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OB/GYN > Pathology of the Breast > Flashcards

Pathology of the Breast Flashcards

1
Q

What extends between the lactiferous ducts and the lobules?

A

Collagenous stroma

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2
Q

What is Paget’s disease?

A

Cancer of the breast that results from underlying DCIS, and manifests as an eczema-like rash of the nipple and areola. May have bloody discharge.

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3
Q

What is DCIS?

A

A precancerous growth of the breast in the cell found lining the ducts.

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4
Q

Carcinoma of the terminal duct?

A

Tubular carcinoma

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5
Q

True or false: increased estrogen exposure is a risk factor for breast CA

A

True

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6
Q

What is the relationship between the number of estrogen cycles and the development of breast cancer?

A

increased number = increased risk

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7
Q

True or false: older age at first live birth is a risk factor for breast cancer

A

True

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8
Q

What are the two genetic mutations that result in breast cancer?

A

BRCA1 and BRCA2

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9
Q

What ethnicity is breast cancer more common in?

A

Blacks

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10
Q

What is the relationship between obesity and breast cancer?

A

Increased

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11
Q

When do malignant breast tumors usually arise?

A

Postmenopausal

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12
Q

Where in the breast are breast tumors usually found?

A

Upper-outer quadrant

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13
Q

Overexpression of what two receptors are commonly found with breast cancers?

A

HER-2/neu

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14
Q

Triple negative breast cancers (ER-, PR-, HER-) have a better or worse prognosis?

A

Worse

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15
Q

What is the single most important prognostic factor for breast cancers?

A

Lymph node involvement

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16
Q

What is the most common invasive carcinoma of the breast? Second?

A
  1. Ductal carcinoma (80%)

2. Lobular carcinoma (10%)

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17
Q

How common is inflammatory carcinoma?

A

Rare

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18
Q

Bloody nipple discharge is most often caused by what?

A

Intraductal papilloma–benign

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19
Q

Which breast (left/right) more commonly develops breast cancer?

A

Left

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20
Q

What are the two least common invasive breast cancers?

A

Inflammatory carcinoma

Papillary carcinoma

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21
Q

What are the three routes of spread for breast carcinomas? Which is most common?

A

Local
Lymphatic
Hematogenous

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22
Q

What are the organs that breast cancers likes to met to? (4)

A

Lungs
Liver
Bones
Brain

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23
Q

What is the 5 years survival for the stage 0,1, and 2 of breast cancer?

A 
0 = 92%
1 = 87%
2 = 75%
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24
Q

What type of breast discharge is suggestive of breast cancer?

A

Bloody

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25
Q

What type of calcifications on mammography is suggestive of breast cancer?

A

Pleomorphic

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26
Q

What characteristics of lymph node involvement are the most important prognostic factors?

A

Size

Grade

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27
Q

Ductal carcinoma in situ (DCIS) arises from what cells?

A

Atypical ductal atypia

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28
Q

True or false: Ductal carcinoma in situ (DCIS) usually fills the ductal lumen

A

True

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29
Q

Ductal carcinoma in situ (DCIS) is often seen early on mammography as what?

A

Microcalcifications on mammography

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30
Q

True or false: Ductal carcinoma in situ (DCIS) is usually palpable

A

False–usually not

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31
Q

What is the key histological findings of Ductal carcinoma in situ (DCIS)?

A

BM is intact around pleomorphic cells

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32
Q

What is comedocarcinoma?

A

subtype of Ductal carcinoma in situ (DCIS) characterized by ductal caseous necrosis

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33
Q

What are the histological characteristics of Comedocarcinoma?

A

Central Ductal caseous necrosis surrounded by cancer cells, but still NO penetration of the BM

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34
Q

Central Ductal caseous necrosis surrounded by cancer cells, but without penetration of the BM = which cancer?

A

Comedocarcinoma

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35
Q

What is Paget’s disease of the breast? (presentation)

A

Results from underlying DCIS, with eczematous patches on the nipple

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36
Q

What are the histological characteristics of Paget’s cells?

A

Large cells in the epidermis with clear halo

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37
Q

Large cells in the epidermis with clear halo = which cancer?

A

Paget’s disease of the breast

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38
Q

How does Paget’s disease of the breast present clinically?

A

eczematous patches on the nipple

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39
Q

What is the prognosis for invasive ductal carcinoma?

A

Worst (most invasive) and most common

40
Q

What are the gross features of invasive ductal carcinoma?

A

Firm, fibrous (“rock hard”) mass with sharp margins

41
Q

Firm, fibrous (“rock hard”) mass with sharp margins = which cancer?

A

Invasive ductal CA

42
Q

What are the microscopic features of invasive ductal carcinoma?

A

Small, duct like or glandular cells with dense collagenous stroma between cells

43
Q

Small, duct like or glandular cells with dense collagenous stroma between cells = which breast cancer?

A

Invasive ductal carcinoma

44
Q

What are the clinical characteristics of invasive lobular cancer?

A

Often bilateral with multiple lesions in the same location

45
Q

What are the histological characteristics of invasive lobular breast cancer?

A

Small, uniform cells in an orderly row of cells in “indian file”, with dense stroma

46
Q

Small, uniform cells in an orderly row of cells in “indian file”, with dense stroma = which cancer?

A

Invasive lobular

47
Q

What is the prognosis, generally, for medullary breast cancer?

A

Good

48
Q

What are the histological characteristics of medullary breast cancer?

A

Fleshy, cellular lymphocytic infiltrate

49
Q

What is the 5 year survival rate of inflammatory breast cancer?

