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MHD II Test 3 > Pathology of the Breast > Flashcards

Pathology of the Breast Flashcards

1
Q

Normal Breast Anatomy

  1. How many major duct systems?
  2. Describe the ducts
  3. What are the 2 cell layers that line ducts and lobules?
A
  1. 6-10
  2. large ducts branch and lead to the terminal duct lobular unit; small acini form the lobule at the end of the terminal duct
  3. epithelial and myoepithelial cells
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2
Q

Life Changes in the Breast

  1. What is the breast like as a young adult?
  2. What about during lactation?
  3. What about as an older adult?
A
  1. more dense; lots of fibrotic stroma
  2. more acini develop
  3. fibrotic stroma replaced by fat
How well did you know this?
1
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3
Q

What are some disorders of breast development? (4)

A
  1. Supernumerary Nipples or Breasts
  2. Accessory Axillary Breast Tissue: Lactational changes or carcinoma may be seen
  3. Congenital Inversion of Nipples
  4. Macromastia
How well did you know this?
1
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2
3
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4
Q

How can breast disease present? (4)

  1. In general, how often is it cancer?
  2. When do these symptoms need to be taken more seriously?
A
  1. Pain
  2. Palpable mass
  3. Nipple Discharge
  4. Lumpiness or other symptoms
  5. Rare, btwn 1-12%
  6. When the pt is older
How well did you know this?
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5
Q

Acute Mastitis

  1. What is it?
  2. When does it occur?
  3. What can cause it?
A
  1. infection/inflammation
  2. lactation
  3. staph and strep infections
How well did you know this?
1
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2
3
4
5
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6
Q

Fat necrosis

  1. Associated with what?
  2. Why is it clinically significant?
  3. Histology
A
  1. trauma, up to 50% don’t report trauma
  2. confusion with cancer due to palpable mass or calcification on mammogram
  3. necrotic fat cells surrounded by macrophages and neutrophils, then fibroblasts, lymphocytes and histiocytes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Fibrocystic Changes

  1. What is it?
  2. How common is it?
  3. When is it clinically relevant?
  4. When is it diagnosed?
  5. 3 Histologic Patterns
A
  1. noncancerous lumps in the breast; non-proliferative
  2. single most common breast disorder; >50% of all breast surgical -procedures
  3. when there is a mass, mammographic calcification, or nipple discharge
  4. 20-40
  5. Cyst w/ apocrine metaplasia; dense fibrosis; adenosis
How well did you know this?
1
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8
Q

Fibrocystic Changes: 3 Histologic Patterns

  1. Cyst w/ apocrine metaplasia
  2. Dense fibrosis
  3. Adenosis
A
  1. dilated lobules; coalesce and form “blue-dome” cysts
  2. reaction to cyst rupture
  3. increase in the number of acini per lobule
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9
Q

Breast Stromal Lesions (3)

A

Fibroadenoma (most common)
Phyllodes Tumor (can be benign, borderline, or malignant)
Sarcoma (rare)

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10
Q

Fibroadenoma

  1. How common is it?
  2. When does it occur?
  3. Presentation
  4. Gross look
  5. Histo Look
A
  1. most common benign tumor, usually small
  2. during reproductive life (more common <30 y/o)
  3. palpable mass
  4. sharply circumscribed nodule
  5. delicate around compressed, distorted slit-like glandular spaces (stroma proliferates and compresses the ducts)
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11
Q

Phyllodes Tumor

  1. When does it occur?
  2. 3 types
  3. What do larger lesions look like?
  4. How is it distinguished from fibroadenomas (5)
A
  1. 6th decade, larger than fibroadenomas
  2. benign, borderline, and malignant types (mostly benign)
  3. often have bulbous protrusions
  4. cellularity, mitotic rate, nuclear pleomorphism, stromal overgrowth, infiltrative borderes; has a more cellular stroma
How well did you know this?
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12
Q

Intraductal Papilloma

  1. Most common cause of what?
  2. Histo look
A
  1. blood nipple discharge in younger women

2. multiple branching fibrovascular cores, each having a connective tissue axis lined by luminal and myoepithelial cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Breast Carcinoma: Epidemiology

  1. How common is it?
  2. Which breast is more common?
  3. What location of the breast is most common?
A
  1. most common non-skin malignancy is women
  2. left
  3. upper outer quadrant
How well did you know this?
1
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2
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14
Q

