Robbins Ch 23 - Breast Flashcards
Break shows more numerous branchings of terminal ducts and larger lobules, lactational changes are occuring
Findings during pregnancy
Breast lobules decrease in number and size, interlobular stroma is replaces by adipose tissue making mammograms are more radiolucent
Findings with increasing age
MC palpable lesions
Cysts, fibroadenomas, invasive carcinomas
MC area for carcinomas
Upper outer quadrant of the breast
Drugs that can cause milky discharge
OCs, tricyclic antidepressants, methyldopa, phenothiazines
Bloody or serous breast d/c in a non-pregnant F is MCly from
Large duct papilloma and cysts
Clusters of apocrine cysts, hyalineized fibroadenomas, sclerosing adenosis
Calicifications on mammogram - b9 lesions
Small, irregular, numerous and clustered calcifications on mammography
MCly ass’d with malignancy
Breast ca that is MCly detected as mammographic calcifications
Ductal carcinoma in situ
Breast is radiodense or white in appearance, there is a predominanace of fibrous interlobular stroma with a small amount of adipose tissue, lobules are small and are invested in loose cellular intralobular stroma
Findings in young women
Occurs during the first month of breastfeeding and is cause by local bacterial infection of the breast
Acute mastitis
MCCs of acute mastitis
Staphlylococcus > streptocci
Causes acute mastitis with breast single or multiple abscesses
Staph
Causes acute mastitis that spreads as cellulitis
Streptococci
Recurrent subareolar abcesses, periductal mastitis, zuska disease
Sq metaplasia of lactiferous ducts
Keratinizing sq metaplasia of the nipple duct leasing to dilation and rupture
Sq metaplasia of the lactiferous ducts
Sq metaplasia of the lactiferous ducts occurs MCly in
smokers
Thick, white nipple secretions, skin retraction, multiparous F in 5th/6th decade
Duct ectasia
Duct fulled with inspissated secretions and numerous lipid-laden MPs, potentially granuloma formation
Duct ectasia
Duct ectasia can mimic
Invasive breast carcinoma
Hemorrhagic areas with central liquefactive necrosis that appear as firm, gray/white nodeuls with small chalky-white foci grossly
Fat necrosis of the breast
Hard palpable mass(es) with lymphocytic infiltrate, MCly in women with T1 DM or autoimmune thyroid dz
Lymphocytic mastopathy
Granulomatous mastitis only occurs in
Parous women
Caused by HSN reaction to antigens expressed during lactation
Granulomatous mastitis
MCC of cystic neutrophilic granulomatous mastitis
Corynebacteria
Breast cyts diagnosis is confirmed by
Disappearance of mass after FNA of contents
Increased number of acini per lobule
Adenosis
Clonal proliferation ass’d with deletions of ch 16q
Flat epi atypia of the breast
Palpable masses in pregnant or lactating F that are an exaggerated local response to gestational hormones
Lactational adeomas
Increased numbers of luminal andmyoepithelial cells that fill and distend breast ducts and lobules
Epithelial hyperplasia
Increased in acini that are compressed, distorted in the center with stromal fibrosis potentially compressing the lumen; acini are arraged in a swirling pattern with a well circumscribed outer border
Sclerosing adenosis
Central nidus of small tubules entrapped in a densely fibrotic stroma with numerous projections, varying degrees of cyst formation and hyperplasia
Radial sclerosing lesion
More than 80% of duct papillomas produce
Nipple discharge
Imbalance btwn estrogens and androgens can result in
Gynecomastia
Proliferation of regularly spaces ells with cribiform spaces that only partially fill involved ducts; looks like DCIS
Atypical ductal hyperplasia
Atypical lobular cells btwn ductal BM and normal luminal cells that do not fill or distend more than 50% of the acini; resembles LCIS
Atypical lobular hyperplasia
Hyperplasia ass’d with loss of e-cadherin
Atypical lobular hyperplasia
Malignant clona proliferation of epi ells limited to ducts and lobules by the BM
