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Endo > SM_196: Histology and Pathology of Breast > Flashcards

SM_196: Histology and Pathology of Breast Flashcards

1
Q

____ is most common site of origin of breast cancer

A

Upper outer is most common site of origin of breast cancer

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2
Q

Describe breast anatomy

A

Breast anatomy

  • Skin and superficial fascia
  • Nipple and areola
  • Breast parenchyma: glandular epithelium (15-20 lobes), fibrous stroma, fibroadipose tissue
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3
Q

Describe histology of the nipple areolar complex

A

Nipple areolar complex

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4
Q

Breast ductal system consists of ____, ____, and ____

A

Breast ductal system consists of terminal duct lobular unit, breast duct, and nipple ducts

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5
Q

Describe basic breast histology

A

Basic breast histology

  • White: fat
  • Pink: fibrous stroma
  • Purple: epithelial cells
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6
Q

Describe histology of breast ducts

A

Breast ducts

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7
Q

____ are the site of most breast lesions including cancer

A

Terminal duct lobular units are the site of most breast lesions including cancer

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8
Q

Younger breast has more ____ stroma on histology

A

Younger breast has more fibrous stroma on histology

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9
Q

Older breast has more ____ stroma on histology

A

Older breast has more fatty stroma on histology

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10
Q

Describe histological changes in breast during pregnancy and lactation

A

Pregnancy and lactation breast

  • Number of lobules and acini within each lobule increase at expense of intralobular and extralobular stroma
  • Luminal epithelial cells with cytoplasmic vacuoles, often protruding into lumen
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11
Q

Postmenopausal breast consists largely of ____

A

Postmenopausal breast consists largely of adipose tissue containing a few residual breast ducts and blood vessels

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12
Q

Inflammatory processes of breast are ___, ___, and ___

A

Inflammatory processes of breast are acute mastitis, duct ectasia, and fat necrosis

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13
Q

Fever and enlarged red painful breast mass in nursing mother (during lactation) is ___

A

Fever and enlarged red painful breast mass in nursing mother (during lactation) is acute mastitis

  • Most commonly caused by Staphylococcus aureus entering through cracks on the nipple
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14
Q

Describe pathology of acute mastitis

A

Acute mastitis pathology

  • Neutrophils (polymorphonuclear cells: acute inflammatory cells) infiltrate the breast (mast) and cause inflammation (itis)
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15
Q

Older multiparous women with poorly defined palpable periareolar mass, unilateral discharge, and nipple pain / retraction is ____

A

Older multiparous women with poorly defined palpable periareolar mass, unilateral discharge, and nipple pain / retraction is ductal ectasia

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16
Q

Describe pathology of ductal ectasia

A

Ductal ectasia pathology

  • Ducts are dilated (ectasia) with chronic inflammation (mononuclear cells without multilobulation: lymphocytes and plasma cells)
  • Fibrosis and squamous metaplasia
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17
Q

Hard breast mass, calcifications on mammogram, due to trauma is ____

A

Hard breast mass, calcifications on mammogram, due to trauma is fat necrosis

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18
Q

Describe pathology of fat necrosis

A

Fat necrosis pathology

  • Hemorrhage and neutrophils early
  • Macrophages, fibrosis, and calcifications
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19
Q

This is ____

A

This is acute mastitis

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20
Q

___ is the most common breast finding and includes non-proliferative and proliferative lesions

A

Fibrocystic changes is the most common breast finding and includes non-proliferative and proliferative lesions

  • 20-50 years
  • Cyclic breast pain
  • Engorgement
  • Nodularity
  • Nipple discharge
  • Can also be asymptomatic and associated with mammographic findings
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21
Q

____ involve the terminal duct lobular unit and are dilated ducts with inner luminal epithelial cells and outer myoepithelial cells

A

Simple cysts involve the terminal duct lobular unit and are dilated ducts with inner luminal epithelial cells and outer myoepithelial cells

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22
Q

Non-proliferative breast lesions are ____, ____, and ____

A

Non-proliferative breast lesions are cysts, apocrine metaplasia, and fibroadenoma