Precursor Carcinoma Sequence

A

Normal –> Proliferative disease –> Atypical Hyperplasia –> Low/moderate grade DCIS (cookie cutter on histo)/High grade DCIS –> (Low or High) grade invasive carcinoma
*High grade is ER negative

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15
Q

Risk Factors for Breast Carcinoma

  1. Most important risk factor
  2. Other risk factors
A
  1. gender
  2. age
    age at menarche (younger = higher risk)
    age at first live birth (older = higher risk)
    First degree relatives with breast cancer
    Atypical Hyperplasia
    Race (non-hispanic white women have the highest rates of breast cancer)
    Estrogen exposure, Radiation exposure, Breast density, Contralateral breast cancer or Endometrial cancer, Geographic location, Diet (caffeine consumption may decrease the risk), obesity, exercise, environmental toxins, tobacco
How well did you know this?
1
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16
Q

Hereditary Breast Cancer

  1. What % of all breast cancers?
  2. Other features?
A
  1. 12
  2. number of 1st degree relatives, multiple affected relatives, early onset, bilaterality, ovarian cancer, male breast cancer, BRCA1/2; other genetic syndromes (Li-Fraumeni, Cowden’s disease, Peutz-Jegher’s syndrome)
How well did you know this?
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17
Q

BRCA1

  1. Chromosome
  2. Functions
  3. # of ID’ed mutations
  4. Risk of breast cancer at age 70
  5. Age at onset
  6. Ovarian Ca %
  7. Male Breast cancer incidence
  8. Pathology
A
  1. 17q21
  2. Tm suppressor
  3. > 500
  4. 40-90%
  5. 40s-50s
  6. 20-40%
  7. lower than BRCA2
  8. triple negative (basal-like cancers)
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18
Q

BRCA2

  1. Chromosome
  2. Functions
  3. # of ID’ed mutations
  4. Risk of breast cancer at age 70
  5. Age at onset
  6. Ovarian Ca %
  7. Male Breast cancer incidence
  8. Pathology
A
  1. 13q12.3
  2. Tm suppressor
  3. > 300
  4. 30-90%
  5. 50 years
  6. 10-20%
  7. more frequently seen
  8. similar to sporadic breast cancers
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19
Q

Why is it important to identify BRCA carriers?

A

increased surveillance, prophylactic mastectomy, and oophorectomy can reduce cancer-related morbidity and mortality

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20
Q

Classification of Breast Carcinoma

1. 2 main types

A
  1. in situ (neoplastic proliferation that is limited to ducts and lobules by the basement membrane); ductal and lobular
  2. invasive (penetrated through the basement membrane in stroma)
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21
Q

Define

  1. Ductal carcinoma in situ (DCIS)
  2. What cell type may be reduced in number?
  3. What is lobular carcinoma in situe (LCIS)
  4. What is the risk of developing invasive carcinoma with DCIS and LCIS?
A
  1. malignant cells confined to the ductal system without light microscopic evidence of invasion through the basement membrane into the surrounding stroma;
  2. myoepithelial cells
  3. like ductal, but in the lobules
  4. 8- 10x more likely
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22
Q

DCIS Architectural subtypes

  1. Comedo
  2. Non-comedo
  3. What risk is higher in comedo?
A
  1. prominent necrosis present and high nuclear grade; high proliferation rates leads to necrosis;
  2. solid, cribriform, papillary, and micropapillary
  3. invasive carcinoma
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23
Q

LCIS: Histology (3)

A
  1. characteristic, small uniform cells
  2. filling of all the acini (no spaces between cells)
  3. cells lack the cell adhesion protein E-cadherin
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24
Q

Paget Disease

  1. How common is it?
  2. What is it when cancer is present?
  3. How often is there cancer?
  4. What does prognosis depend on?
  5. Histol
A
  1. rare, 1-4%
  2. DCIS arising w/in the ductal system of the breast can extend up the lactiferous ducts into nipple skin without crossing the basement membrane
  3. almost always
  4. extent of underlying carcinoma
  5. Large (cancerous) cells in the epidermis
How well did you know this?
1
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2
3
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25
Q

Invasive Carcinoma

  1. What is the most common type?
  2. What does it look like grossly?
  3. What does the histo look like?
A
  1. Ductal Carcinoma
  2. irregular border, invasive
  3. malignant glands, no myoepithelial cells surrounding ducts
26
Q

Prognostic Factors of Breast Cancer

  1. Most important
  2. 2nd most important
  3. Other major prognostic factors
  4. Minor Prognostic Factors
A
  1. lymph node metastases
  2. second most important factor
  3. invasive or in situ, distant metastases, locally advanced disease
  4. histologic subtype, tumor grade, lymphovascular invasion, estrogen and progesterone receptors, proliferative rate, DNA content, expression of oncogenes, response to neoadjuvant therapy, gene expression profiling
27
Q

What stains can be used to help type cancers?

