Pathology of the Breast Flashcards
1
Q
What extends between the lactiferous ducts and the lobules?
A
Collagenous stroma
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.
3
Q
What is DCIS?
A
A precancerous growth of the breast in the cell found lining the ducts.
4
Q
Carcinoma of the terminal duct?
A
Tubular carcinoma
5
Q
True or false: increased estrogen exposure is a risk factor for breast CA
A
True
6
Q
What is the relationship between the number of estrogen cycles and the development of breast cancer?
A
increased number = increased risk
7
Q
True or false: older age at first live birth is a risk factor for breast cancer
A
True
8
Q
What are the two genetic mutations that result in breast cancer?
A
BRCA1 and BRCA2
9
Q
What ethnicity is breast cancer more common in?
A
Blacks
10
Q
What is the relationship between obesity and breast cancer?
A
Increased
11
Q
When do malignant breast tumors usually arise?
A
Postmenopausal
12
Q
Where in the breast are breast tumors usually found?
A
Upper-outer quadrant
13
Q
Overexpression of what two receptors are commonly found with breast cancers?
A
HER-2/neu
14
Q
Triple negative breast cancers (ER-, PR-, HER-) have a better or worse prognosis?
A
Worse
15
Q
What is the single most important prognostic factor for breast cancers?
A
Lymph node involvement
16
Q
What is the most common invasive carcinoma of the breast? Second?
A
- Ductal carcinoma (80%)
2. Lobular carcinoma (10%)
17
Q
How common is inflammatory carcinoma?
A
Rare
18
Q
Bloody nipple discharge is most often caused by what?
A
Intraductal papilloma–benign
19
Q
Which breast (left/right) more commonly develops breast cancer?
A
Left
20
Q
What are the two least common invasive breast cancers?
A
Inflammatory carcinoma
Papillary carcinoma
21
Q
What are the three routes of spread for breast carcinomas? Which is most common?
A
Local
Lymphatic
Hematogenous
22
Q
What are the organs that breast cancers likes to met to? (4)
A
Lungs
Liver
Bones
Brain
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%
24
Q
What type of breast discharge is suggestive of breast cancer?
A
Bloody
25
What type of calcifications on mammography is suggestive of breast cancer?
Pleomorphic
26
What characteristics of lymph node involvement are the most important prognostic factors?
Size
| Grade
27
Ductal carcinoma in situ (DCIS) arises from what cells?
Atypical ductal atypia
28
True or false: Ductal carcinoma in situ (DCIS) usually fills the ductal lumen
True
29
Ductal carcinoma in situ (DCIS) is often seen early on mammography as what?
Microcalcifications on mammography
30
True or false: Ductal carcinoma in situ (DCIS) is usually palpable
False--usually not
31
What is the key histological findings of Ductal carcinoma in situ (DCIS)?
BM is intact around pleomorphic cells
32
What is comedocarcinoma?
subtype of Ductal carcinoma in situ (DCIS) characterized by ductal caseous necrosis
33
What are the histological characteristics of Comedocarcinoma?
Central Ductal caseous necrosis surrounded by cancer cells, but still NO penetration of the BM
34
Central Ductal caseous necrosis surrounded by cancer cells, but without penetration of the BM = which cancer?
Comedocarcinoma
35
What is Paget's disease of the breast? (presentation)
Results from underlying DCIS, with eczematous patches on the nipple
36
What are the histological characteristics of Paget's cells?
Large cells in the epidermis with clear halo
37
Large cells in the epidermis with clear halo = which cancer?
Paget's disease of the breast
38
How does Paget's disease of the breast present clinically?
eczematous patches on the nipple
39
What is the prognosis for invasive ductal carcinoma?
Worst (most invasive) and most common
40
What are the gross features of invasive *ductal* carcinoma?
Firm, fibrous ("rock hard") mass with *sharp* margins
41
Firm, fibrous ("rock hard") mass with *sharp* margins = which cancer?
Invasive ductal CA
42
What are the microscopic features of invasive *ductal* carcinoma?
Small, duct like or glandular cells with dense collagenous stroma between cells
43
Small, duct like or glandular cells with dense collagenous stroma between cells = which breast cancer?
Invasive ductal carcinoma
44
What are the clinical characteristics of invasive *lobular* cancer?
Often bilateral with multiple lesions in the same location
45
What are the histological characteristics of invasive *lobular* breast cancer?
Small, uniform cells in an orderly row of cells in "indian file", with dense stroma
46
*Small*, *uniform* cells in an orderly row of cells in "indian file", with dense stroma = which cancer?
Invasive lobular
47
What is the prognosis, generally, for medullary breast cancer?
Good
48
What are the histological characteristics of medullary breast cancer?
