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Anatomic Pathology > The Breast > Flashcards

The Breast Flashcards

1
Q

The breasts are lined by two cells type, what and what??

A

Myoepithelial cells - contractile cells with myoflaments that lies of the basement membrane and help in milk ejection

Luminal cells; only those in terminal ducts and mobiles produce milk

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2
Q

Two different stromas of the breast

A

Interlobular - dense fibrous connective tissue admixed with adipose tissue
Intra lobular - breast specific hormonay respsonsive, delicate, myxomatosis stroma that contains a scattering of lymphocytes

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3
Q

At the beginning of menarche, what changes in the breast occur?

A
  • Terminal duct gives rise to lobules
  • Inter lobular stroma increases in volume
  • Paucity of Adipose tissue (radio dense breast)
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4
Q

Changes in the breast in the follicular phase

A
  • Cell proliferation and increase in the number of acini per lobule
  • vacuolization of epithelial cells
  • Markedly edematous intralobular stroma

Sense of fullness in follicular phase is from the stimulatory effect of progesterone and estrogen combined

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5
Q

Breast changes in Menstrual phase

A
  • fall in hormones leads to epithelial cell apoptosis
  • a disappearance of stromal edema
  • regression of the size of the lobules
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6
Q

When does the breast achieve its complete morphological maturation and functional activity?

A

During pregnancy
- lobules increase in both number and size
- Breast composed of almost entirely lobules and scant stroma
- Montgomery tubercles; nipple lubrication
- secretory vacuole of lipid material are found in the TDLU epithelial cells. Milk production is inhibited by progesterone

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7
Q

Lactation changes in the breast ?

A

Immediately after birth, breast produces colostrum (high in protein)
- so within 10 days (charges to milk -higher in calories and fat)
- IgA , neutrophils, lymphocytes and macrophages, cytokines, fibronectin, lysozyme are transferred to the baby
- postpartum health of the mother can influence lactating child (radiation)

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8
Q

Involution of the breast involves?

A
  • After the third decade, lobules and their stroma start to involute
  • Radiodense fibrous imterlobular stroma of the young female breast is progressively replaced by radioluscent adipose tissue.
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9
Q

Disorders of the breast

A

Macromastia - juvenile hypertrophy (reduction mammoplasty removed breast tissue but preserves the nipple
Congenital Nipple inversion
Milk line remnants; extends from axilla to perineum (supernumerary nipples)sThe

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10
Q

Inflammatory condition of the breast ?

A

Acute mastitis
Periductal mastitis
Mammary duct ecstasies
Fat necrosis
Lymphocytic mastopathy
Granulomatous mastitis
————//

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11
Q

Acute mastitis is caused by?

A
  • Staph aureus, streptococcus species
    During lactation
    -erythematous painful breast, fever
  • at onset, only 1 duct system is involved. Can progress without treatment
  • treated with antibiotics and complete drainage of milk from the breast
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12
Q

Morphology of acute mastitis

A

Staph aureus
- An area Acute inflammation and multiple abscesses
Strep infection
- diffuse spreading infection that involves the entire breast
- necrosis, neutrophil infiltration.

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13
Q

Periductal mastitis can also be called?

A
  • Zuska disease
  • Recurrent Subareolar abscess
  • Squamous metaplasia of lactiferous ducts
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14
Q

Periductal mastitis morphology and epidemiology?

A
  • Seen in both men and women
  • Painful erythematous subarealola mass
  • seen mostly among smokers
  • fistula may form and open at the edge of areola
  • many present with inverted nipple secondary to fibrosis and scarring
  • condition may contribute to squamous metaplasia of the duct
  • may be related to vitamin A deficiency in smokers with alter the ductal epithelium
  • keratin plug may be formed
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15
Q

Fat necrosis may present as which ways?

A
  • painless palpable mass
  • slim thicikening or retraction
  • Mammogrpahic density
  • mammographic retraction

History of trauma or prior surgery

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16
Q

Lymphocytic mastopathy features

A
  • presents with single or multiple hard palpable mass (extremely hard lesions)
  • collagenized stroma surrounding atrophic ducts and lobules
  • BM is often thickened
  • lymphocytic infiltrates
  • common in women with type 1 DM
  • autoimmune disease of the breast
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17
Q

Granulomatous mastitis Is associated with which diseases ?

A
  • Wegeners granulomatosis
  • sarcoidosis
  • mycobacterial infection/fungal infection (breast prosthesis or nipple piercing)
  • granulomas involving the lobular epithelium
  • only parous women are affected
  • may be an hypersensitivity reactions
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18
Q

MONDOR’S DISEASE ?

A
  • Thrombophlebitis of the superficial veins of the chest wall
  • cordlike induration if the breast
  • resolves spontaneously
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19
Q

IgG4 related mastopathy?

A
  • Due to proliferation of IgG4 lymphocytes
  • associated with the following?
    • Granulomatous mastitis
    • retroperitoneal fibrosis
    • salivary gland inflammation (sialadenitis)
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20
Q

Benign diseases can be classified as ?

A
  • Non-proliferative
  • Proliferative
  • Atypical hyperplasia
21
Q

Fibrocystic change;

A
  • non proliferative benign disease
  • exaggerated and uncoordinated response of the mammary ducts and stroma to hormone stimulation
    Main histological change
  • Fibrosis, cystic dilatation and adenosis
22
Q

Changes that occur in each histological fibrocystic change

A

Fibrosis
- Dense Interlobular fibrous tissue expands into the lobules replacing the loose Intralobular connective tissue
Cystic dilation
- strands of fibrous tissue constrict ducts (blocked normal secretions)
- distal dialatation of these terminal ducts
Adenosis
- changes resulting from proliferation of terminal ducts cells that are group around the centrally dilated ducts

23
Q

Apocrine metaplasia

A
  • Ducts are lined by cell with granular eosinophilic cytoplasm and small nuclei
  • presence usually suggest benign lesion
24
Q

Epithelial hyperplasia features?

