Weibliche Geschlechtsorgane - Breast Flashcards
Fibrocystic changes
- What are the subtypes of Fibrocystic changes?
- What is the most common subtype of Fibrocystic changes?
- nonproliferative and proliferative pattern
2. nonproliferative changes
Fibrocystic changes
- How common are cyst formation and fibrosis in the breast?
- When do they occur?
- How does estrogen and oral contraceptives affect fibrocystic
changes?
- the most common breast abnormality seen in premenopausal
women - Fibrocystic changes tend to arise during reproductive age
and are most likely a consequence of the cystic breast changes
that occur normally in the menstrual cycle - They do not increase the incidence! However, oral
contraceptives may, in fact, decrease the risk
Fibrocystic changes - nonproliferative changes
- Name the characteristics of nonproliferative changes!
- What does a cyst contain?
1.
- increased fibrous stroma
- dilatated ducts
- 1-5 cm in diameter cysts
- unopened cysts are brown to blue -> blue dome cysts
-> they are filled with watery, turbid/trüb fluid
The sexretions within the cysts may calcify
(On mammograms-> microcalcifications)
Fibrocystic changes - nonproliferative changes
- What do you see histological?
1.
- A epithelial lining that in larger cysts may be flattened
(abgeflacht) or totally atrophic
- the lining cells are frequently large and polygonal with
granular and eosinophilic cytoplasma and small, round, deeply
chromatic nuclei -> apocrine metaplasia (always benign)
Fibrocystic changes - Proliferative Change
- What layers do normal ducts and lobules have?
- Ducts and lobules of the breast have two layers:
- a layer of luminal cells
- which are overlying a second layer of myoepithelial cells
Fibrocystic changes - Proliferative Change
- Epithelial Hyperplasia-
1. What characterizes epithelial hyperplasia?
- The presence of more than two cell layers.
-> the hyperplasia may consists of mild and orderly
or atypical hyperplasiaStill the epithelial hyperplasia contains cysts and fibrous
changes
Fibrocystic changes - Proliferative Change
- Epithelial Hyperplasia-
1. How does an epithelial hyperplasia looks like histologically?
1.
- The ducts, ductules, or lobules may be filled with orderly
cuboidal cells within which small gland patterns (called
fenestrations) can be discerned.
-> the lumen is filled with cells of different morphology.
irregular slitlike fenestrations are prominent at the periphery
- Sometimes, the proliferating epithelium projects as multiple
small papillary excrescences into the ductal lumen
-> ductal papillomatosis - Occasionally hyperplasia produces microcalcifications on
mammography
Fibrocystic changes - Proliferative Change
- Epithelial Hyperplasia-
1. What type of Epithelial hyperplasia is not so good?
- Atypical ductal and lobular hyperplasia
-> They are associated with an increased risk of invasive
carcinoma
Fibrocystic changes - Proliferative Change
- Sclerosing Adenosis-
1. Why are sclerosing adenosis so important?
2. What is it?
- Even when they are rare, they are important because they
mimic clinical and morphological features of carcinoma
2. Sclerosing adenosis (SA) is a benign (non-cancerous) condition of the breast in which extra tissue develops within the breast lobules (the small portions of the glands that can produce milk.
Sclerosing adenosis often presents as a proliferation of elongated, obliterated, or distorted glands and tubules, in addition to hardening of surrounding collagen and stroma tissue.
Fibrocystic changes - Proliferative Change
- Sclerosing Adenosis-
1. How is the consistency of sclerosing adenosis?
2. What does the histologic view offer?
- Similary to breast cancer -> hard, rubbery consistency
- A characteristic proliferation of luminal spaces (adenosis)
lined by epithelial cells and myoepithelial cellsMarked stromal fibrosis, which may compress and distort the
proliferation epithelium, is always associated with the
Adenosis -> sclerosing adenosisThis overgrowth of fibrous tissue may completely compress the
lumina of the acini and ducts, so that they appear as solid
cords of cells- a pattern that is difficult to distinguish
histologically from invasive ductal carcinomaThey is a double layer of epithelium and myopeithelial elements
Fibrocystic changes - Proliferative Change
- What increases the risk of breast cancer?