DCIS
Appear as clusters or liner branching areas of calcification; tumor cells with pleomorphic, high grade nuclei and areas of central necrosis
Comedo DCIS
DCIS with rounded, cookie cutter-like spaces (cribiform)
noncomedo type DCIS
DCIS with bulbous protrusions without a fibrovascular core
Micropapillary noncomedo DCIS
U/l erythematous eruption with a scale crust on the nipple, commonly accompanied by pruitis and mistaken for eczma
Paget disease
3 indications of higher rate of recurrence of DCIS
1) high nuclear grade and necrosis 2) extent of disease 3) positive surgical margins
Clonal proliferation of cells within ducts and lobules that grow in a discohesive fashion
LCIS
LCIS is always an incidental finding becuase
Its not associated with calcifications or stromal reactions
MC form of invasive BC
ER-positive HER-negative
MC type of BC found in older F and in M
Low proliferation ER-positive HER-negative
MC BC ass’d with BRCA2 mutations
High proliferation ER-positive HER-negative
HER2-positive BC is MC in
Young F and non-white F
Common in young, premenopausal F,AA and Hispanic women
ER-negative HER-negative
Carcinomas grow in a tubular pattern with small round nuclei and low proliferative rate
Grade I
Carcinoma may show some tubule formation, but solid clusters or single infiltrating cells are present with a greater degree of nuclear pleomorphism and mitotic figures
Grade II
Carcinoma invades as ragged nests or solid sheets with enlarged irregular nuclei with a high proliferative rate and areas of tumor necrosis
Grade III
Biallelic loss of CDH1 is found in what and increases risk of
Lobular BC; inc risk of gastric signet ring cell ca
Higher survival rates and better chemo response in medullary carcinoma is ass’d with
Lymphocytic infiltrates
Pale gray-blue gelatin
Mucinous (Colloid) carcinoma
Hollow balls of cells that float within intercellular fluid
Micropapillary carcinoma
Indicates poor prognosis in breast ca
Distant mets, inflammatory carcinoma
Women with no node involvement and a carcinoma
> 90% survival rate
Peau d’orange
Inflammatory carcinoma - poor prognosis
Proliferation rate in primarily impt for
ER-positive HER2-negative
ER-positive cancers are less likely to respond to
Chemo
HER2 overespression is ass’d with
Poorer survival
MC b9 tumor of the female breast
Fibroadenoma
Well circumscribed, rubbery, grayish white nodules that bulge above surrounding tissue that often contain slitlike spaces
Fribroadenoma of the breast
Tx with cyclosporin A after a rental transplant can lead to
Development of breast fribroadenomas
Phyllodes tumors are ass’d with clonal ch changes - MCly in
Ch 1q
Phyllodes tumors ass’d with more aggresive clinical behavior
More numerous ch abberation and HOXB13 overexpression
Leaflike architecture
Phyllodes tumor
CI in phyllodes tumor
axillary LN biopsy
Type of tumor than is equally as common in M and F
Myofibroblastoma
Ass’d with familial adenomatous polyposis, hereditary desmoid syndrome, and Gardner syndrome
Myofibroblastoma
Only carcom that occurs with fx in the breat
Angiosarcoma
Massive b/l breast invomvment, often woment are pregnancy or lactating
Burkitt lymphoma can present this way
Mets to the breast are MCly from
Melanomas and ovarian ca
tumor suppressor mutation ass’d with increased risk of ovarian carcinoma as well as breast cancer
BRCA1
tumor suppressor mutation more fx ass’d with male breast cancer
BRCA2
on ch17q21
BRCA1
on ch13q12.3
BRCA2
BRCA1 ass’d breast ca are very similar to
ER-negative/HER2-negative ca
BRCA2 are MCly ________ than BRCA1 ca
ER-positive
MC subtype of BC in BRCA2 + individuals
ER-positive, HER2-negative
HER2-positive cancers are strongly ass’d with aplifications on
ch17q
MC subtype of breast cancer in pts with TP53 mutations (Li-Fraumeni syndrome)
HER2-positive
“basal-like” pattern of mRNA expression
ER-negative, HER2-negative breast ca