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23
Q

Describe pathology of apocrine metaplasia

A

Apocrine metaplasia pathology

  • Apocrine: glands that release some of their cytoplasm in their secretions (apical snouts)
  • Large polygonal cells lining ducts
  • Eosinophilic (red) finely granular cytoplasm
  • Small nuceli with prominent nucleoli
  • Metaplasia: change in type of lining epitheliu,m
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24
Q

Firm, rubbery, mobile, rounded breast mass is ____

A

Firm, rubbery, mobile, rounded breast mass is fibroadenoma

  • Most common benign neoplasm of female breast
  • 20-35 years old
25
Q

Mass with smooth circumscribed borders oriented parallel to skin on US is ___

A

Mass with smooth circumscribed borders oriented parallel to skin on US is fibroadenoma

26
Q

Describe pathology of fibroadenoma

A

Fibroadenoma pathology

  • Circumscribed mass with whorled cut surface
  • Biphasic: neoplastic stroma (fibro) induces a glandular epithelial proliferation (adeno), mass forming (oma)
27
Q

Fibroadenoma has ___

A

Fibroadenoma has well defined circumscribed border between fibroadenoma and normal fatty breast tissue

28
Q

Phyllodes tumor is ___ breast lesion that presents as ____ in women aged ____

A

Phyllodes tumor is NOT benign breast lesion that presents as a rapidly enlarging mass in women aged 30-35 years

29
Q

Describe pathology of phyllodes tumor

A

Phyllodes tumor pathology

  • Leaf like
  • Benign to sarcomatous proliferation

(requires wide margin, high recurrence rate)

30
Q

This is ___

A

This is fibroadenoma

31
Q

Describe relative risk of benign breast disease

A

Benign breast disease

  • Non-proliferative: minimal to no increase in risk for developing breast carcinoma
  • Proliferative without atypia: 1.5-2x
  • Proliferative with atypia: 4-5x
32
Q

Proliferative breast lesions without atypia are ____, ____, ____, and ____

A

Proliferative breast lesions without atypia are usual ductal hyperplasia, sclerosing adenosis, radial scar, and intraductal papilloma

33
Q

Describe pathology of usual ductal hyperplasia

A

Usual ductal hyperplasia pathology

  • Usual: cells look like cells in background terminal duct lobular units (no atypia)
  • Ductal: cells that proliferate
  • Hyperplasia: increase in cell number
34
Q

Describe pathology of sclerosing adenosis

A

Sclerosing adenosis pathology

  • Lobulocentric proliferation: centered around normal terminal duct lobular units
  • Sclerosing: fibrosis of stroma
  • Adenosis: increased number of acini
35
Q

Describe pathology of radial scar

A

Radial scar pathology

  • Radial: stellate configuration
  • Scar: central nidus of small entrapped glands in hyalinized stroma
  • Dilated glands at periphery with cysts or hyperplasia
36
Q

Mass below nipple with bloody nipple discharge is ____

A

Mass below nipple with bloody nipple discharge is intraductal papilloma

37
Q

Describe pathology of intraductal papilloma

A

Intraductal papilloma pathology

  • Intraductal: involves large excretory ducts
  • Papillae: fibrovascular stalks lined by both myoepithelial cells (inner) and benign epithelial cells (outer)
  • Mass forming (oma)
38
Q

This is ____

A

This is usual ductal hyperplasia

39
Q

Proliferative breast lesions with atypia are ____ and ____

A

Proliferative breast lesions with atypia are atypical ductal hyperplasia and atypical lobular hyperplasia

40
Q

Pathology of atypical ductal hyperplasia

A

Atypical ductal hyperplasia pathology

  • Atypical: cytologic atypia (monotonous cells) and architectural atypia (Roman bridges, cribriform structures)
  • Ductal: luminal epithelial proliferation
  • Hyperplasia: increased number of cells
41
Q

Late 40s, either breast and any quadrant, nonspecific presentation, and microcalcifications on mammography is ____

A

Late 40s, either breast and any quadrant, nonspecific presentation, and microcalcifications on mammography is atypical ductal hyperplasia

42
Q

Incidental finding on core breast biopsy, multicentric and bilateral is ____

A

Incidental finding on core breast biopsy, multicentric and bilateral is atypical lobular hyperplasia

  • Multicentric: involves multiple quadrants of some breast
  • Bilateral: involves both breasts
43
Q

Describe atypical lobular hyperplasia on pathology

A

Atypical lobular hyperplasia on pathology

  • Lobular: uniform, small, dyscohesive cells
  • Round nuclei that may be peripheral: look like plasma cells
  • Intracytoplasmic lumens
44
Q

One duct is partially involved by monotonous ductal epithelial cells that form punched out secondary lumens (cribriform spaces).