A

Estrogen receptor
Progesterone receptor
Her-2/Neu receptors (membrane)

28
Q

4 types of Breast Cancer based on Gene Expression

A
  1. Luminal A
  2. Luminal B
  3. HER2/NEU
  4. BASAL-LIKE
29
Q

Tell whether +/- for Estrogen receptor (ER), progesterone receptor (PR), HER2/NEU

  1. Luminal A
  2. Luminal B
  3. HER2/NEU
  4. BASAL-LIKE
  5. Describe Basal-like
A
  1. ER+, PR+, HER2/NEU-
  2. ER+, PR+, HER2/NEU+
  3. ER-, PR-, HER2/NEU+
  4. ER-, PR-, HER2/NEU-
  5. express basal keratins, arise in women w/ BRCA1 mutations, poor prognosis; poorly differentiated, syncytial growth pattern w/ pushing margins and lymphocytic response
30
Q

Male Breast:

  1. Define Gynecomastia
  2. Does it appear in 1 breast or both?
  3. What does it indicate?
  4. What happens to ductal lining?
  5. How often do lobules form?
A
  1. growth of breast tissue in males- benign
  2. unilateral or bilateral
  3. hyperestrinism (cirrhosis or functioning testicular tumor)
  4. marked micropapillary hyperplasia
  5. rarely
31
Q

Male Breast: Carcinoma

  1. How common?
  2. Risk Factors
  3. What is notably not a risk factor?
  4. What is a common mutation?
  5. Histo look?
  6. Why is it dangerous?
A
  1. rare
  2. first degree relatives w/ breast cancer, decreased testicular funciton, age, infertility, obesity, radiation, residency in western countries,
  3. gynecomastia
  4. BRCA2
  5. same histologic subtypes of invasive cancer
  6. infiltrates easily, usually detected later
32
Q

Normal Breast Anatomy

  1. How many major duct systems?
  2. Describe the ducts
  3. What are the 2 cell layers that line ducts and lobules?
A
  1. 6-10
  2. large ducts branch and lead to the terminal duct lobular unit; small acini form the lobule at the end of the terminal duct
  3. epithelial and myoepithelial cells
33
Q

Life Changes in the Breast

  1. What is the breast like as a young adult?
  2. What about during lactation?
  3. What about as an older adult?
A
  1. more dense; lots of fibrotic stroma
  2. more acini develop
  3. fibrotic stroma replaced by fat
34
Q

What are some disorders of breast development? (4)

A
  1. Supernumerary Nipples or Breasts
  2. Accessory Axillary Breast Tissue: Lactational changes or carcinoma may be seen
  3. Congenital Inversion of Nipples
  4. Macromastia
35
Q

How can breast disease present? (4)

  1. In general, how often is it cancer?
  2. When do these symptoms need to be taken more seriously?
A
  1. Pain
  2. Palpable mass
  3. Nipple Discharge
  4. Lumpiness or other symptoms
  5. Rare, btwn 1-12%
  6. When the pt is older
36
Q

Acute Mastitis

  1. What is it?
  2. When does it occur?
  3. What can cause it?
A
  1. infection/inflammation
  2. lactation
  3. staph and strep infections
37
Q

Fat necrosis

  1. Associated with what?
  2. Why is it clinically significant?
  3. Histology
A
  1. trauma, up to 50% don’t report trauma
  2. confusion with cancer due to palpable mass or calcification on mammogram
  3. necrotic fat cells surrounded by macrophages and neutrophils, then fibroblasts, lymphocytes and histiocytes
38
Q

Fibrocystic Changes

  1. What is it?
  2. How common is it?
  3. When is it clinically relevant?
  4. When is it diagnosed?
  5. 3 Histologic Patterns
A
  1. noncancerous lumps in the breast; non-proliferative
  2. single most common breast disorder; >50% of all breast surgical -procedures
  3. when there is a mass, mammographic calcification, or nipple discharge
  4. 20-40
  5. Cyst w/ apocrine metaplasia; dense fibrosis; adenosis
39
Q

