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Pathology II > Pathology of the Breast > Flashcards

Pathology of the Breast Flashcards

1
Q

Terminal Duct-Lobule Unit (TDLU)

A
  • Intralobular terminal duct (ITD)
  • Extralobular terminal duct (ETD)
  • Ductule
  • Lobule
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2
Q

Periductal Mastitis response

A
  • Obtain imaging studies (eg, U/S mammography)
  • Specific modality is determined on a case-by-case basis
  • Other Dx test ductography and ductal lavage and cytology
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3
Q

Untreated periductal mastitis may result in

A
  • Repeated breast infections
  • Nipple inversion from fibrosis
  • Mammary fistula development (shown)
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4
Q

If periductal mastitis is treated in its early stages

A
  • Only antibiotics may be needed
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5
Q

Pus with periductal mastitis

A
  • Needle aspiration or surgical drainage is required
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6
Q

Repeated infections with periductal mastitis

A
  • Major duct excision may be needed

- Fistulas require surgical excision

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7
Q

Periductal mastitis infection starts in

A
  • Subareolaror juxta-areolar ducts
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8
Q

Common associations with periductal mastitis

A
  • Cigarette smoking
  • Nipple inversion
  • Nipple piercing
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9
Q

Classic presentation of lactational abscess

A
  • Pain, fever, chills, malaise
  • Swelling, Erythema
  • Currently breast feeding
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10
Q

20% of all lactating mothers develop

A
  • Breast abscesses

- Develop from inadequately treated infectious mastitis

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11
Q

Most common causative organism of lactational abscess

A
  • Staphylococcus aureus
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12
Q

Ultrasound of lactaitonal abscess demonstrates

A
  • Irregular hypoechoic mass lesion with internal debris
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13
Q

Inflammatory disorders of the breast

A
  • Acute Mastitis
  • Fat Necrosis
  • Squamous metaplasia of lactiferous ducts
  • Mammary Duct Ectasia
  • Lymphocytic Mamopathy
  • Granulomatous Masititis
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14
Q

Acute mastitis

A
  • Local bacterial infection
  • Portals of Entry (cracks and fissures in the nipples)
  • Staph and Streptococci
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15
Q

Clinical presentation of acute mastitis

A
  • Erythematous and painful
  • Fever
  • Initially one duct system or sector of the breast is involved
  • Can spread to the entire breast (if not treated)
  • Staphylococcal abscesses may be single or multiple whereas
  • Streptococci cause spreading infection in the form of cellulitis
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16
Q

Squamous metaplasia of lactiferous ducts

A
  • When extending deep into a nipple duct, keratin becomes trapped and accumulates
  • If duct ruptures, the ensuing intense inflammatory response to keratin results in an erythematous painful mass
  • Fistula tract may burrow beneath smooth muscle of the nipple to open at the edge of the areola
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17
Q

Smaller breast abscess treatment

A
  • Aspiration under ultrasound guidance and oral antibiotic

- Symptomatic care

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18
Q

Larger abscess treatment

A
  • Incision and drainage (I/D)
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19
Q

Fat necrosis

A
  • Mimics breast cancer

- About ½ of affected women have Hx of breast trauma or prior surgery

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20
Q

Fat necrosis presentation

A
  • Painless palpable mass
  • Skin thickening or retraction
  • Mammographic densities or calcifications
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21
Q

Benign epithelial lesions of the breast

A
  • Nonproliferative breast changes

- Proliferative breast disease without atypia

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22
Q

Nonproliferative breast changes

A
  • Fibrocystic Changes
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23
Q

Proliferative breast disease without atypia

A
  • Epithelial Hyperplasia
  • Sclerosing Adenosis
  • Complex Sclerosing Lesion
  • Papilloma
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24
Q

