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Q5 GNMD > The breast: Lasku > Flashcards

The breast: Lasku Flashcards

1
Q

Disorders of development (4)

A
  1. supernumerary nipple or breasts
  2. accessory axillary breast tissue
  3. congenital inversion of the nipples
  4. macromastia
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2
Q

supernumerary nipple or breast

A

persistence of epidermal thickening along the milk like

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3
Q

accessory axillary breast tissue

A

extension of the normal ductal system over the entire anterolateral chest wall and into the axillary fossa

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4
Q

congenital inversion of the nipples

A

occurs in women with large or pendulous breasts and frustrates attempts at nursing

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5
Q

macromastia

A

very large breasts that may cause severe back pain and disability

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6
Q

Acute mastitis definition

A

inflammation of the breast usually during the early weeks of nursing , because of development of cracks and fissures in the nipples

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7
Q

acute mastitis etiology

A

staph aureus or streptococcus

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8
Q

morphology of acute mastitis

A

unilateral
-localized area of acute inflammation that may progress to the formation of a single or multiple abscesses

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9
Q

is acute mastitis usually bilateral or unilateral

A

unilateral

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10
Q

when does acute mastitis usually occur

A

during the early weeks of nursing

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11
Q

Periductal mastitis clinical presentation

A

painful erythematous subareolar mass

can look like infectious process

90% of smokers

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12
Q

periductal mastitis pathogenesis

A

fistula is formed from under the nipple onto the skin at the edge of the areola

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13
Q

periductal mastitis morphology

A

keratinizing squamous epithelium extends into the nipple ducts and blocks them causing dilation and rupture of the ducts

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14
Q

possible complications in periductal mastitis

A

-secondary infections are common
- recurrences are common

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15
Q

Mammary duct ectasia incidence

A

multiparous women in their 5th or 6th decade

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16
Q

mammary duct ectasia clinical features

A
  • poorly defined periareolar mass
    -skin retraction
    -thick and cheesy nipple secretion
    -pain and erythma are uncommon
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17
Q

mammary duct ectasia pathogenesis

A

-dilatation of ducts,
-inspissation(thickening) of secretions

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18
Q

mammary duct ectasia morphology

A

periductal and interstitial granulomatous inflammation with lymphocytes, macrophages and plasma cells

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19
Q

what can cause Fat necrosis

A

the most common etiology is trauma, but can also occur with surgery and radiation therapy

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20
Q

Fat necrosis clinical presentation

A

tumoral masses that can stimulate carcinomas

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21
Q

Fat necrosis pathogenesis

A

adipose tissue becomes inflamed and necrotic

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22
Q

fat necrosis morphology

A

-areas of dystrophic calcification and saponification
-chronic inflammatory cells and lipid-filled macrophages

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23
Q

what does fat necrosis look like

A

it can be a localized, firm area with scarring that can mimic a breast carcinoma

-some lipid-laden macrophages are seen between the necrotic adipose tissue cells

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24
Q

Incidence of fibrocystic changes

A
  • women ages 30-menopause
  • most common disorder of the breast accounting for more than 50% of breast surgeries
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25
Q

Etiology of fibrocystic changes

A
  • hormonal imbalances: excess estrogen, functioning ovarian tumors , progesterone deficiency in anovulatory women
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26
Q

what decreases the risk of developing fibrocystic changes

A

use of oral contraceptives

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27
Q

Morphology of fibrocystic changes

A

cysts, fibrosis, adenosis

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28
Q

Clinical features in fibrocystic changes

A
  • pain, palpable lumps
    -nipple discharge
    -mammographic calcifications
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29
Q

does having fibrocystic changes increase your risk of developing cancer

A

they do not, as long as there are less than 4 layers present

30
Q

how is fibrocystic changes diagnoses

A

fine needle biopsy or surgical removal clarifies the Dx

31
Q

Epithelial hyperplasia definition

A

a increase in the layers of the myoepithelial and epithelial cells (normally 2) above the basement membrane of the ducts.

-if 4 layers are present, there is increased risk of developing carcinoma

32
Q

Epithelial hyperplasia morphology

A

lumen is filled with round and spindle cells taht obliterate it, but irregular lumens (fenestrations) are peripherally located

atypia may be presnt

33
Q

Atypical ductal hyperplasia

A

intraductal cell population is homogenous and fenestrations are regular shape and evenly spaced.

as long as cellular invasion does not occur, there is no cancer diagnosis

34
Q

atypical lobular hyperplasia

A

proliferation of acinar cells that can extend to the ducts increasing the risk of developing invasive carcinoma

35
Q

is there an increased risk of developing carcinoma with atypical ductal epithelial hyperplasia

A

5x normal increased risk of breast cancer carcinoma

36
Q

Sclerosing adenosis definition and pathogenesis

A

increased in distorted or compressed acini

-proliferation of small ducts and fibrous stroma

37
Q

sclerosing adenosis may resemble what?