A
  • Proliferating Breast changes without Atypia
  • presence of more than two cell layers
  • moderate to florid (> 4 cell layers)
  • cells fill and distends the ducts and lobules
  • can form fenestrations
25
Q

Papillomas features ?

A
  • Small duct papillomas are usually multiple deep in ductal system. Increased risk of breast carcinoma
  • Large duct papillomas are usually solitary in lactiferous duct of the nipple
  • multiple branching fibrovascular cores
26
Q

Other proliferative disease without Atypia ?

A
  • Endothelial hyperplasia
  • Papillomas
  • Sclerosing adenosis
  • Complex Sclerosing lesions
  • Fibroadenoma with complex figures
27
Q

Examples of proliferative disease with Atypia ?

A

Atypical ductal hyperplasia (ADH)
Atypical lobular hyperplasia (ALH)

  • resembles ductal carcinoma in situ or LCIS
  • no features of carcinoma
28
Q

Atypical ductal hyperplasia

A
  • associated with calicufications
  • adjacent to anothe calcifying lesion
  • resembles DCIS (with round lamina, regular cell placement, monomorphic cell population)
29
Q

Atypical lobular hyperplasia (ALH)

A
  • Resembles LCIS
  • cells do not distend more than 50% of the acini within the lobules
  • can extend into the ducts, increase sef risk of invasive carcinoma
30
Q

Clinical significance of ADH and LH

A

1) Proliferative dx with Atypia - moderate increase in risk for carcinoma
2) carcinoma in situ (DCIS, LCIS) - substantial risk for carcinoma if not tested
3) proliferative dx without Atypia - mild risk
4) non proliferative dx - no risk

31
Q

Fibroadenoma

A
  • benign breast tumor
  • elongated ducts surrounded by loose fibrous stroma
  • well circumscribed, movable mass
  • 20-35year age group
32
Q

Phyllodes tumor

A
  • stroma shows increased cellularity and Anaplasia
  • most are benign
  • metastasizing malignant tumor is rare
  • malignant phyllodes is locally invasive and may recur after incomplete excision
33
Q

Intraductal papillomas

A
  • being tumors of the main lactiferous ducts
  • can be easily torn away and lead to bleeding from nipple
34
Q

The most common malignant tumor

A
  • breast cancer
  • second most common cause of cancer mortality in women
35
Q

Risk factors for breast cancer ?

A

Aging
family history X2-9
Menstrual history X2
Nulliparity X 3
Proliferative breast disease and hyperplasia X2
Atypical hyperplasia - X4
Carcinoma In situ - X8
Carcinoma of contralateral breast
Breast feeding
Geographic influence
Breast biopsies

36
Q

Most common locations for breast cancer

A

Upper outer quadrant - 50%
Central area - 20%
Others - 30%

37
Q

Classification or breast cancer

A

Site of origin
- Ductal (90%)
- lobular
- other
Based of invasion
- invasive
- non invasive

38
Q

Intraductal carcinoma

A
  • DCIS
  • pre-invasive form of breast carcinoma
  • mammography
  • most common form of newly diagnosed breast cancer
  • most ominous are comedo-carcinoma
39
Q

Lobular carcinoma in situ ?

A
  • pre-invasive form of lobular carcinoma
  • less common
  • lesion are often bilateral
  • LCIS should be taken
40
Q

Most Breast cancers are ?

A

Adenocarcinomas

41
Q

Histologic type of DCIS?

A

Comedo type
Micro papillary
Cribiform
Pagers disease

42
Q

Prognostic factors in breast carcinoma ?

A
  • Distant metastasis
  • Invasive carcinoma
  • Lymph node metastasis
  • tumor size
  • Locally advanced disease
  • Inflammatory carcinoma
  • macrometastasis
  • HER2/neu or HER2 receptors
  • Lymphobascualr invasion
  • proliferative rate
  • DNA content
  • Estrogen and progesterone receptors
43
Q

Most common breast lesions detected as densities are ?

A
  • Fibroadenoma
  • invasive carcinomas
  • cysts
44
Q

The most common malignancy associated with calcifications ?

A

DCIS
Benign calcifications
- Sclerosing adenomas
- hyalinized Fibroadenomas
- apocrine cysts

45
Q

Diagnostic methods for breast lesions

A

Mammography and ultrasound
- basis of screening
- less value in young women due to dense breast
- ultrasound is of value in young women
Fine-needle aspiration cytology
- needle inserted, cells aspirated and stained
- need adequate sample for diagnosis
Core biopsy
- when infufficient sample is obtained at FNA
- to obtain samples for markers studies
- follow up for recurrence
Frozen section
Core imprints

46
Q

Male breast cancer

A
  • palpable subareaolar mass, 2-3cm in diameter
  • nipple discharge is common
  • ulceration through the skin is common
  • dissemination follows same pattern in women (axillary lymph nodes)
  • prognosis is better in men than women when they are matched by stage
  • treated locally with mastectomy and axillary node dissection
  • papillary carcinomas are common
  • Estrogen receptor +Ve is more common in men (81%)
  • incidence of ER positive tumors does not increase with age unlike women
47
Q

Zuska disease ?

A
  • Periductal mastitis
  • seen in smokers
  • inverted nipple
48
Q

Which Brest lesion is associated with Tyoe 1 diabetes ?

A

Lymphocytic mastopathy

49
Q

Cord like induration of the breast is seen in?

A
  • Mondors disease
  • Thrombophlebitis of the superficial veins in the chest wall

Anatomic Pathology (12 decks)

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