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ABBEY MSII Unit 1 > Pathoma breast. > Flashcards

Pathoma breast. Flashcards

1
Q

What is breast tissue derived from?

A

skin (modified sweat gland)

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2
Q

What is the functional unit of the breast?

A

terminal duct lobular unit

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3
Q

What are lobules and ducts lined by?

A

two layers of epithelium: luminal cell layer (inner cell layer responsible for milk production) and myoepithelial layer (outer cell layer; contractile function)

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4
Q

What supports the fact that breast tissue is hormone sensitive?

A
  1. before puberty, breast tissue is primarily large ducts under nipple 2. development after menarche is primarily driven by estrogen and progesterone 3. breast tenderness during menstrual cycle 4. breast lobules undergo hyperplasia during pregnancy 5. after menopause, atrophy
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5
Q

Where is breast tissue in highest density?

A

upper outer quadrant

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6
Q

What is galactorrhea?

A

milk production outside of lactation (NOT a symptom of breast cancer

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7
Q

What are causes of galactorrhea?

A

nipple stimulation, prolactinoma of the anterior pituitary, drugs

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8
Q

What is acute mastitis?

A

bacterial infection of the breast usually due to staph aureus

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9
Q

What is acute mastitis typically associated with?

A

breast feeding

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10
Q

How does acute mastitis typically present?

A

purulent nipple discharge and may progress to abscess formation

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11
Q

Acute mastitis treatment

A

continued drainage and antibiotics (dicloxacillin)

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12
Q

What is periductal mastitis?

A

inflammation of the subareolar ducts due to vitamin a deficiency

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13
Q

Who is periductal mastitis usually seen in?

A

smokers

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14
Q

What does vitamin A deficiency cause?

A

highly specialized epithelial cells require vitamin A - in breast, this causes switch from columnar to squamous metaplasia of lactiferous ducts producing duct blockage and inflammation

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15
Q

How does periductal mastitis typically present?

A

subareolar mass with nipple retraction (because of fibrosis - myoepithelial cells contract because of myofibroblasts pulling skin in)

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16
Q

What is mammary duct ectasia?

A

inflammation with dilation (ectasia) of the subareolar ducts

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17
Q

What are characteristic signs in mammary duct ectasia?

A

periareolar mass with GREEN-BROWN nipple discharge (inflammatory debris) and plasma cells seen on biopsy

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18
Q

What is fat necrosis?

A

necrosis of breast fat usually related to trauma - presents as mass or calcification on mammography

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19
Q

What is characteristic of fat necrosis?

A

biopsy showing necrotic fat with associated calcification and GIANT CELLS**

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20
Q

What is a fibrocystic change?

A

development of fibrosis and cysts in the breast

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21
Q

How does fibrocystic change present?

A

“lumpy breast”

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22
Q

How do cysts appear in fibrocystic changes?

A

blue-dome appearance

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23
Q

Are fibrocystic changes cancerous?

A

no benign - some can be associated with an increased risk for invasive carcinoma (risk applies to both breasts)

