Pathology of the breast Flashcards
what are the noninvasive malignant tumors of the breast?
- DCIS
- comedocarcinoma
- paget disease
what are the invasive malignant tumors of the breast?
- invasive ductal
- invasive lobular
- medullary
- inflammatory
what are the benign tumors of the breast?
- fibroadenoma
- intraductal papilloma
- phyllodes tumor
what are the risk factors for malignant breast tumors?
- increased estrogen exposure
- increased total number of menstrual cycles
- older age at 1st live birth
- obesity / high fat diet
- BRCA1 and BRCA2 gene mutations
- African American ethnicity
- radiation exposure
do malignant breast tumors occur pre or post menopause?
post menopausal
malignant breast tumors are usually located in which quadrant?
upper lateral
what is the single most important prognostic factor for breast cancer?
axillary lymph node involvement (the ONLY factor that matters)
overexpression of what receptor is common in breast cancer? what is the ligand for this receptor?
HER-2
EGF
what is the most common type of invasive carcinoma of the breast? what is the second most common?
ductal
lobular
what are the two least common invasive carcinomas of the breast?
papillary
inflammatory
which breast more commonly gets breast carcinoma?
left more than right
what is the most common cause of nipple discharge?
papilloma (benign)
what are the local / lymphatic / blood routes of spread for breast carcinoma?
local - skin, nipple, chest wall
lymphatic - lymph nodes
blood - lungs, liver, bones
what are the 5 year survivals for stage 0, 1, 2 breast cancer?
stage 0 - 92%
stage 1 - 87%
stage 2 - 65%
stage 3 - 46%
stage 4 - 13%
how does DCIS arise?
ductal atypia
DCIS fills what structure?
ductal lumen
how is DCIS visualized early on?
microcalcification on mammmography
what is the defining feature of DCIS malignancy?
early malignancy without basement membrane penetration
basement membrane is intact
is the DCIS lesion palpable?
no
what is comedocarcinoma? what is the histology / pathology?
- subtype of DCIS
- ductal caseous necrosis
- central necrosis surrounded by cancer cells
paget disease results from what?
underlying DCIS
what is the gross appearance of paget disease?
eczematous patches on nipple
what is important about comedocarcinoma? why?
basement membrane still intact
because it is a subtype of DCIS
what are paget cells? what is their defining feature?
large cells in epidermis with CLEAR HALO?
which breast carcinoma is made up of large epidermal cells with a CLEAR HALO?
paget disease (paget cells)
what is the most common invasive breast carcinoma?
invasive ductal
what is the ‘worst’ breast carcinoma?
invasive ductal
what are the gross features of invasive ductal carcinoma?
firm, fibrous, “rock hard” mass with sharp margins
what are the microscopic features of invasive ductal carcinoma? IMPORTANT
small nests / cords of cells, duct like, or glandular cells with collagenous stroma
IMPORTANT
which breast cancer type is often bilateral with multiple lesions in the same location, with an “Indian file” row of cells?
invasive lobular
what is unique about invasive lobular carcinoma?
often bilateral with multiple lesions in the same location, with an “Indian file” row of cells
histology for medullary breast carcinoma
fleshy, cellular, lymphocytic infiltrate
peau d’orange is associated with which breast cancer type?
inflammatory
what is the pathogenesis of inflammatory breast cancer?
- dermal lymphatic invasion by breast carcinoma
- neoplastic cells block lymphatic channels
what is the most common breast tumor in patients under 35yo?
fibroadenoma
is fibroadenoma a precursor to breast cancer?
no
what is the microscopic appearance of fibroadenoma?
fibroblastic stroma enclosing glandular structures lined by epithelium
where are intraductal papillomas located? where does it grow?
beneath areola
grows in lactiferous ducts
which breast tumor has serous or bloody nipple discharge?
intraductal papilloma
what is the risk of progression to cancer for intraductal papilloma?
1.5-2x increased risk
what is the most common breast tumor in patients in their 6th decade?
phyllodes tumor
what is a phyllodes tumor? what is the appearance? can it become malignant?
- fast growing mass that forms from periductal stromal cells
- large bulky mass with cysts and leaf like projections
could become malignant
what is the most important clinical manifestation of intraductal papilloma?
bloody nipple discharge
what is the most common cause of “breast lumps” from age 25 to menopause? how does this present?
proliferative breast disease
presents with premenstrual breast pain and multiple lesions
is there an increased risk of cancer for proliferative breast disease?
no
what are the histologic types of proliferative breast disease?
- fibrosis
- cystic changes
- sclerosing adenosis
- epithelial hyperplasia
proliferative breast disease: fibrosis histological type
hyperplasia of breast stroma
proliferative breast diseasecystic changes
fluid filled, blue dome (ductal dilation)
proliferative breast disease: sclerosing adenosis**
- increased acini and intralobular fibrosis
- associated with calcifications
- often confused with cancer
- 1.5-2x increased risk of cancer development
proliferative breast disease: epithelial hyperplasia**
- occurs in patient over 30yo
- increase in number of epithelial cell layers in terminal duct lobules
- increased risk of cancer with atypical cells
what is the most common pathogen associated with acute mastitis? what is the pathogenesis?
s. aureus
during breast feeding cracks in nipples occur and increase risk of bacterial infection
what is the treatment for acute mastitis?
dicloxacillin
what is the main cause of fat necrosis of the breast?
injury / trauma
what are the three major causes of gynecomastia?
- hyperestrogenism (cirrhosis, testicular tumor, puberty, old age)
- klinefelter syndrome
- drugs (spironolactone, marijuana, digitalis, estrogen, cimetidine, alcohol, heroin, DA, D2 antagonists, ketoconazole)