Fibrocystic Changes: 3 Histologic Patterns

  1. Cyst w/ apocrine metaplasia
  2. Dense fibrosis
  3. Adenosis
A
  1. dilated lobules; coalesce and form “blue-dome” cysts
  2. reaction to cyst rupture
  3. increase in the number of acini per lobule
40
Q

Breast Stromal Lesions (3)

A

Fibroadenoma (most common)
Phyllodes Tumor (can be benign, borderline, or malignant)
Sarcoma (rare)

41
Q

Fibroadenoma

  1. How common is it?
  2. When does it occur?
  3. Presentation
  4. Gross look
  5. Histo Look
A
  1. most common benign tumor, usually small
  2. during reproductive life (more common <30 y/o)
  3. palpable mass
  4. sharply circumscribed nodule
  5. delicate around compressed, distorted slit-like glandular spaces (stroma proliferates and compresses the ducts)
42
Q

Phyllodes Tumor

  1. When does it occur?
  2. 3 types
  3. What do larger lesions look like?
  4. How is it distinguished from fibroadenomas (5)
A
  1. 6th decade, larger than fibroadenomas
  2. benign, borderline, and malignant types (mostly benign)
  3. often have bulbous protrusions
  4. cellularity, mitotic rate, nuclear pleomorphism, stromal overgrowth, infiltrative borderes; has a more cellular stroma
43
Q

Intraductal Papilloma

  1. Most common cause of what?
  2. Histo look
A
  1. blood nipple discharge in younger women

2. multiple branching fibrovascular cores, each having a connective tissue axis lined by luminal and myoepithelial cells

44
Q

Breast Carcinoma: Epidemiology

  1. How common is it?
  2. Which breast is more common?
  3. What location of the breast is most common?
A
  1. most common non-skin malignancy is women
  2. left
  3. upper outer quadrant
45
Q

Precursor Carcinoma Sequence

A

Normal –> Proliferative disease –> Atypical Hyperplasia –> Low/moderate grade DCIS (cookie cutter on histo)/High grade DCIS –> (Low or High) grade invasive carcinoma
*High grade is ER negative

46
Q

Risk Factors for Breast Carcinoma

  1. Most important risk factor
  2. Other risk factors
A
  1. gender
  2. age
    age at menarche (younger = higher risk)
    age at first live birth (older = higher risk)
    First degree relatives with breast cancer
    Atypical Hyperplasia
    Race (non-hispanic white women have the highest rates of breast cancer)
    Estrogen exposure, Radiation exposure, Breast density, Contralateral breast cancer or Endometrial cancer, Geographic location, Diet (caffeine consumption may decrease the risk), obesity, exercise, environmental toxins, tobacco
47
Q

Hereditary Breast Cancer

  1. What % of all breast cancers?
  2. Other features?
A
  1. 12
  2. number of 1st degree relatives, multiple affected relatives, early onset, bilaterality, ovarian cancer, male breast cancer, BRCA1/2; other genetic syndromes (Li-Fraumeni, Cowden’s disease, Peutz-Jegher’s syndrome)
48
Q

BRCA1

  1. Chromosome
  2. Functions
  3. # of ID’ed mutations
  4. Risk of breast cancer at age 70
  5. Age at onset
  6. Ovarian Ca %
  7. Male Breast cancer incidence
  8. Pathology
A
  1. 17q21
  2. Tm suppressor
  3. > 500
  4. 40-90%
  5. 40s-50s
  6. 20-40%
  7. lower than BRCA2
  8. triple negative (basal-like cancers)
49
Q

BRCA2

  1. Chromosome
  2. Functions
  3. # of ID’ed mutations
  4. Risk of breast cancer at age 70
  5. Age at onset
  6. Ovarian Ca %
  7. Male Breast cancer incidence
  8. Pathology
A
  1. 13q12.3
  2. Tm suppressor
  3. > 300
  4. 30-90%
  5. 50 years
  6. 10-20%
  7. more frequently seen
  8. similar to sporadic breast cancers
50
Q

Why is it important to identify BRCA carriers?

