The breast: Lasku Flashcards
Disorders of development (4)
- supernumerary nipple or breasts
- accessory axillary breast tissue
- congenital inversion of the nipples
- macromastia
supernumerary nipple or breast
persistence of epidermal thickening along the milk like
accessory axillary breast tissue
extension of the normal ductal system over the entire anterolateral chest wall and into the axillary fossa
congenital inversion of the nipples
occurs in women with large or pendulous breasts and frustrates attempts at nursing
macromastia
very large breasts that may cause severe back pain and disability
Acute mastitis definition
inflammation of the breast usually during the early weeks of nursing , because of development of cracks and fissures in the nipples
acute mastitis etiology
staph aureus or streptococcus
morphology of acute mastitis
unilateral
-localized area of acute inflammation that may progress to the formation of a single or multiple abscesses
is acute mastitis usually bilateral or unilateral
unilateral
when does acute mastitis usually occur
during the early weeks of nursing
Periductal mastitis clinical presentation
painful erythematous subareolar mass
can look like infectious process
90% of smokers
periductal mastitis pathogenesis
fistula is formed from under the nipple onto the skin at the edge of the areola
periductal mastitis morphology
keratinizing squamous epithelium extends into the nipple ducts and blocks them causing dilation and rupture of the ducts
possible complications in periductal mastitis
-secondary infections are common
- recurrences are common
Mammary duct ectasia incidence
multiparous women in their 5th or 6th decade
mammary duct ectasia clinical features
- poorly defined periareolar mass
-skin retraction
-thick and cheesy nipple secretion
-pain and erythma are uncommon
mammary duct ectasia pathogenesis
-dilatation of ducts,
-inspissation(thickening) of secretions
mammary duct ectasia morphology
periductal and interstitial granulomatous inflammation with lymphocytes, macrophages and plasma cells
what can cause Fat necrosis
the most common etiology is trauma, but can also occur with surgery and radiation therapy
Fat necrosis clinical presentation
tumoral masses that can stimulate carcinomas
Fat necrosis pathogenesis
adipose tissue becomes inflamed and necrotic
fat necrosis morphology
-areas of dystrophic calcification and saponification
-chronic inflammatory cells and lipid-filled macrophages
what does fat necrosis look like
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
Incidence of fibrocystic changes
- women ages 30-menopause
- most common disorder of the breast accounting for more than 50% of breast surgeries
Etiology of fibrocystic changes
- hormonal imbalances: excess estrogen, functioning ovarian tumors , progesterone deficiency in anovulatory women
what decreases the risk of developing fibrocystic changes
use of oral contraceptives
Morphology of fibrocystic changes
cysts, fibrosis, adenosis
Clinical features in fibrocystic changes
- pain, palpable lumps
-nipple discharge
-mammographic calcifications
does having fibrocystic changes increase your risk of developing cancer
they do not, as long as there are less than 4 layers present
how is fibrocystic changes diagnoses
fine needle biopsy or surgical removal clarifies the Dx
Epithelial hyperplasia definition
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
Epithelial hyperplasia morphology
lumen is filled with round and spindle cells taht obliterate it, but irregular lumens (fenestrations) are peripherally located
atypia may be presnt
Atypical ductal hyperplasia
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
atypical lobular hyperplasia
proliferation of acinar cells that can extend to the ducts increasing the risk of developing invasive carcinoma
is there an increased risk of developing carcinoma with atypical ductal epithelial hyperplasia
5x normal increased risk of breast cancer carcinoma
Sclerosing adenosis definition and pathogenesis
increased in distorted or compressed acini
-proliferation of small ducts and fibrous stroma
sclerosing adenosis may resemble what?
it may mimic carcinoma
morphology of sclerosing adenosis
calfications or densities on mammography
Will there usually be a palpable mass in patient with sclerosing adenosis
palpable mass rarely present
Fibroadenoma Definition
Stromal tumor: proliferation of fibrous and glandular tissue form intralobular stroma
what is the most common bening tumor of the breast
fibroadenoma
Etiology of fibroadenoma
50% of women that received cyclosporin after renal translplant get this
Clinical presentation of fibroadenoma
-usually multiple and bilateral
-palpable mass in younge women
-mammographic density in older women
Morphology of fibroadenoma
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
what is the #1 cancer in women
breast cancer (lung being 2nd)
responsible for 44,000 deaths each yeah
Incidence of carcinoma of the breast
-rare before 25 years of age
-4th decade: 1 in 232
-7th decade : 1: 29
risk factors for developing carcinoma of the breast
-nulliparous
-delayed childbearing
-fhx
-uterine cancer
-whites
-early menarche
-late menopause
pathogenesis of carcinoma of the breast
- genetic factors
-hormonal influences : endogenous estrogen excess: functioning ovarian tumors that elaborate estrogen
environmental factors associated with breast cancer
-dietary fat
-alcohol
-radiation for hodgkins disease increases risk by 20-30%
-viruses
-organochlorine pesticides
-estrogen and progesterone> estrogen alone
Where is carcinoma of the breast most commonly found
UOQ (60% )
20% in subareolar region
which breast is carcinoma more commonly found?
left breast
where do breast carcinomas originate
all carcinomas are thought to arise from the terminal lobular unit
What mammographic findings would suggest breast cancer?
-calcifications
-densities
-architectural distortion
-changes over time
Clinical features in breast carcinoma
- 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
spread of breast carcinoma
-50% lymphatic axillary
-40% internal mammary artery
-hematogenous spread - lungs, bones, adrenals, liver, brain
What is the most important prognostic factor in breast carcinoma ?
axillary lymph node metastases
if four nodes are involved= poor prognosis
What gene involvement equals poor prognosis in breast carcinoma
HER2/neu= poor prognosis
Breast carcinoma genetics
HER2/neu (30%- worse prognosis)
BRCA1,2 (5%- hereditary)
Invasive ductal carcinoma
- 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.
morphology in invasive ductal carcinoma
-microcalcifications
-intraductal cribriform patter
-rapidly proliferating
-high grade malignant cells
Invasive lobular carcinoma
-5-10% of carcinomas
-bilateral multicentric within the same breast
pathogenesis of invasive lobular carcinoma
neoplastic cells in the terminal breast ducts and acini
morphology of invasive lobular carcinoma
“indian files” strands
possible complications in invasive lobular carcinoma
30% chance to develop in the other breast
Medullary carcinoma incidence
- 1-5% of all breast cancers
-occurs in younger women
Colloid/mucinous carcinoma incidence
-1-6 % of all carcinomas
-older women
Colloid carcinoma morphology
-abundant bluish mucin
-The carcinoma cells appear to be floating in the mucin.
-better prognosis
Tubular carcinoma
incidence and prognosis
-10% of all carcinomas less than 1cm in size
-tumors are multifocal or bilateral -excellent prognosis
Invasive papillary carcinoma
1% of all breast cancer
found in lactiferous ducts, accompanied with bleeding: better prognosis
Paget disease of the nipple
an uncommon variant of ductal carcinoma, either in situ or invasive that extends to involve the epidermis of the nipple and areola
Clinical features of paget disease of the nipple
-erythematous, scaly and weeping “eczema” that involves the nipple
morphology of paget disease of the nipple
epidermis contains clusters of ductal cell carcinoma, which are larger and have more abundant pale cytoplasm (paget cells) than the surrounding keratinocytes