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24
Q

fibrosis, cysts, and apocrine metaplasia

A

NO INCREASED RISK for breast cancer

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25
ductal hyperplasia and sclerosing adenosis
2x increased risk for cancer
26
atypical hyperplasia
5x increased risk for cancer
27
What is an intraductal papilloma?
papillary growth (fingerlike growth with blood vessel in core) - usually in large duct
28
What is an intraductal papilloma characterized by?
both epithelial and myoepithelial cells and presents as bloody nipple discharge in a premenopausal woman
29
What presents as bloody nipple discharge?
papillary carcinoma and intraductal papilloma
30
How can you tell the difference between papillary carcinoma and intraductal papilloma?
papillary carcinoma has no myoepithelial cells and is more commonly seen in postmenopausal women
31
What is fibroadenoma?
tumor of fibrous tissue and glands - most common BENIGN neoplasm of the breast (no increased risk for cancer)
32
How does fibroadenoma present? In who?
well-circumscribed, mobile marble-like mass (distinct from the rest of the breast) in premenopausal women
33
What is fibroadenoma sensitive to?
estrogen
34
What is phyllodes tumor?
fibroadenoma-like tumor with overgrowth of the fibrous component
35
What is characteristic of a phyllodes tumor?
leaf-like projections
36
Who is phyllodes tumor most commonly seen in?
post-menopausal women - so there is an increased risk of cancer
37
What are the 6 risk factors for breast cancer?
1. female 2. age (usually postmenopausal women) 3. early menarche/late menopause 4. obesity 5. atypical hyperplasia 6. first degree relative **basically anything that gives an excess of estrogen (plus cancer genes)***
38
What is DCIS?
ductal carcinoma in situ: malignant proliferation of cells in ducts with no invasion of the basement membrane
39
How is DCIS detected?
does not usually produce a mass - detected as calcification on mammography
40
What can calcifications be associated with?
DCIS, fibrocystic changes - esp sclerosing adenosis (benign), and fat necrosis
41
How do you tell the difference between a malignant and benign calcification?
biopsy
42
What is comedo type of DCIS?
high-grade cells with necrosis and dystrophic calcification in the center of ducts
43
What is paget disease?
DCIS that extends up the ducts to involve the skin of the nipple (presents as nipple ulceration and erythema) - almost always associated with underlying carcinoma
44
What is invasive ductal carcinoma?
invasive carcinoma that forms duct-like structures
45
What is the most common type of invasive carcinoma (of the breast)
invasive DUCTAL carcinoma
46
How does invasive ductal carcinoma present?
a mass detected by physical exam or mammography - sometimes have dimpling of skin or retraction of nipple (which also happens as a result of inflammatory cause)
47
What does biopsy of invasive ductal carcinoma reveal?
duct-like structures in a desmoplastic stroma (has connective tissue growing with the tumor)
48
Tubular carcinoma
form of invasive ductal carcinoma - well-differentiated tubules lacking my epithelial cells - good prognosis
49
Mucinous carcinoma
form of invasive ductal carcinoma - abundant extracellular mucin “tumor cells floating in a mucus pool” - good prognosis (cells are stuck in mucus and can’t move)
50
Medullary carcinoma
form of invasive ductal carcinoma - large, high-grade cells growing in sheets with lymphocytes and plasma cells - good prognosis - well-circumscribed mass
51
Inflammatory carcinoma
form of invasive ductal carcinoma - in dermal lymphatics - presents as inflamed, swollen breast because tumor cells block drainage - no discrete mass - poor prognosis
52
Which of the invasive ductal carcinomas has increased incidence in BRCA1 carriers?
medullary carcinoma
53
Which invasive ductal carcinoma can be mistaken for acute mastitis?
inflammatory carcinoma - it is important to have woman checked again 5-10 days after treating her with antibiotics for acute mastitis
54
Lobular carcinoma in situ
malignant proliferation of cells in lobules with no invasion of the basement membrane - does no produce mass or calcifications
55
How is lobular carcinoma in situ usually discovered?
incidentally on biopsy
56
How is lobular carcinoma characterized?
dyscohesive cells lacking E-cadherin adhesion protein
57
Which carcinoma is often multifocal and bilateral?
lobular carcinoma in situ
58
How is lobular carcinoma in situ treated?
tamoxifen (reduce risk of subsequent carcinoma) and close follow up
59
Invasive lobular carcinoma
invasive carcinoma that characteristically grows in a single-file pattern
60
Why does invasive lobular carcinoma not form ducts?
no E-cadherin
61
How is breast cancer staged?
TNM - tumor size, metastasis to lymph nodes, distant metastasis
62
What is the most useful prognostic factor?
spread to axillary lymph nodes
63
What is used to assess axillary lymph nodes?
sentinel lymph node biopsy
64
What factors are predictive for response to treatment?
estrogen receptor (ER), progesterone receptor (PR) and HER2/neu gene amplification(overexpression) status
65
HER2/neu amplification is associated with what?
response to trastuzumab - designer antibody directed against the HER2 receptor
66
Who has an increased propensity to develop triple-negative carcinoma? (ER-, PR-, HER2/neu - )
african american women
67
What is BRCA1 associated with?
breast and ovarian carcinomas
68
What is BRCA2 associated with?
breast carcinoma in males
69
How does breast cancer typically present in males?
subareolar mass in older males, may produce nipple discharge
70
What is the most common histological subtype of breast cancer in males?
invasive ductal carcinoma (no lobules in males - mostly ducts)

ABBEY MSII Unit 1 (4 decks)

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