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JL Reproduction and Sexual Health > Week 7 part 1 > Flashcards

Week 7 part 1 Flashcards

1
Q

In the basic structure of the non-lactating breast what is secretory tissue made up from?

A

15-25 lobules each consisting of a compound tubulo-acinar gland which drains via a series of ducts leading to nipple

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2
Q

What structure system of the mammary gland is described: terminal ductules lead into an intralobular collecting duct which leads into the lactiferous duct for that lobe. The lactiferous duct leads to the nipple, passing through an expanded duct region near the nipple termed the lactiferous sinus?

A

Duct system

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3
Q

What cells in the mammary gland stain brown for actin and have contractile filaments

A

Myoepithelial cells

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4
Q

What covers the nipple?

A

Highly pigmented keratinised stratified squamous epithelium

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5
Q

What is in the nipple core?

A

Dense irregular connective tissue mixed with bundles of smooth muscle - severeal lactiferous sinuses can be seen

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6
Q

What lines the lactierous duct?

A

As it approaches surface - stratified squamous epithelium

deeper - lined with stratified cuboidal epithelium

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7
Q

During the luiteal phase of menstrual cycle what happens to epithelial cells and ducts in breast?

A

Epithelial cells increase in height, lumina of ducts becomes enlarged and small amounts of secretion appear in ducts

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8
Q

What trimester of pregnancy has these breast changes: glandular tissue continues to develop with differentiation of secretory alveoli. Also, plasma cells and lymphocytes infiltrate the nearby connective tissue.

A

Second

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9
Q

What trimester in pregnancy has these changes in breast: there is elongation and branching of the smaller ducts, combined with proliferation of the epithelial cells of the glands and the myoepithelial cells.

A

First

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10
Q

What trimester has these changes: secretory alveoli continue to mature, with development of extensive rER.

A

Third

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11
Q

In pregnancy oestrogen and progesterone stimulate proliferation of what tissue?

A

Secretory. Fibrofatty becomes sparse

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12
Q

What four components make up human milk?

A
  1. 88% water
  2. 1.5% protein
  3. 7% Carbohydrate
  4. 3.5% lipid

With small quantities of ions, vitamins and IgA

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13
Q

How are lipid droplets in human milk secreted?

A

Apocrine secretion - bud off carrying small amount of cytoplasm with it

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14
Q

How are proteins in milk secreted?

A

Merocrine secretion - secreted in vesicles which merge with apical membrane to release onkly their contents into duct sustem

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15
Q

following menopause what happens to the secretory cells of the terminal ductal lobule unit?

A

Degenerate leaving only ducts

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16
Q

Four methods of breast cytopathology?

A
  1. FNA
  2. Fluid
  3. Nipple discharge
  4. Nipple scrape
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17
Q

In breast FNA cytology - what is atypia, probably benign?

A

C3

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18
Q

In breast FNA cytology what is maligannt?

A

C5

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19
Q

In needle core biopsy, what is benign?

A

B2

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20
Q

In needle core biopsy, what is suspicious of malignmancy

A

B4

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21
Q

In needle core biopsy, what is B5?

A

mAlignant - B5b invasice, a is carcinoma in situ

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22
Q

What is the term for ductal growth without lobular development in males?

A

Gynaecomastia - caused by liver disease, cannabis, drugs and steroids

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23
Q

What benign breast condition affects women 20-50, very common, has menstrual abnormaltiies, early menarche, late menopause and often resolves after menopause?

A

Fibrocystic change

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24
Q

What benign breast condition: smooth discrete lumps, sudden pain, cyclical pain, lumpiness, incidental finding on screening?

A

Fibrocystic change

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25
Q

What gross pathology does fibrocystic change show?

A

Cysts blue domed with pale fluid

microscopically lined by apocrine epithelium

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26
Q

Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution

A

Hamartoma

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27
Q

What woen is fibroademoma commoner in?

A

Africans

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28
Q

What benign breast lesions has peak incidence 3rd decade, painless, firm, discrete, mobile mass which is solid on ultrasound?

A

Fibroadenoma

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29
Q

Breast mouse

A

Fibroadenoma - rubbery, grey-white colour, biphasic tumour

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30
Q

Age 20-70, asymptomatic, pain, tenderness or lumpiness/thickening?

A

Sclerosing adenosis

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31
Q

Stellate architecture, central puckering, radiating fibrosis?

A

Radial scar

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32
Q

On histology what is seen with a radial scar?

A

Fibroelastotic core
Radiating fibrosis containing distorted ductules
Fibrocystic change
Epithelial proliferation

33
Q

What can cause fat necrosis?

A

Local trauma - seat belt injury

Warfarin therapy

34
Q

Damage and disruption of adipocytes, infiltration by acute inflammatory cells, “foamy” macrophages, subseuent fibrosis and scarring?

A

Fat necrosis of breast

35
Q 
Affects sub-areolar ducts
Pain
Acute episodic inflammatory changes
Bloody and/or purulent discharge
Fistulation
Nipple retraction and distortion
A

Duct ectasia

36
Q

What is duct ectasia associated with?

A

Smoking

37
Q

In acute mastitis/abscess what are the two causes related to duct ectasia?