A

it may mimic carcinoma

38
Q

morphology of sclerosing adenosis

A

calfications or densities on mammography

39
Q

Will there usually be a palpable mass in patient with sclerosing adenosis

A

palpable mass rarely present

40
Q

Fibroadenoma Definition

A

Stromal tumor: proliferation of fibrous and glandular tissue form intralobular stroma

41
Q

what is the most common bening tumor of the breast

A

fibroadenoma

42
Q

Etiology of fibroadenoma

A

50% of women that received cyclosporin after renal translplant get this

43
Q

Clinical presentation of fibroadenoma

A

-usually multiple and bilateral
-palpable mass in younge women
-mammographic density in older women

44
Q

Morphology of fibroadenoma

A

sharply circumscribed
free moveable 2-4 cm
fibrous capsule (presence of the capsule tells us its bening)
calcification
hormonally responsive
fibroblastic stroma and enlongated compressed ducts

45
Q

what is the #1 cancer in women

A

breast cancer (lung being 2nd)

responsible for 44,000 deaths each yeah

46
Q

Incidence of carcinoma of the breast

A

-rare before 25 years of age
-4th decade: 1 in 232
-7th decade : 1: 29

47
Q

risk factors for developing carcinoma of the breast

A

-nulliparous
-delayed childbearing
-fhx
-uterine cancer
-whites
-early menarche
-late menopause

48
Q

pathogenesis of carcinoma of the breast

A
  • genetic factors
    -hormonal influences : endogenous estrogen excess: functioning ovarian tumors that elaborate estrogen
49
Q

environmental factors associated with breast cancer

A

-dietary fat
-alcohol
-radiation for hodgkins disease increases risk by 20-30%
-viruses
-organochlorine pesticides
-estrogen and progesterone> estrogen alone

50
Q

Where is carcinoma of the breast most commonly found

A

UOQ (60% )

20% in subareolar region

51
Q

which breast is carcinoma more commonly found?

A

left breast

52
Q

where do breast carcinomas originate

A

all carcinomas are thought to arise from the terminal lobular unit

53
Q

What mammographic findings would suggest breast cancer?

A

-calcifications
-densities
-architectural distortion
-changes over time

54
Q

Clinical features in breast carcinoma

A
  • pain (not always)
    -lump (always)
    -dimpling of the skin
    -retraction of the nipple
    -nipple discharge
    -lymphedema
    -thick skin (pau d’orange)
    -axillary changes
    -inflammatory carcinoma: not a good prognosis . lesion that never heals
55
Q

spread of breast carcinoma

A

-50% lymphatic axillary
-40% internal mammary artery
-hematogenous spread - lungs, bones, adrenals, liver, brain

56
Q

What is the most important prognostic factor in breast carcinoma ?

A

axillary lymph node metastases

if four nodes are involved= poor prognosis

57
Q

What gene involvement equals poor prognosis in breast carcinoma

A

HER2/neu= poor prognosis

58
Q

Breast carcinoma genetics

A

HER2/neu (30%- worse prognosis)

BRCA1,2 (5%- hereditary)

59
Q

Invasive ductal carcinoma

A
  • 70-80% of all carcinomas
    -neoplastic cells in ducts can infeltrate into stroma

picture: The center is very firm (scirrhous) and white because of the desmoplasia.

60
Q

morphology in invasive ductal carcinoma

A

-microcalcifications
-intraductal cribriform patter
-rapidly proliferating
-high grade malignant cells

61
Q

Invasive lobular carcinoma

A

-5-10% of carcinomas
-bilateral multicentric within the same breast

62
Q

pathogenesis of invasive lobular carcinoma

A

neoplastic cells in the terminal breast ducts and acini

63
Q

morphology of invasive lobular carcinoma

A

“indian files” strands

64
Q

possible complications in invasive lobular carcinoma

A

30% chance to develop in the other breast

65
Q

Medullary carcinoma incidence

A
  • 1-5% of all breast cancers
    -occurs in younger women
66
Q

Colloid/mucinous carcinoma incidence

A

-1-6 % of all carcinomas
-older women

67
Q

Colloid carcinoma morphology

A

-abundant bluish mucin
-The carcinoma cells appear to be floating in the mucin.
-better prognosis

68
Q

Tubular carcinoma

incidence and prognosis

A

-10% of all carcinomas less than 1cm in size

-tumors are multifocal or bilateral -excellent prognosis

69
Q

Invasive papillary carcinoma

A

1% of all breast cancer

found in lactiferous ducts, accompanied with bleeding: better prognosis

70
Q

Paget disease of the nipple

A

an uncommon variant of ductal carcinoma, either in situ or invasive that extends to involve the epidermis of the nipple and areola

71
Q

Clinical features of paget disease of the nipple

A

-erythematous, scaly and weeping “eczema” that involves the nipple

72
Q

morphology of paget disease of the nipple

A

epidermis contains clusters of ductal cell carcinoma, which are larger and have more abundant pale cytoplasm (paget cells) than the surrounding keratinocytes

Q5 GNMD (15 decks)

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