A

50%

50
Q

Peau d’orange is usually seen with what breast cancer?

A

Inflammatory breast cancer

51
Q

What is the odd characteristic about the lymphatic spread of inflammatory breast cancer?

A

Neoplastic cells block lymphatic drainage

52
Q

Fibroadenomas are the most common benign lesion in whom?

A

Women less than 35 years old

53
Q

Are fibroadenomas a precursor to breast cancer?

A

No

54
Q

What are the general characteristics of fibroadenomas?

A

Small
Mobile
Firm
Sharp edges

55
Q

What is the effect of estrogen on fibroadenomas?

A

Increases size and tenderness with increasing estrogen levels

56
Q

Bloody discharge most likely suggests which breast lesion?

A

Intraductal papilloma

57
Q

Small, firm, well circumscribed mass that increases in size and tenderness with estrogen levels = ?

A

Fibroadenomas

58
Q

What type of history should be elicited from patients about breast masses?

A
  • tenderness

- changes in size

59
Q

What are the histological characteristics of fibroadenomas?

A

Circumscribed tumor with fibroblastic stroma enclosing glandular structures

60
Q

Circumscribed tumor with fibroblastic stroma enclosing glandular structures = which breast pathology?

A

Fibroadenoma

61
Q

Intraductal papillomas are located where?

A

Beneath the papilloma within the lactiferous ducts

62
Q

What are the gross characteristics of intraductal papillomas?

A

Small mass that grows in lactiferous ducts

63
Q

What is the discharge that is seen with intraductal papillomas?

A

Serous or bloody discharge

64
Q

What is the risk for intraductal papillomas for developing into cancer?

A

1.5-2x risk

65
Q

Phyllodes tumors are benign or malignant?

A

Benign, but fast growing

66
Q

In whom are phyllodes tumors most commonly found?

A

Patients in their 6th decade

67
Q

What are the gross characteristics of Phyllodes tumors? Histologically?

A

Large, bulky mass with cysts

Leaf like projections on histology

68
Q

Large, bulky mass with cysts and leaf-like projections on histology = which breast pathology

A

Phyllodes

69
Q

What is the risk of Phyllodes tumor?

A

May progress to malignant tumor

70
Q

What is the most common “breast lumps” from age 25 to menopause?

A

fibroadenoma

71
Q

How do fibroadenomas usually present?

A

Premenstrual breast pain with multiple lesions

72
Q

Are fibroadenomas usually unilateral or bilateral?

A

Bilateral

73
Q

Is there a risk of breast cancer with fibroadenomas

A

No

74
Q

Do fibroadenomas fluctuate in size?

A

Yes

75
Q

Do intraductal papillomas have a risk of developing to breast cancer?

A

Yes

76
Q

What are the major types of proliferative breast changes?

A

Fibrosis

Cystic changes

77
Q

What are the characteristics of fibrosis in the breast?

A

Hyperplasia of breast stroma

78
Q

What are the characteristic of cystic changes of the breast?

A

Fluid filled, blue dome. Ductal dilation

79
Q

What is sclerosing adenosis? (histological changes, mammogram findings, risk for progression)

A
  • increased acini and intralobular fibrosis
  • Associated with calcifications
  • 1/5-2 x cancer risk
80
Q

What is epithelial hyperplasia? (Whom does it occur in, causes, histological changes, risk for progression)

A

Occurs in patients greater than 30, caused by an increase in epithelial cells layers in the terminal duct lobules.

Increased risk of cancer with atypical cells

81
Q

What are the gross characteristics of fibrocystic changes?

A

White tissue with multiple cysts present throughout

82
Q

What are the histological changes of fibrocystic changes?

A
  • Multiple cysts with sections
  • Microcalcifications
  • Background of fibrotic stroma
83
Q

What are the histological features of epithelial hyperplasia?

A

Duct lumina are almost completely filled with proliferating epithelium, with no cytologic atypia present

84
Q

What is the most common pathogen that causes acute mastitis?

A

S. aureus

85
Q

What are the risk factors of mastitis?

A

During breast feeding, cracks in the nipples increase the risk of bacterial infection

86
Q

What is the treatment for acute mastitis?

A

Dicloxacillin and continued breastfeeding

87
Q

What is the usual cause of fat necrosis of the breast?

A

Injury to the breast tissue

88
Q

What are the characteristics of fat necrosis of breast (gross and on mammography)?

A

Benign, usually painless lump with abnormal calcification on mammography

89
Q

What are the histological characteristics of fat necrosis?

A

Necrotic fat cells and giant cells

90
Q

What are the causes of gynecomastia (3)?

A

Hyperestrogenism caused by:

  • Cirrhosis
  • Testicular tumor
  • Old age/puberty
91
Q

What is the genetic disease that may cause gynecomastia?

A

Klinefelter syndrome (XXY)

92
Q

What is the diuretic that can cause gynecomastia?

A

Spironolactone

93
Q

What are the illitic drugs that can cause gynecomastia?

A

Heroin

Marijuana

94
Q

What is the cardiac medication that can cause gynecomastia?

A

Digitalis

95
Q

What is the psych drugs that can cause gynecomastia?

A

Dopamine antagonists (think prolactinaoma)

96
Q

What is the antifungal drug that can cause gynecomastia? How?

A

Ketoconazole from inhibition of cholesterol desmolase

97
Q

What antihistamine classically causes gynecomastia?

A

Cimetidine

OB/GYN (33 decks)

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