Topic 87-89: pregnancy, breast Flashcards
what are the 4 pathologies of pregnancy that you should be aware of?
- placental inflammation and infection
- ectopic pregnancy
- gestational trophoblastic disease
- pre-eclampsia/eclampsia
placental infections/inflammation occur through two routes: what are they? what happens? what is causing the inflma?
- ascending through birth canal - most common mode of placental infection, typically bacterial infection causing a WBC infiltration which may reach to the umbilical cord and placental villi, causing vasculitis of the umbilical cord. Candida and other vaginal bacterial flora could cause this
- hematogenous- occurs rarely, most often causing villitis. typically viral
ectopic pregnancy are how common? what is the most common site of implantation? why does ectopic pregnancy occur?how do ovarian and abdominal cavity pregnancies occur?
-1% of pregnancies, more than 90% of which occur in the oviducts.
anything that slows the eggs movement along the oviduct will induce ectopic pregnancies such as chronic inflam, tumors, or endometriosis
- ovarian pregnancies occur just as the egg pops out of the follicle
- abdominal pregnancies occur when the fertilized egg drops out of the fimbriated end of the oviduct and implants on the peritoneum
what is gestational trophoblastic disease? what are the 4 conditions associated with GTD? what is a common feature of all conditions?
-GTD is a group of pregnancy related disorders that arise from trophoblasts
- hydatidiform moles (partial and complete)
- invasive mole
- choriocarcinoma
all conditions lead to a increase in human chorionic gonadotropin in the blood
what is a hydatidiform mole? what is the difference between partial and complete mole?
a hydatidiform mole is a mass of chorionic villi tissue that originates from the fertilization of an egg with two sperm. the mass is totally benign
- complete mole is when an empty egg is fertilized by two sperm = 2n cells (totally paternal) with no embryogenesis possible
- partial mole is the fertilization of a normal egg with 2 sperm = 3n, mostly paternal, some embryogenesis possible thus it contains fetal parts.
what is an invasive mole? what does it do? can it metastasize?
what is a choriocarcinoma? what are the differences?
- invasive moles are complete moles that are locally invasive, penetrate the uterine wall and sometimes cause rupture or hemorrhage.
- they do not metastasize
- choriocarcinoma is not a mole, it is a malignant tumor that originates from gestational chorionic epithelium of either normal pregnancies, abortions or complete moles.
- it metastasizes widely in the blood with extreme aggressiveness. however with chemotherapy, there is 100% cure rate even if there are metastases in the lung!
what is eclampsia/preeclampsia? what conditions can it lead to? what are some events that may trigger the condition?
pre-eclampsia/eclampsia is the development of hypertension, proteinuria and edema in the third trimester. It can lead to seizures, DIC, and placental infarcts.
- Not totally understood but the basic feature is that the placental spiral arteries fail to properly develop and the placenta receives inadequate blood flow. this can eventually lead to infarction
- another development is that vasodilators are not produced by the trophoblasts as they should and thus hypertension is produced
Inflammation of the breast occurs in 3 different conditions: what are they?
- acute mastitis: inflammation of the beast due to bacteria that gain access to the breast tissue via the ducts. this can induce abscess formation
- mammary duct ectasia - a non bacterial inflammation that causes thickened breast secretions and ductal dilation/rupture.
- traumatic fat necrosis -due to trauma such as car accidents
fibrocystic changes in the breast are what? what are the two major categories?
they are a collection of changes in the breast that range from harmless to lesions that increase the risk of breast cancer. they can be palpable masses and occur with menstrual cycle changes
types
- nonproliferative patterns
- proliferative patterns
what is the difference between nonproliferative and proliferative fibrotic changes in the breast?
-nonproliferative patterns - cysts and fibrosis caused by an increase in fibrous stroma
- proliferative patterns
- -epithelial hyperplasia - a range of proliferating lesions in the ductal epithelium. can be mild or a high risk proliferative
–sclerosing adenosis - less common than cysts and hyperplasia,
fibrocystic changes and breast cancer have some relationship. How can you differentiate between the two with certainty? which one has no risk and which one is high risk?
- distinguishing factor is purely biopsy and histology
- minimal risk: fibrosis,cystic changes, fibroadenoma
- high risk: atypical hyperplasia, duct or lobular epithelial hyperplasia
what are the 4 neoplasma of the breast? describe them in origin, general morphology, prognosis. what are the risk factors for carcinoma?
- fibroadenoma - most common, solitary, rubbery, movable mass that enlarge with menstrual cycles/estrogen activity and never become malignant.
- phyllodes tumor - less common, lobulated or cystic with potential to be anaplastic, highly dividing, invasive and sometimes metastasize
- intraductal papilloma - intraductal papilloma is a benign epithelial tumor found in the lactiferous ducts or sinuses. when single, it is prob solitary but when multiple it can be malignant.
- carcinoma - 2nd cause of cancer death in women, related to risk factors: Diet/reproductive habits, age (over 40), genetics
- -less well established risk factors: estrogen, obesity, alcohol, smoking, radiation
in pathogenesis, genetic changes, hormones and environment seem to influence carcinogenesis the most
What are the genetic mutations associated with breast carcinoma? what are some of the hormonal influences?
Genetics related Breast cancer
- 50% of women with hereditary breast cancer have mutations in the BRCA1 genes
- 33% have mutations in the BRCA2 gene
pathogenesis of all breast cancer:
- 30% have overexpression of HER2/NEU proto oncogenes (suggests bad prognosis)
- mutations in RB and p53
- amplifications in RAS and MYC
hormone:
- estrogen stimulates the production of growth factors from breast epithelial cells
- ovarian tumors that produce estrogen are associated with breast cancer
- it is suggested that breast cancer may eventually create an autocrine mechanism for tumor development
what are the variables that determine the prognosis of breast cancer?
- size
- lymph node involvement
- distant metastases
- grade of the carcinoma
- histology
- presence or absence of estrogen receptors
- proliferation rate
- aneuploidy
- overexpression of HER2/NEU
what defines invasive vs noninvasive carcinoma? what are some examples of noninvasive and invasive types? what is the staging of breast cancer?
- invasiveness is whether or not it breaks the basement membrane.
- noninvasive:Ductal or lobular carcinoma in situ (DCIS, LCIS)
- invasive: invasive ductal and invasive lobular carcinoma, medullary, colloid, tubular carcinoma
stage 0: LCIS, DCIS
stage 1: small invasive type carcinoma, no nodal involvement
stage 2: larger with or without node involvement
stage 3: even larger with 4+ node involved, axillary nodes, skin
stage 4:any breast cancer with distant metastases
