that is characterized by fibrovascular projections lined by epithelial and MYOEPITHELIAL cells in a PREmenopausal woman.
  • presents as BLOODY NIPPLE DISCHARGE.
27
Q

*** How do you distinguish intraductal papilloma from papillary carcinoma of the breast?

A
  • papillary carcinoma has fibrovascular projections lined by epithelial cells WITHOUT underlying MYOepithelial cells, and is more commonly seen in a POSTmenopausal woman.
28
Q

** What is a fibroadenOMA? (stromal tumor)

A
  • MOST COMMON BENIGN tumor of fibrous tissue and glands that is ESTROGEN sensitive (painful during menstrual cycle).
  • presents as WELL-CIRCUMSCRIBED, MOBILE marble-like mass is PREmenopausal women.
  • histology may show STAGHORN configuration.
29
Q

** What is a PHYLLODES tumor? (stromal tumor)

A
  • fibroadenoma-like tumor with OVERGROWTH of the FIBROUS component; characteristic “LEAF-LIKE” projections seen on biopsy of a POSTmenopausal woman.
30
Q

** Can PHYLLODES tumor be malignant in some cases?

A

YES

31
Q

What is thelarche?

A
  • rapid growth of breasts at onset of puberty (age 10-11 in females).
  • influenced by estrogens, growth hormone and prolactin, but NOT progesterone.
32
Q

How many lobes make up the breast?

A

15-25 lobe, emptying into separate major duct terminating in the nipple.

33
Q

Into what is the breast lobule divided?

A

10-100 alveoli

34
Q

What is macromastia?

A
  • female breasts undergo rapid and massive enlargement at puberty
35
Q

How do benign and malignant lesions tend to differ on mammography?

A
  • benign= well-circumscribed and round.

- malignant= stellate and circular w or w/o calcifications

36
Q

What is gynecomastia?

A
  • enlargement of male breast tissue (specifically ducts without lobules) due to imbalance of estrogens and androgens.
  • puberty related or associated with Klinefelter syndrome, marijuana, anabolic steroids, or psychoactive drugs.
  • usually resolves spontaneously.

RGU 2 (24 decks)

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