Robbins Ch 23 Breast

Question 1

Presence of breast tissue in axilla that responds to prolactin stimulation…

Answer 1

Accessory breast tissue with lactational change

Question 2

A 2 month post part breastfeeding mother presents with an erythematous and tender region around the left nipple. Fissures are seen on the skin and a purulent exudate is coming from this abscess. What is the most likely diagnosis and what is causing the symptoms?

Answer 2

Mastitis caused by a staphylococcal infection

Question 3

Patient presents concerned about a recently discovered breast mass. The patient states she found a firm, painless lump upon self breast examination. The patient is a softball player and recently underwent trauma to the same breast. What is the most likely diagnosis and what causes the lump to form?

Answer 3

Fat necrosis of the breast

Necrotic fat is phagocytosed by macrophages forming lipid laden–most often occurring after trauma

Question 4

Dermal lymphatic invasion by underlying breast carcinoma with a rough red/orange appearance on the skin…

Answer 4

Inflammatory carcinoma of the breasts

Question 5

What are non proliferative fibrocystic changes that occur in the breast?

Answer 5

Common in the breast

• ductal proliferation
• ductal dilation–sometimes with apocrine metaplasia
• fibrosis

Question 6

Cells lining non proliferative cysts of the breast of what characteristics?

Answer 6

Flattened cuboidal to atrophic with abundant pink cytoplasm resembling apocrine change

Question 7

What do the cysts in non proliferative cysts of the breast represent?

Answer 7

Calcified secretions–when excised is a blue/brown color

Question 8

Describe findings with non proliferative fibrocystic changes of the breast…

Answer 8

Irregular, firm area palpated beneath lateral edge of areola

Not painful and is moveable

No axillary lymphadenopathy

Question 9

Discrete mass formed by a proliferation of fibrous storm with compressed ductules…

Answer 9

Fibroadenoma

Question 10

Female patient presents with bloody discharge from nipple. A solitary 1cm mass located in the lactiferous sinus is found. What is the most likely diagnosis?

Answer 10

Intraductal papilloma–benign

Can also be located in large ducts

Question 11

A male patient presents with bilateral symmetric gynecomastia. The breast development is not painful. The patient has a history of chronic alcoholism. What is the most likely cause of the gynecomastia?

Answer 11

Micronodular cirrhosis–impairs hepatic estrogen metabolism

Question 12

Atypical lobular/ductal hyperplasia increases the risk of what and the risk is higher in what demographic?

Answer 12

Breast cancer–risk is higher in premenopausal women or women with FHx of breast cancer

Question 13

What are the two gene mutations that predispose women to invasive breast cancer?

Answer 13

BRCA 1 & 2

Question 14

What are risk factors that increase the risk of developing breast cancer?

Answer 14

FHx
Hx of bilateral breast dz and earlier age of onset of cx
Longer reproduction life–early menarche/late menopause

Nulliparity

Question 15

A patient has overexertion of HER2/neu-epidermal growth factor receptor. What is the most effective therapy for this patient?

Answer 15

Trastuzumab–monoclonal antibody targeting specific biochemical component of the cell (HER2/neu receptor)

Question 16

Invasive breast carcinoma with ER+ HER2 - and PIK3CA is very responsive to what therapy?

Answer 16

antiestrogen hormonal therapy

Surgery alone can be curative

Luminal A form comprises over 1/2 of all invasive breast cancers

Question 17

Large, atypical cells in a cribriform pattern on microscopy. Gross appearance is soft, white material extruded from small ducts when pressure is applied. Necrosis of the neoplastic cells in the ducts with dystrophic calcification. This makes up 1/4 of all breast cancers

Answer 17

Intraductal carcinoma/Ductal carcinoma in situ (DCIS)

Question 18

What is paget disease of the nipple and what appearance does it produce?

Answer 18

Extension of the malignant cells to the skin of the nipple and areola–produces appearance of a seborrheic dermatitis

Question 19

Clear mutinous cytoplasm, infiltrates into skin overlying the breast, malignant, and extend to the skin from an underlying breast carcinoma are all characteristics of what type of cells?

Answer 19

Paget cells

Question 20

What is the appearance of Paget Dz of the breast and what can it be a sign of?

Answer 20

Red, scaly area and eczematous skin on the breast

May be first sign of malignancy

Question 21

Ultrasound is performed on a patients left breast. A cystic mass is seen. Histology of the mass shows predominantly fibrocystic changes. Very similar mass is found within the right breast. What is the most likely diagnosis?

Answer 21

Lobular carcinoma in situ (LCIS)

Question 22

A firm, irregular mass is palpated in a female patients breast. There are no overlying skin lesions. Lymph node metastases are present. What is the most likely diagnosis?

Answer 22

Infiltrating ductal carcinoma–by the time a mass is palpable–lymph node metastases are present in 50% of pts

Question 23

When bloody nipple discharge occurs what is the first thought?

Answer 23

Intraductal papilloma

Question 24

Pleomorphic cells infiltrating single file through the storm is characteristic of what type of breast cancer?

Answer 24

Lobular carcinoma of the breast

Question 25

Lobular carcinoma of the breast can become metastatic. What are the two locations most common for mets to occur?

Answer 25

Carcinomatous meningitis–leptomeningeal enhancement seen on CT–onset of headaches with Nausea

Intra-abdominal mets

Question 26

This breast cancer occurs at younger age than most other breast cancers and is often a triple negative.

Answer 26

Medullary Carcinomas

Question 27

Soft, tan, fleshy surface mass is discovered in a young womans breast. Upon histological examination, large cells with vesicular nuclei and prominent nucleoli are seen. The mass is discrete and has non infiltrative borders. What is the most likely diagnosis?

Answer 27

Medullary carcinoma of the breast

Question 28

What are the risk factors for the development of breast cancer in males?

Answer 28

Old age
1st degree relatives with breast cx
Decreased testicular function
Exposure to exogenous estrogens
Infertility
Obesity 
Prior benign breast dz
Exposure to ionizing radiation
Residency in western countries

Question 29

Patients with BRCA1 gene mutation have a high incidence of…

Answer 29

Carcinomas with medullary features that are poorly differentiated and triple negative

Question 30

What is one of the most important prognostic factors of breast cancer?

Answer 30

involvement of axillary lymph nodes

Question 31

Basal-like subset of non specific type breast cancers are…

Answer 31

Triple negative and highly aggressive–metastasize early-must be treated with chemo

Question 32

Triple negative breast cancer do NOT respond well to what therapies?

Answer 32

Tamoxifen or trastuzumab

Question 33

A patient presents with area of swelling with tenderness of the breast. Erythematous skin on the breast is tender with a rough, firm surface resembling an orange peel. The patient has nipple retraction and axilla contender lymphadenopathy. what is the most likely diagnosis and what is the cause of the orange peel appearance of the skin?

Answer 33

Infiltrating ductal carcinoma

Orange peel–inflammatory carcinoma

Question 34

Sclerosing adenosine if a feature of what?

Answer 34

benign fibrocystic changes of the breast–produces breast lumps and has NO skin involvement

Question 35

A pregnant patient presents with an enlarging discrete, freely movable mass beneath the nipple. The mass has been present for some time but has become larger since becoming pregnant. What is the diagnosis?

Answer 35

Fibroadenoma

Question 36

A nontender, large firm mass is palpated within the breast of a 52 year old women. It was found that the cellular storm was protruding into spaces lined by a single layer of cuboidal epithelium. This mass is unlikely to metastasize, but can recur after excision. What is the diagnosis?

Answer 36

Phyllode tumor