Intraductal papilloma gross and microscopy

A
  • Rarely exceeds 3cm
  • Soft and fragile with areas of hemorrhage
  • Central fibrovascular core
  • Papillae arborize within the lumen
  • Lined by myoepithelial and luminal cells
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25
Central fibrovascular core of intraductal papilloma
- Extends from the wall of a duct Papillae arborize within the lumen - Lined by myoepithelial and luminal cells
26
Intraductal papilloma clinical presentation
- >80% of large duct papillomas produce a nipple discharge - Palpable mass - Densities or calcifications on mammograms
27
Fibrocystic breast changes (formerly fibrocystic breast disease)
- Glandular and stromal tissues changes - Most common in young women - Can occur at any age - Breast cysts are multiple (shown) unilateral or bilateral - Symptoms wax and wane with the menstrual cycle
28
Fibrocystic breast changes (formerly fibrocystic breast disease) symptoms
- Swollen, tender/painful, and/or thick or lumpy breasts - Discharge may be present - Diagnosis based on the patient’s symptoms and a breast examination - U/S or fine-needle aspiration (FNA) is obtained
29
Fibrocystic change warning signs (require additional workup)
- Cysts are considered benign - Bloody aspiration - Failure to collapse upon aspiration - Solid tissue components
30
Fibrocystic change treatment
- No definitive treatment - Supportive measures - Analgesics - Applying heat/ice to the affected breast(s)
31
Fibrocystic change pharmacotherapy
- Oral contraceptives - Tamoxifen - Androgens - Diuretics - Aspiration for symptomatic relief - Repeat aspirations may be needed as cysts recur
32
3 principal morphologic changes in fibrocystic change
- Cystic change (apocrine metaplasia) - Fibrosis - Adenosis
33
Cysts associated with fibrocystic change
- Formed by the dilation of lobules - Small cyst coalesce to form larger cysts - Unopened cysts contain turbid fluid (blue-dome cysts) - Lined by a flat atrophic epithelium or by metaplastic apocrine cells - Calcifications are common
34
Fibrosis in fibrocystic change
- Chronic inflammation develops when cyst rupture | - Fibrosis contribute to the palpable nodularity of the breast
35
Adenosis associated with fibrocystic change
- Increase in the number of acini per lobule - Calcifications are occasionally present within lumen - Acini are lined by columnar cells - Columnar cells may show “ flat epithelial atypia” - Flat epithelial atypia is clonal
36
Flat epithelial atypia associated with adenosis is clonal
- Associated with deletions of chromosome 16q | - Earliest recognizable precursor of low-grade breast cancers
37
Fibroadenoma
- Etiology unknown - Most common benign tumors of the breast - Women younger than 30 years and in black women
38
Fibroadenoma risk factors
- Oral contraceptives use before age 20 | - Increased risk for breast cancer (1.5 – 2x >)
39
Fibroadenoma tumor composition
- Tumors are mobile  | - Composed of glandular and stromal elements
40
Fibroadenoma Dx
- Imaging studies | - Biopsies
41
Atypical lesions on the U/S that should be biopsied
- Larger than 2 cm | - Exhibit rapid growth
42
Fibroadenoma removal
- Surgical excision is recommended | - Smaller lumps can be removed by minimally invasive techniques
43
Fibroadenoma removal techniques
- Vacuum-assisted biopsy | - Cryoablation
44
Fibroadenoma imaging
- Partially circumscribed oval mass with some obscured margins
45
Fibroadenoma appearance
- Vary in size from less than 1 cm to large tumors that replace most of the breast - Well-circumscribed, rubbery, grayish white nodules - Cut surface bulges above the surrounding tissue
46
Fibroadenoma stromal elements
- Delicate and often myxoid stroma - Epithelium may be surrounded by stroma (pericanicular pattern) or compressed and distorted by it (intracanicular pattern) - In older women, the stroma typically becomes densely hyalinized and the epithelium atrophic
47
Phyllodes tumors arise from
- Intralobular stroma - The majority are detected as palpable mass - Few are found by mammography
48
Phyllodes tumors metastasis
- Most are low-grade - Do not metastasize - Lymphatic spread is rare - Only the stromal component metastasize with high grade lesions
49
Phyllodes tumors microscopic characteristics
- Compared to a fibroadenoma, there is increased stromal cellularity and overgrowth - Giving rise to the typical leaflike architecture
50
Breast carcinoma
- 95%> are Adenocarcinomas - CIS - confined to ducts and lobules by the basement membrane - Invasive CA (“infiltrating” CA) penetration through basement membrane
