Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

Untreated periductal mastitis may result in

A
  • Repeated breast infections
  • Nipple inversion from fibrosis
  • Mammary fistula development (shown)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

If periductal mastitis is treated in its early stages

A
  • Only antibiotics may be needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pus with periductal mastitis

A
  • Needle aspiration or surgical drainage is required
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Repeated infections with periductal mastitis

A
  • Major duct excision may be needed

- Fistulas require surgical excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Periductal mastitis infection starts in

A
  • Subareolaror juxta-areolar ducts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Common associations with periductal mastitis

A
  • Cigarette smoking
  • Nipple inversion
  • Nipple piercing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Classic presentation of lactational abscess

A
  • Pain, fever, chills, malaise
  • Swelling, Erythema
  • Currently breast feeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

20% of all lactating mothers develop

A
  • Breast abscesses

- Develop from inadequately treated infectious mastitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Most common causative organism of lactational abscess

A
  • Staphylococcus aureus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Ultrasound of lactaitonal abscess demonstrates

A
  • Irregular hypoechoic mass lesion with internal debris
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Inflammatory disorders of the breast

A
  • Acute Mastitis
  • Fat Necrosis
  • Squamous metaplasia of lactiferous ducts
  • Mammary Duct Ectasia
  • Lymphocytic Mamopathy
  • Granulomatous Masititis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Acute mastitis

A
  • Local bacterial infection
  • Portals of Entry (cracks and fissures in the nipples)
  • Staph and Streptococci
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Smaller breast abscess treatment

A
  • Aspiration under ultrasound guidance and oral antibiotic

- Symptomatic care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Larger abscess treatment

A
  • Incision and drainage (I/D)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Fat necrosis

A
  • Mimics breast cancer

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Fat necrosis presentation

A
  • Painless palpable mass
  • Skin thickening or retraction
  • Mammographic densities or calcifications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Benign epithelial lesions of the breast

A
  • Nonproliferative breast changes

- Proliferative breast disease without atypia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Nonproliferative breast changes

A
  • Fibrocystic Changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Proliferative breast disease without atypia

A
  • Epithelial Hyperplasia
  • Sclerosing Adenosis
  • Complex Sclerosing Lesion
  • Papilloma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Central fibrovascular core of intraductal papilloma

A
  • Extends from the wall of a duct Papillae arborize within the lumen
  • Lined by myoepithelial and luminal cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Intraductal papilloma clinical presentation

A
  • > 80% of large duct papillomas produce a nipple discharge
  • Palpable mass
  • Densities or calcifications on mammograms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Fibrocystic breast changes (formerly fibrocystic breast disease)

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Fibrocystic breast changes (formerly fibrocystic breast disease) symptoms

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Fibrocystic change warning signs (require additional workup)

A
  • Cysts are considered benign
  • Bloody aspiration
  • Failure to collapse upon aspiration
  • Solid tissue components
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Fibrocystic change treatment

A
  • No definitive treatment
  • Supportive measures
  • Analgesics
  • Applying heat/ice to the affectedbreast(s)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Fibrocystic change pharmacotherapy

A
  • Oral contraceptives
  • Tamoxifen
  • Androgens
  • Diuretics
  • Aspiration for symptomatic relief
  • Repeat aspirations may be needed as cysts recur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

3 principal morphologic changes in fibrocystic change

A
  • Cystic change (apocrine metaplasia)
  • Fibrosis
  • Adenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Cysts associated with fibrocystic change

A
  • 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
Q

Fibrosis in fibrocystic change

A
  • Chronic inflammation develops when cyst rupture

- Fibrosis contribute to the palpable nodularity of the breast

35
Q

Adenosis associated with fibrocystic change

A
  • 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
Q

Flat epithelial atypia associated with adenosis is clonal

A
  • Associated with deletions of chromosome 16q

- Earliest recognizable precursor of low-grade breast cancers

37
Q

Fibroadenoma

A
  • Etiology unknown
  • Most common benign tumors of the breast
  • Women younger than 30 years and in black women
38
Q

Fibroadenoma risk factors

A
  • Oral contraceptives use before age 20

- Increased risk for breast cancer (1.5 – 2x >)

39
Q

Fibroadenoma tumor composition

A
  • Tumors are mobile

- Composed of glandular and stromal elements

40
Q

Fibroadenoma Dx

A
  • Imaging studies

- Biopsies

41
Q

Atypical lesions on the U/S that should be biopsied

A
  • Larger than 2 cm

- Exhibit rapid growth

42
Q

Fibroadenoma removal

A
  • Surgical excision is recommended

- Smaller lumps can be removed by minimally invasive techniques

43
Q

Fibroadenoma removal techniques

A
  • Vacuum-assisted biopsy

- Cryoablation

44
Q

Fibroadenoma imaging

A
  • Partially circumscribed oval mass with some obscured margins
45
Q

Fibroadenoma appearance

A
  • 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
Q

Fibroadenoma stromal elements

A
  • 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
Q

Phyllodes tumors arise from

A
  • Intralobular stroma
  • The majority are detected as palpable mass
  • Few are found by mammography
48
Q