This is ____

Relative risk of developing breast cancer is ____

A

One duct is partially involved by monotonous ductal epithelial cells that form punched out secondary lumens (cribriform spaces).

This is atypical ductal hyperplasia

Relative risk of developing breast cancer is 4-5 fold

45
Q

In situ carcinoma consists of ____ and ____

A

In situ carcinoma consists of ductal carcinoma in situ and lobular carcinoma in situ

46
Q

Describe in situ carcinoma

A

In situ carcinoma

  • In situ: in its original place or position
  • Carcinoma: cancer arising from epithelial cells
  • Noninvasive: has not penetrated the limiting basement membrane and remains within this normal boundary (intact outer layer of myoepithelial cells)
  • Arise from terminal duct lobular unit
    Relative risk of cancer is 8-10x
47
Q

Ductal carcinoma in situ ___

A

Ductal carcinoma in situ fills and disorts duct spaces

48
Q

Lobular carcinoma in situ ____

A

Lobular carcinoma in situ expands but does not alter acini of lobules

49
Q

Ductal carcinoma is frequently associated with ____

A

Ductal carcinoma is frequently associated with calcifications

(secretory material or necrotic debris)

(5% in unscreened and 40% in screened populations)

50
Q

Describe pathology of ductal carcinoma in situ

A

Ductal carcinoma in situ pathology

  • Architectural patterns: solid, cribriform, papillary
  • Comedo: extensive central necrosis
  • Nuclear grade
    • Low (bland and monotonous): cells look like each other
    • High (pleimorophic cells): cells with varying sizes and shapes
51
Q

Lobular carcinoma in situ is rarely associated with ___

A

Lobular carcinoma in situ is RARELY associated with calcifications

(incidental)

52
Q

Describe pathology of lobular carcinoma in situ

A

Lobular carcinoma in situ pathology

  • Uniform monomorphic cells with bland round nuclei in loosely cohesive clusters
  • Intracellular mucin
53
Q

This is ___

Treatment involves ___

A

This is ductal carcinoma in situ

Treatment involves surgery

54
Q

Invasive breast carcinoma consists of ___ and ___

A

Invasive breast carcinoma consists of invasive ductal carcinoma and invasive lobular carcinoma

  • Invasive: has penetrated the limiting basement membrane, spreading beyond it, and infiltrating into the stroma
  • Characterized by a lack of the outer layer of myoepithelial cells: negative for myoepithelial cell makrers such as p53 and smooth muscle myosin heavy chain
  • Desmoplastic stroma: pale blue-gray stroma reacting to the infiltration
55
Q

Hard palpable fixed breast that comprises 70-80% of all breast cancers is ____

A

Hard palpable fixed breast that comprises 70-80% of all breast cancers is invasive ductal carcinoma

56
Q

Describe pathology of invasive ductal carcinoma

A

Invasive ductal carcinoma pathology

  • Well developed tubules with low grade nuclei to sheets of pleomorphic cells
  • 2/3 express estrogen receptor (ER) and progesterone receptor (PR) and 1/3 overexpress HER2
57
Q

____ comprise 20% of all breast cancers and 10-20% are bilateral

A

Invasive lobular carcinoma comprise 20% of all breast cancers and 10-20% are bilateral

58
Q

Describe pathology of invasive lobular carcinoma

A

Invasive lobular carcinoma pathology

  • Cells identical to atypical lobular hyperplasia and lobular carcinoma in situ
  • Mutations in E-cadherin (surface protein that allows for normal cohesion of breast epithelium)
  • Invade individually and aligned in single file strands
  • Almost all epxress ER and PR, rarely overexpress HER2
  • Metastasis: CSF, serosal surfaces, GI tract, ovary, uterus, bone marrow
59
Q

This is ___

A

This is invasive ductal carcinoma

Endo (25 decks)

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