51
Classification of breast CA
- Based on tumor cell genetics and biology | - Ductal (DCIS) or lobular carcinoma in situ (LCIS)
52
Most important prognostic indicator of breast CA
- Axillary node involvement
53
Ductal carcinoma in situ (DCIS)
- Involves ductules; resembles small ducts - Myoepithelial cells are preserved but diminished in number in involved ducts/lobules - Can spread throughout the ductal system
54
DCIS detection
- Almost always detected by mammography | - Most are identified as a result of calcifications
55
DCIS major architectural subtypes
- Comedo DCIS | - Noncomedo DCIS
56
Comedo DCIS
- Lesion has a vague nodularity | - Most lesions are comprised of a mixture of patterns
57
Comedo DCIS mammography appearance
- Clustered or linear | - Branching areas of calcification
58
Comedo DCIS defining features
- Tumor cells are pleomorphic with high-grade nuclei | - Areas of central necrosis
59
Noncomedo DCIS
- Lacks high-grade nuclei or central necrosis - Cribriform DCIS may have rounded (cookie cutter – like spaces) - Solid patterns can be seen
60
Micropapillary DCIS (noncomedo)
- Produces bulbous protrusions | - DCIS can also produce true papillae with fibrovascular cores that lack a myoepithelial cell layer
61
Noncomedo DCIS calcifications may be seen
- Associated with focal necrosis or intraluminal secretions
62
Lobular carcinoma in situ (LCIS)
- Neoplastic cells grow in ducts and lobules in a discohesive fashion - “Lobular” malignant cells expand but preserves lobular architecture - LCIS is always an incidental finding on biopsy
63
LCIS mammography findings
- Densities are absent
64
LCIS calcifications
- No associated calcifications or stromal reactions
65
LCIS location
- Bilateral in 20-40% of cases | - DCIS 10-20% of cases
66
Morphologically identical cells
- Cells of atypical lobular hyperplasia - LCIS - Invasive lobular carcinoma
67
Morphology of LCIS
- Uniform population of cells - Mucin-positive signet-ring cells are present - E-cadherin results in a rounded shape without attachment to adjacent cells - Cribriform spaces or papillae are absent
68
LCIS spread
- Pagetoid spread is common - Does not involve nipple skin - Necrosis and secretory activity are absent
69
LCIS gene expression
- Almost always expresses ER and PR | - Overexpression of HER2 is not observed
70
3 major molecular subtypes of invasive (infiltrating) carcinoma
- ER-positive, HER2-negative - HER2-positive (approximately 20% of cancers) - ER-negative, HER2-negative tumors (“basal-like” triple negative carcinoma; approximately 15% of cancers)
71
ER-positive, HER2-negative (Luminal 50-65% of cancers) types
- ER-positive, HER2-negative / Low proliferation (40% to 55% of cancers) - ER-positive, HER2-negative / High proliferation (approx.10% of cancers)
72
ER-positive, HER2-negative / Low proliferation (40% to 55% of cancers)
- Most common - Detected early - Treated with hormone therapy - Older women, late metastasis, respond well to hormonal treatment
73
ER-positive, HER2-negative / High proliferation (approx.10% of cancers)
- Most common associated with BRCA2 germline mutations | - Respond to chemotherapy
74
HER2-Positive (approximately 20% of cancers) clinical presentation
- Common in young women and in non-white women | - Metastasize when small in size and early (to viscera and brain)
75
HER2-Positive (approximately 20% of cancers) identification
- Assays of HER2 protein overexpression | - HER2 gene amplification
76
ER-Negative, HER2-Negative Tumors (“Basal-like” Triple Negative CA; approx 15% of cancers) clinical presentation
- More common in young premenopausal women - Majority of CA’s arising in women with BRCA1 mutations - High proliferation \ rapid growth (presents as a palpable mass between screenings)
77
ER-Negative, HER2-Negative Tumors (“Basal-like” Triple Negative CA) survival
- Local recurrence is common \ even after mastectomy | - Prolonged survival after distant metastasis is rare
78
BRCA1 and 2 Genes
- Provides instructions for making a protein that acts as a tumor suppressor - Tumor suppressor proteins help prevent cells from growing and dividing too rapidly or in an uncontrolled way
79
BRCA1 protein
- Involved in repairing damaged DNA
80
BRCA2 protein
- Interacts with several other proteins to mend breaks in DNA
81
BRCA1 related conditions
- Breast - Ovarian - Prostate - Pancreatic - Colon
82
BRCA2 related conditions
- Breast - Ovarian - Prostate - Pancreatic - Melanoma

Pathology II (7 decks)

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