A

Mixed organisms

Anaerobes

38
Q

In acute mastitis/abscess what are the two causes related to lactqtion?

A

Staph auresus

Strep pyogenes

39
Q

40-50 years

Slow growing unilateral breast mass?

A

Phyllodes tumour

40
Q 
Age 35-60
Nipple discharge +/- blood
Asymptomatic at screening
Nodules
calcification
Papillary fronds containing a fibrovascular core
covered by myoepithelium and epithelium
Epithelium may show proliferative activity
A

Intraduct papilloma

41
Q

What miscellaneous malignant breast tumour comes post radiotherapy?

A

Angiosarcoma

42
Q

Name three carcinomas that metastasise to breast?

A

Bronchial
Ovarian serous carcinoma
Clear cell carcinoma of kidney

43
Q

What is the definition of breats carcinoma?

A

A malignant tumour of breast epithelial cells

44
Q

Where does a breast carcinoma arise?

A

In the glandular epithelium of the terminal duct lobular unit

45
Q

In relation to breast pathology what are precursor lesions?

A

Epithelial proliferations

46
Q

Intra-lobular proliferation of characteristic cells.
Small-intermediate sized nuclei
Solid proliferation
Intra-cytoplasmic lumens/vacuoles
ER positive
E-cadherin negative (deletion & mutation of CDH1 gene on Chr 16q22.1)

A

Lobular in situ neoplasia

47
Q

15-20% of breast malignancies are DCIS (formerly 5%)
Arises in TDLU
Characteristically unicentric (single duct system)

A

Ductal carcinoma in situ

48
Q

What might involve nipple skin (Pagets disease?

A

Ductal carcinoma in situ

49
Q

High grade DCIS extending along ducts to reach the epidermis of the nipple
Still in situ carcinoma (ie non-invasive)

A

Pagets disease of the nipple

50
Q

What is an invasive breast carcinoma?

A

Malignant epithelial cells that have breached the basement membrane

51
Q

What are the risk factors for breast cancer?

A

Age
Age of menarche, use of OCP, parity, breast feeding, menopause, HRT
Diet, smoking, BMI, alcohol
Genetics

52
Q

What is the commonest female cancer?

A

Invasive breast cancer

1 in 8 will develop it

53
Q

Classification of Invasive Breast Carcinoma: most common types/

A

Ductal

Lobular

54
Q

What are the predictive and prognostic factors for invasive carcinoma?

A

ER (PgR) - estrogen receptor

HER 2

55
Q

Symptoms of breast cancer?

A
  1. Dimled or depressed nipple
  2. Visible lump
  3. Nipple change ex. inversion
  4. Bloody discharge
  5. Texture change
  6. Colour change
56
Q

What is the most common benign neoplasm of the breast?

A

Fibroadenoma

57
Q

When are fibroadenimas usually diagnosed?

A

Early reproductive years- usually with ultrasound core biopsy

58
Q

rubbery to firm, mobile, smooth with distinct borders, and is usually nontender.

A

Fibroadenoma

59
Q

What resembles a fibroadenoma?

A

Phyllodes tumour - often larger 3-6cm, 35-45 y/o

60
Q

When do breast cysts occur?

A

Late reproductive years

61
Q

When are breast cysts most tender?

A

before menstruation

62
Q

How do you diagnose and treat a cyst?

A

FNA

63
Q

wHAT Can sometimes occur within a cyst and is often associated with bloody cyst fluid?

A

A benign intracystic papillary proliferation called a papilloma

64
Q

How is normal nipple discharge described?

A

Clear, yellow and watery

65
Q

What can present as an erythematous weeping lesion on the surface of the nipple and aerola?

A

Pagets disease of nipple

66
Q

What can present as a flocculent sometimes bulging mass in central area of mastitis?

A

Breast abscess

67
Q

If there is a breast mass under 40 years old what imaging is done?

A

Ultrasound

68
Q

If there is a breast mass over 40 years old what imaging is done?

A

Mammography and ultrasound

69
Q

On mammography: what is the best single view?

A

Mediolateral oblique

70
Q

In relation to malignant calcification features: what is the distribution like to hint suspicious?

A

Cluster or segmental

If scattered or diffuse most likely benign

71
Q

In relation to malignant calcification features on mammogram: what form of cluster shape is suspicous?

A

Rhomboid forms

72
Q

Common in women under the age of 30 years

Often described as ‘breast mice’ due as they are discrete, non-tender, highly mobile lumps

A

fibroadenoma

73
Q

More common in obese women with large breasts
May follow trivial or unnoticed trauma
Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump
Rare and may mimic breast cancer so further investigation is always warranted

A

fat necrosis

74
Q

Stimulates breast development (both initially and further hyperplasia during pregnancy)
Stimulates milk productio

It decreases GnRH pulsatility at the hypothalamic level and to a lesser extent, blocks the action of LH on the ovary or testis.

A

prolactin

75
Q

Stimulates the lactiferous duct system to grow at puberty

A

oestrogen

76
Q

Stimulates the mammary glands to produce milk

A

prolactin

77
Q

The most common histological type of breast cancer is,

A

invasie ductal cancer

78
Q

extensive microcalcifications in the inner quadrant of her left breast.

A

ductal carcinoma in situ

JL Reproduction and Sexual Health (18 decks)

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