Fleshy, cellular lymphocytic infiltrate
49
What is the 5 year survival rate of inflammatory breast cancer?
50%
50
Peau d'orange is usually seen with what breast cancer?
Inflammatory breast cancer
51
What is the odd characteristic about the lymphatic spread of inflammatory breast cancer?
Neoplastic cells block lymphatic drainage
52
Fibroadenomas are the most common benign lesion in whom?
Women less than 35 years old
53
Are fibroadenomas a precursor to breast cancer?
No
54
What are the general characteristics of fibroadenomas?
Small
Mobile
Firm
Sharp edges
55
What is the effect of estrogen on fibroadenomas?
Increases size and tenderness with increasing estrogen levels
56
Bloody discharge most likely suggests which breast lesion?
Intraductal papilloma
57
Small, firm, well circumscribed mass that increases in size and tenderness with estrogen levels = ?
Fibroadenomas
58
What type of history should be elicited from patients about breast masses?
- tenderness
| - changes in size
59
What are the histological characteristics of fibroadenomas?
Circumscribed tumor with fibroblastic stroma enclosing glandular structures
60
Circumscribed tumor with fibroblastic stroma enclosing glandular structures = which breast pathology?
Fibroadenoma
61
Intraductal papillomas are located where?
Beneath the papilloma within the lactiferous ducts
62
What are the gross characteristics of intraductal papillomas?
Small mass that grows in lactiferous ducts
63
What is the discharge that is seen with intraductal papillomas?
Serous or bloody discharge
64
What is the risk for intraductal papillomas for developing into cancer?
1.5-2x risk
65
Phyllodes tumors are benign or malignant?
Benign, but fast growing
66
In whom are phyllodes tumors most commonly found?
Patients in their 6th decade
67
What are the gross characteristics of Phyllodes tumors? Histologically?
Large, bulky mass with cysts
Leaf like projections on histology
68
Large, bulky mass with cysts and leaf-like projections on histology = which breast pathology
Phyllodes
69
What is the risk of Phyllodes tumor?
May progress to malignant tumor
70
What is the most common "breast lumps" from age 25 to menopause?
fibroadenoma
71
How do fibroadenomas usually present?
Premenstrual breast pain with multiple lesions
72
Are fibroadenomas usually unilateral or bilateral?
Bilateral
73
Is there a risk of breast cancer with fibroadenomas
No
74
Do fibroadenomas fluctuate in size?
Yes
75
Do intraductal papillomas have a risk of developing to breast cancer?
Yes
76
What are the major types of proliferative breast changes?
Fibrosis
| Cystic changes
77
What are the characteristics of fibrosis in the breast?
Hyperplasia of breast stroma
78
What are the characteristic of cystic changes of the breast?
Fluid filled, blue dome. Ductal dilation
79
What is sclerosing adenosis? (histological changes, mammogram findings, risk for progression)
- increased acini and intralobular fibrosis
- Associated with calcifications
- 1/5-2 x cancer risk
80
What is epithelial hyperplasia? (Whom does it occur in, causes, histological changes, risk for progression)
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
What are the gross characteristics of fibrocystic changes?
White tissue with multiple cysts present throughout
82
What are the histological changes of fibrocystic changes?
- Multiple cysts with sections
- Microcalcifications
- Background of fibrotic stroma
83
What are the histological features of epithelial hyperplasia?
Duct lumina are almost completely filled with proliferating epithelium, with no cytologic atypia present
84
What is the most common pathogen that causes acute mastitis?
S. aureus
85
What are the risk factors of mastitis?
During breast feeding, cracks in the nipples increase the risk of bacterial infection
86
What is the treatment for acute mastitis?
Dicloxacillin and continued breastfeeding
87
What is the usual cause of fat necrosis of the breast?
Injury to the breast tissue
88
What are the characteristics of fat necrosis of breast (gross and on mammography)?
Benign, usually painless lump with abnormal calcification on mammography
89
What are the histological characteristics of fat necrosis?
Necrotic fat cells and giant cells
90
What are the causes of gynecomastia (3)?
Hyperestrogenism caused by:
- Cirrhosis
- Testicular tumor
- Old age/puberty
91
What is the genetic disease that may cause gynecomastia?
Klinefelter syndrome (XXY)
92
What is the diuretic that can cause gynecomastia?
Spironolactone
93
What are the illitic drugs that can cause gynecomastia?
Heroin
| Marijuana
94
What is the cardiac medication that can cause gynecomastia?
Digitalis
95
What is the psych drugs that can cause gynecomastia?
Dopamine antagonists (think prolactinaoma)
96
What is the antifungal drug that can cause gynecomastia? How?
Ketoconazole from inhibition of cholesterol desmolase
97
What antihistamine classically causes gynecomastia?
Cimetidine
