Robbins Ch 23 Breast Flashcards
Presence of breast tissue in axilla that responds to prolactin stimulation…
Accessory breast tissue with lactational change
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?
Mastitis caused by a staphylococcal infection
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?
Fat necrosis of the breast
Necrotic fat is phagocytosed by macrophages forming lipid laden–most often occurring after trauma
Dermal lymphatic invasion by underlying breast carcinoma with a rough red/orange appearance on the skin…
Inflammatory carcinoma of the breasts
What are non proliferative fibrocystic changes that occur in the breast?
Common in the breast
- ductal proliferation
- ductal dilation–sometimes with apocrine metaplasia
- fibrosis
Cells lining non proliferative cysts of the breast of what characteristics?
Flattened cuboidal to atrophic with abundant pink cytoplasm resembling apocrine change
What do the cysts in non proliferative cysts of the breast represent?
Calcified secretions–when excised is a blue/brown color
Describe findings with non proliferative fibrocystic changes of the breast…
Irregular, firm area palpated beneath lateral edge of areola
Not painful and is moveable
No axillary lymphadenopathy
Discrete mass formed by a proliferation of fibrous storm with compressed ductules…
Fibroadenoma
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?
Intraductal papilloma–benign
Can also be located in large ducts
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?
Micronodular cirrhosis–impairs hepatic estrogen metabolism
Atypical lobular/ductal hyperplasia increases the risk of what and the risk is higher in what demographic?
Breast cancer–risk is higher in premenopausal women or women with FHx of breast cancer
What are the two gene mutations that predispose women to invasive breast cancer?
BRCA 1 & 2
What are risk factors that increase the risk of developing breast cancer?
FHx
Hx of bilateral breast dz and earlier age of onset of cx
Longer reproduction life–early menarche/late menopause
Nulliparity
A patient has overexertion of HER2/neu-epidermal growth factor receptor. What is the most effective therapy for this patient?
Trastuzumab–monoclonal antibody targeting specific biochemical component of the cell (HER2/neu receptor)
Invasive breast carcinoma with ER+ HER2 - and PIK3CA is very responsive to what therapy?
antiestrogen hormonal therapy
Surgery alone can be curative
Luminal A form comprises over 1/2 of all invasive breast cancers
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
Intraductal carcinoma/Ductal carcinoma in situ (DCIS)
What is paget disease of the nipple and what appearance does it produce?
Extension of the malignant cells to the skin of the nipple and areola–produces appearance of a seborrheic dermatitis
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?
Paget cells
What is the appearance of Paget Dz of the breast and what can it be a sign of?
Red, scaly area and eczematous skin on the breast
May be first sign of malignancy
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?
Lobular carcinoma in situ (LCIS)
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?
Infiltrating ductal carcinoma–by the time a mass is palpable–lymph node metastases are present in 50% of pts
When bloody nipple discharge occurs what is the first thought?
Intraductal papilloma
Pleomorphic cells infiltrating single file through the storm is characteristic of what type of breast cancer?
Lobular carcinoma of the breast
Lobular carcinoma of the breast can become metastatic. What are the two locations most common for mets to occur?
Carcinomatous meningitis–leptomeningeal enhancement seen on CT–onset of headaches with Nausea
Intra-abdominal mets
This breast cancer occurs at younger age than most other breast cancers and is often a triple negative.
Medullary Carcinomas
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?
Medullary carcinoma of the breast
What are the risk factors for the development of breast cancer in males?
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
Patients with BRCA1 gene mutation have a high incidence of…
Carcinomas with medullary features that are poorly differentiated and triple negative
What is one of the most important prognostic factors of breast cancer?
involvement of axillary lymph nodes
Basal-like subset of non specific type breast cancers are…
Triple negative and highly aggressive–metastasize early-must be treated with chemo
Triple negative breast cancer do NOT respond well to what therapies?
Tamoxifen or trastuzumab
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?
Infiltrating ductal carcinoma
Orange peel–inflammatory carcinoma
Sclerosing adenosine if a feature of what?
benign fibrocystic changes of the breast–produces breast lumps and has NO skin involvement
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?
Fibroadenoma
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?
Phyllode tumor
