Repro-Endo: Breast Flashcards
Responsible for Milk production in the Lobules?
Luminal Cell Layer
Inner cell layer ining the Ducts and Lobules
Responsible for Contractile function, propelling the Milk?
Myoepithelial Cell Layer
Outer cell layer lining the Ducts and Lobules
Galactorrhea?
Milk production outside of Lactation
Not a symptom of Breast cancer
A/w Nipple stimulation, Prolactinoma, Drugs (Oxytocin, Ptocin)
- Erythematous Breast w/ Purulent Nipple discharge
- Pain and Fever
- Abcess or mass may be felt w/in Breast or behind Nipple
- A/w Breast-feeding
- Fissures / Cracks develop in the Nipple
- -> Route of Entry for Microbes
- Bacterial infection of the Breast, Staphylococcus aureus
- Tx: Continued drainage (Breast-feeding) and ABX (Dicloxacillin or Cephalexin) check for Methicillin Resistance
Acute Mastitis
- Inflammation of the Subareolar ducts
- Subareolar mass w/ Nipple Retraction
- Relative Vit. A deficiency (Retinoid)
- -> Highly specialized cells require Vit. A (Keratin)
- -> Squamous metaplasia of Lactiferous Ducts
- -> Duct blockage and Inflammation
- A/w Smoking
Periductal Mastitis
-
Periareolar Mass w/ Green-brown Nipple discharge
(Inflammatory debris) - Main ducts fill up w/ Depris
–> Dilation, Rupture, Inflammation - May produce Skin and Nipple retraction
- Multiparous Postmenopausal Women
- Chronic Inflammation w/ Plasma cells
- Inflammation w/ Dilation (Ectasia) of Subareolar ducts
- Tx: ABX and Surgery
Mammary Duct Ectasia
- Benign, Painless, Breast Mass on physical exam
-
Abnormal Calcification on Mammography
(Saponification) - Lipid-laden Macrophages w/ Foreign body Giant cells
- Dystrophic Calcification
- Biopsy –> Necrotic fat w/ Calcification of Giant Cells
- Necrosis of Breast fat
Fat Necrosis
(3) Benign Breast Tumors
- Fibroadenoma
- Intraductal Papilloma
- Phyllodes Tumor
Most common change in Premenopausal Breast?
Fibrocystic change
Fibrocystic changes of the Breast?
- “Breast lumps” “Lumpy” vague irregularity of Breast tissue
- 25 - 50 y.o.
- Premenstrual Breast Pain - Bilateral
- Multiple Lesions –> NOT RISK Cancer
- Fibrosis - Hyperplasia of Breast Stroma (5x Risk)
- Cystic - Fluid filled, “Blue-dome appearance” Ductal dilation.
- Sclerosing adenosis - Increased Acini and Intralobular Fibrosis –> Calcification (slight risk cancer 1.5 - 2x)
- Epithelial hyperplasia - Increase Epithelial cell layers in Terminal Duct lobule
Intraductal Papilloma
- “Straw colored** and **Bloody” Nipple Discharge
- Premenopausal woman
-
Small Tumor, Grows in Lactiferous Ducts** or **Sinuses
- Typically beneath Areola
- NO increased risk of Cancer
- Fibrovascular projections lined by Epithelial (Luminal) and Myoepithelial cells (1.5 - 2x risk of Carcinoma)
- Must be distinguished** from **Papillary Carcinoma
- Tx: Surgical excision
Papillary Carcinoma?
Distinguished from IntraDuctal Papilloma
-
Papillary Carcinoma
- Fibrovascular projections Lined by Epithelial cells WITHOUT Myoepithelial cells
- Risk of Papilary Carcinoma Increases w/ Age
- -> Postmenopausal women
-
Intraductal Papilloma
- Fibrovacular projections Lined by Epithelial cells WITH Myoepithelial cells
- Small, Well circumscribed “Mobile - Marble like mass”
- Discrete and Movable, Painless / Painful
- Premenopausal, < 25 y.o.
- Sharp Edges
- Estrogen sensitive - Grows during Pregnancy and Painful during Menses, Increases in size w/ Estrogen lvls
- Tumor of Fibrous Tissue and Glands and Stroma
- Benign Tumor, No Risk for Carcinoma
- Most common Benign Neoplasm in
Fibroadenoma
- LARGE Bulky mass of Connective tissue Stromal cells
- Fibroadenoma-like Tumor with Overgrowth of the Fibrous component ‘Leaf-like’ projections
- 50 - 60 y.o.
- Post-menopausal women
-
Can be Malignant
- Serial mammograms and Biopsy as it grows
- Tx: Wide excision
Phyllodes Tumor
(9) Risk Factors for Breast Cancer
- Early Menarch / Late Menopause
- Nullparity (Fewer Pregnancies, Less Time Breast-feeding)
- Hormone Replacemnt Therapy (Est. w/out Prog.)
- Endometrial cancer, Ionizing XRT, Smoking
- Older age at 1st Live Birth
- Obesity (aromatization of androstenedione to Estrone)
- Family History / Ash. Jew - BRCA mutation, First-degree relative (BRCA 1, BRCA2, p53, RAS, ERBB2, RB1)
- Atypical Hyperplasia
- HNPCC - Hereditary Nonpolyposis Colorectal Cancer