Phyllodes tumors metastasis

A
  • Most are low-grade
  • Do not metastasize
  • Lymphatic spread is rare
  • Only the stromal component metastasize with high grade lesions
49
Q

Phyllodes tumors microscopic characteristics

A
  • Compared to a fibroadenoma, there is increased stromal cellularity and overgrowth
  • Giving rise to the typical leaflike architecture
50
Q

Breast carcinoma

A
  • 95%> are Adenocarcinomas
  • CIS - confined to ducts and lobules by the basement membrane
  • Invasive CA (“infiltrating” CA) penetration through basement membrane
51
Q

Classification of breast CA

A
  • Based on tumor cell genetics and biology

- Ductal (DCIS) or lobular carcinoma in situ (LCIS)

52
Q

Most important prognostic indicator of breast CA

A
  • Axillary node involvement
53
Q

Ductal carcinoma in situ (DCIS)

A
  • Involves ductules; resembles small ducts
  • Myoepithelial cells are preserved but diminished in number in involved ducts/lobules
  • Can spread throughout the ductal system
54
Q

DCIS detection

A
  • Almost always detected by mammography

- Most are identified as a result of calcifications

55
Q

DCIS major architectural subtypes

A
  • Comedo DCIS

- Noncomedo DCIS

56
Q

Comedo DCIS

A
  • Lesion has a vague nodularity

- Most lesions are comprised of a mixture of patterns

57
Q

Comedo DCIS mammography appearance

A
  • Clustered or linear

- Branching areas of calcification

58
Q

Comedo DCIS defining features

A
  • Tumor cells are pleomorphic with high-grade nuclei

- Areas of central necrosis

59
Q

Noncomedo DCIS

A
  • Lacks high-grade nuclei or central necrosis
  • Cribriform DCIS may have rounded (cookie cutter – like spaces)
  • Solid patterns can be seen
60
Q

Micropapillary DCIS (noncomedo)

A
  • Produces bulbous protrusions

- DCIS can also produce true papillae with fibrovascular cores that lack a myoepithelial cell layer

61
Q

Noncomedo DCIS calcifications may be seen

A
  • Associated with focal necrosis or intraluminal secretions
62
Q

Lobular carcinoma in situ (LCIS)

A
  • 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
Q

LCIS mammography findings

A
  • Densities are absent
64
Q

LCIS calcifications

A
  • No associated calcifications or stromal reactions
65
Q

LCIS location

A
  • Bilateral in 20-40% of cases

- DCIS 10-20% of cases

66
Q

Morphologically identical cells

A
  • Cells of atypical lobular hyperplasia
  • LCIS
  • Invasive lobular carcinoma
67
Q

Morphology of LCIS

A
  • 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
Q

LCIS spread

A
  • Pagetoid spread is common
  • Does not involve nipple skin
  • Necrosis and secretory activity are absent
69
Q

LCIS gene expression

A
  • Almost always expresses ER and PR

- Overexpression of HER2 is not observed

70
Q

3 major molecular subtypes of invasive (infiltrating) carcinoma

A
  • 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
Q

ER-positive, HER2-negative (Luminal 50-65% of cancers) types

A
  • ER-positive, HER2-negative / Low proliferation (40% to 55% of cancers)
  • ER-positive, HER2-negative / High proliferation (approx.10% of cancers)
72
Q

ER-positive, HER2-negative / Low proliferation (40% to 55% of cancers)

A
  • Most common
  • Detected early
  • Treated with hormone therapy
  • Older women, late metastasis, respond well to hormonal treatment
73
Q

ER-positive, HER2-negative / High proliferation (approx.10% of cancers)

A
  • Most common associated with BRCA2 germline mutations

- Respond to chemotherapy

74
Q

HER2-Positive (approximately 20% of cancers) clinical presentation

A
  • Common in young women and in non-white women

- Metastasize when small in size and early (to viscera and brain)

75
Q

HER2-Positive (approximately 20% of cancers) identification

A
  • Assays of HER2 protein overexpression

- HER2 gene amplification

76
Q

ER-Negative, HER2-Negative Tumors (“Basal-like” Triple Negative CA; approx 15% of cancers) clinical presentation

A
  • 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
Q

ER-Negative, HER2-Negative Tumors (“Basal-like” Triple Negative CA) survival

A
  • Local recurrence is common \ even after mastectomy

- Prolonged survival after distant metastasis is rare

78
Q

BRCA1 and 2 Genes

A
  • 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
Q

BRCA1 protein

A
  • Involved in repairing damaged DNA
80
Q

BRCA2 protein

A
  • Interacts with several other proteins to mend breaks in DNA
81
Q

BRCA1 related conditions

A
  • Breast
  • Ovarian
  • Prostate
  • Pancreatic
  • Colon
82
Q

BRCA2 related conditions

A
  • Breast
  • Ovarian
  • Prostate
  • Pancreatic
  • Melanoma

Pathology II (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions