Pathology of the Breast

Question 1

What is the most common cancer in females?

Answer 1

Breast

Question 2

What are the 2 cells layers that line the ducts and lobules of the breast?

Answer 2

• Epithelium

- Myoepithelium

Question 3

What are the 3 tissues that make up the breast?

Answer 3

• Fat
• Stroma
• Epithelium

Question 4

What changes occur in breast tissue as patients age?

Answer 4

Less lobules with stroma replaced by adipose tissue

Question 5

What are common reasons of breast pathology for patient clinic visits?

Answer 5

• Palpable Mass
• Mammogram Lesion
• Nipple Discharge

Question 6

Acute Mastitis

Answer 6

Occurs during lactation due to skin breaks with S. aureus as the most common cause

Question 7

Fat Necrosis of Breast

Answer 7

Generally due to trauma but can be due to surgery or radiation

Question 8

What is a possible risk of fat necrosis?

Answer 8

Confusion with cancer even on x-ray

Question 9

What is the most common breast disorder?

Answer 9

Non-proliferative fibrocystic changes

Question 10

What are examples of stroll lesions without atypia?

Answer 10

• Fibroadenoma

- Phyllodes Tumor

Question 11

Fibroadenoma

Answer 11

Most common benign tumor, usually small with well-circumscribed borders and occurs during reproductive life around less than 30 yrs

Question 12

What happens to fibroadenomas with age?

Answer 12

Calcifications grow and the glands decrease

Question 13

Phyllodes Tumor

Answer 13

More common in older patients - 60s - and are larger than fibroadenomas with leaflike shape and are not well defined
- Most are benign but they can be malignant

Question 14

Most common cause of bloody nipple discharge in younger women

Answer 14

Intraductal Papilloma

Question 15

Intraductal Papilloma

Answer 15

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

Question 16

Atypical Duct Hyperplasia

Answer 16

Expansion of ductal cells

Question 17

Atypical Lobar Hyperplasia

Answer 17

Expansion of terminal duct lobar units

Question 18

Where do most breast carcinomas arise?

Answer 18

Upper Outer Quadrant

Question 19

What are some risk factors for breast cancer?

Answer 19

• Age
•  Female gender
•  Family history of breast cancer
•  Genetic predisposition
•  Prior personal history of breast cancer
•  Increased estrogen exposure

Question 20

Do OCPs increase the risk of breast cancer?

Answer 20

No

Question 21

What type of breast carcinoma in situ is more common?

Answer 21

Ductal Carcinoma In Situ

Question 22

What type of invasive breast carcinoma is more common?

Answer 22

Invasive Ductal Carcinoma

Question 23

What breast is at risk of cancer with lobar carcinoma in situ?

Answer 23

Both breasts

Question 24

What breast is at risk of cancer with ductal carcinoma in situ?

Answer 24

Only the ipsilateral breast

Question 25

Paget Disease

Answer 25

Rare manifestation of breast cancer- DCIS arising within ductal system of the breast can extend up the lactiferous ducts into nipple skin without crossing the BM

Question 26

What will be seen in Paget disease?

Answer 26

A scaly crust on the skin surface and histology will show Paget cells in the epidermis

Question 27

What are some features that indicate increased likelihood of BRCA mutations?

Answer 27

-  Multiple cases of early onset breast cancer - Ovarian cancer - Breast and ovarian cancer in the same woman - Bilateral breast cancer - Male breast cancer

Question 28

What is the function of BRCA1/2?

Answer 28

They are tumor suppressor genes

Question 29

What are risk factors for male breast cancer?

Answer 29

- 1st degree family with breast cancer - Testicular dysfunction - Obesity ***Gynecomastia is NOT a risk

Question 30

What will be seen on histology of gynecomastia?

Answer 30

- micropapillary hyperplasia of ductal lining | - periductal lymphocytic infiltrate

Question 31

A 34 year old female presents with a 4 cm palpable mass in her left breast. A mammogram reveals a speculated mass, a core biopsy is performed and a diagnosis of Invasive Ductal Carcinoma, Nottingham Grade III, Basal Like Type. ``` This patient most likely has a mutation of the following gene:  BRCA2  BCR/ABL  PTEN  BRCA1 ``` In what chromosome is this gene located: 1  10  17  22 X

Answer 31

BRCA1 on Ch17

Question 32

What do basal-like type invasive ductal carcinomas have as their gene profile?

Answer 32

ER- PR- and HER2-

Question 33

``` What is the most common cause of bloody nipple discharge:  Intraductal papilloma  Paget’s disease  Fibroadenoma  Invasive ductal carcinoma ```

Answer 33

Intraductal papilloma

Question 34

``` Of the following breast carcinomas which is the one with the best prognosis  Fibroadenoma  Phyllodes tumor  Tubular carcinoma  Metaplastic carcinoma  Invasive ductal carcinoma ```

Answer 34

Tubular carcinoma

Question 35

 What is the most common breast pathology in men:  Invasive lobular carcinoma  Invasive ductal carcinoma  Gynecomastia  Chronic mastitis  Granulomatous mastitis  Infectious mastitis

Answer 35

Gynecomastia

Question 36

``` What is the most common location for breast carcinoma in males? Upper outer quadrant  Retroareolar  Lower outer quadrant  Lower inner quadrant ```

Answer 36

Retroareolar

Question 37

What are the 2 most important prognostic factors in breast cancer:  Laterality and histologic grade  Size and histologic grade  Histologic grade and lymph node metastasis  Lymph node metastasis and size  Size and resistance

Answer 37

Lymph node metastasis and size