A

increased surveillance, prophylactic mastectomy, and oophorectomy can reduce cancer-related morbidity and mortality

51
Q

Classification of Breast Carcinoma

1. 2 main types

A
  1. in situ (neoplastic proliferation that is limited to ducts and lobules by the basement membrane); ductal and lobular
  2. invasive (penetrated through the basement membrane in stroma)
52
Q

Define

  1. Ductal carcinoma in situ (DCIS)
  2. What cell type may be reduced in number?
  3. What is lobular carcinoma in situe (LCIS)
  4. What is the risk of developing invasive carcinoma with DCIS and LCIS?
A
  1. malignant cells confined to the ductal system without light microscopic evidence of invasion through the basement membrane into the surrounding stroma;
  2. myoepithelial cells
  3. like ductal, but in the lobules
  4. 8- 10x more likely
53
Q

DCIS Architectural subtypes

  1. Comedo
  2. Non-comedo
  3. What risk is higher in comedo?
A
  1. prominent necrosis present and high nuclear grade; high proliferation rates leads to necrosis;
  2. solid, cribriform, papillary, and micropapillary
  3. invasive carcinoma
54
Q

LCIS: Histology (3)

A
  1. characteristic, small uniform cells
  2. filling of all the acini (no spaces between cells)
  3. cells lack the cell adhesion protein E-cadherin
55
Q

Paget Disease

  1. How common is it?
  2. What is it when cancer is present?
  3. How often is there cancer?
  4. What does prognosis depend on?
  5. Histol
A
  1. rare, 1-4%
  2. DCIS arising w/in the ductal system of the breast can extend up the lactiferous ducts into nipple skin without crossing the basement membrane
  3. almost always
  4. extent of underlying carcinoma
  5. Large (cancerous) cells in the epidermis
56
Q

Invasive Carcinoma

  1. What is the most common type?
  2. What does it look like grossly?
  3. What does the histo look like?
A
  1. Ductal Carcinoma
  2. irregular border, invasive
  3. malignant glands, no myoepithelial cells surrounding ducts
57
Q

Prognostic Factors of Breast Cancer

  1. Most important
  2. 2nd most important
  3. Other major prognostic factors
  4. Minor Prognostic Factors
A
  1. lymph node metastases
  2. second most important factor
  3. invasive or in situ, distant metastases, locally advanced disease
  4. histologic subtype, tumor grade, lymphovascular invasion, estrogen and progesterone receptors, proliferative rate, DNA content, expression of oncogenes, response to neoadjuvant therapy, gene expression profiling
58
Q

What stains can be used to help type cancers?

A

Estrogen receptor
Progesterone receptor
Her-2/Neu receptors (membrane)

59
Q

4 types of Breast Cancer based on Gene Expression

A
  1. Luminal A
  2. Luminal B
  3. HER2/NEU
  4. BASAL-LIKE
60
Q

Tell whether +/- for Estrogen receptor (ER), progesterone receptor (PR), HER2/NEU

  1. Luminal A
  2. Luminal B
  3. HER2/NEU
  4. BASAL-LIKE
  5. Describe Basal-like
A
  1. ER+, PR+, HER2/NEU-
  2. ER+, PR+, HER2/NEU+
  3. ER-, PR-, HER2/NEU+
  4. ER-, PR-, HER2/NEU-
  5. express basal keratins, arise in women w/ BRCA1 mutations, poor prognosis; poorly differentiated, syncytial growth pattern w/ pushing margins and lymphocytic response
61
Q

Male Breast:

  1. Define Gynecomastia
  2. Does it appear in 1 breast or both?
  3. What does it indicate?
  4. What happens to ductal lining?
  5. How often do lobules form?
A
  1. growth of breast tissue in males- benign
  2. unilateral or bilateral
  3. hyperestrinism (cirrhosis or functioning testicular tumor)
  4. marked micropapillary hyperplasia
  5. rarely
62
Q

Male Breast: Carcinoma

  1. How common?
  2. Risk Factors
  3. What is notably not a risk factor?
  4. What is a common mutation?
  5. Histo look?
  6. Why is it dangerous?
A
  1. rare
  2. first degree relatives w/ breast cancer, decreased testicular funciton, age, infertility, obesity, radiation, residency in western countries,
  3. gynecomastia
  4. BRCA2
  5. same histologic subtypes of invasive cancer
  6. infiltrates easily, usually detected later

MHD II Test 3 (14 decks)

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