1.
Significantly increased risk:
- atypical hyperplasia (ductal or lobular hyperplasia)
Slightly increased risk:
- Moderate to florid hyperplasia (without atypia)
- ductal papillomatosis
- sclerosing adenosis
Inflammatory processes
- Name the possible inflammatory processes
of the breast!
1.
- mastitis
- traumatic fat necrosis
Inflammatory processes
- explain the pathogenesis of acute mastitis!
- What are the clinical symptoms?
- What do you see histologically?
1.
- bacteria, almost always staphylococcus areus, reaches the
breast tissue through the ducts or through cracks (Riss) on the
nipple
- The vast majority of cases arise during the early weeks of
nursing (stillen)
2.
- Pain
- Rubor (redding)
- Fiever
- early axilliar lymph node swelling
- inflammatory changes and abscesses may develope
3.
- a prominent lymphoplasmacytic infiltrate
- occasional granulomas in the periductyl strima
- the ducts are filled with granular debris and sometimes
leucocytes and lipid-laden macrophages
Inflammatory processes
- fat necrosis is a possible inflammatory disease of the breast.
How does it look in early and in advanced state?
- fat necrosis commonly after trauma!
Early stage:
- small lesion
- sharply localized
- central focus of necrotic fat cells
-> surrounded by neutrophils and lipid-laden macrophages
and sometimes giant cells
Later:
- the lesion becomes enclosed by fibrous tissue and
mononuclear leukocytes
- and eventually replaced by scar tissue or a cyst consisting of
necrotic debris
- calicification may develop in the scar or the cysr wall
Tumors of the breast - Benign tumors
Fibroadenoma
- How frequently does the fribroadenoma occur?
- What tissue does the fibroadenoma have?
- Does the tumor occur solitary or multiple?
- It is the most frequent benign neoplasm of the femal breast
1/3 of all young women are affected - This tumor is biphasic, by an percentage of 97%. It contains:
- epithelium-lined glands (drüsiger Anteil->epithelial, Adenom)
- fibroblastic stroma -> only the stroma cells are truly neoplastic!
(Mesenchymal, Fibrom) - mostly solitary, just 10% multiple
Tumors of the breast - Benign tumors
Fibroadenoma
- When does it occure (age)?
- How is the consistency of the tumor?
- young women are affected: 20-35 years of age
- sharply seperated
- mobile
- hart
- not painfully!!!
Tumors of the breast - Benign tumors
Fibroadenoma
- What supports the growing rate of the fibroadenoma?
- What shrinks the fibroadenoma?
- What shrinks the fibroadenoma?
1.
- pregnancy!!!
- late menstrual cycle!
- > the growth is stimulated by estrogen
2. The fibroadenoma may regress (zurückentwickeln) and calcify
after menopuase (postmenopausal)
Tumors of the breast - Benign tumors
Intraductal Papilloma
Wie der Name schon sagt: papillomatöse Milchgangepithelwucherung (gefäßführendes Bindegewebe, mit Epithel überzogen)- also intraductal gelegen oder in Zysten
- What are the clinical symptoms?
1.
- serous nipple discharge(Absonderung)
- or bloody nipple discharge
- In rare instances: nipple retraction (Zurücknahme)
Carcinoma
- Name the risk factors of breast cancer?
1.
- risk increases after age 30
- Family history
- early menarche < 12
- late menopause > 1,5-2,0
- late pregnancy or nulliparous
- benign breast disease: with and without atypia hyperplasia
Other factors
- obesity
- oral contraceptives - maybe, maybe not
- Alcohol
- Cigarette
- Exogenous estrogen like homone replacement therapy
Carcinoma
- Name the genetic changes!
1.
- Overexpression of the HER2/NEU proto-oncogen
- Amplification of RAS and MYC genes
- Mutation in BRCA I or BRCA 2
- Estrogen Rezeptor (ER)-positive or negative
- Progesteron Rezeptor (PgR)- positive or negative
Carcinoma
- Describe the HER2/NEU proto-oncogene?
1.
- this mutation occurs in 30% of invasive breast cancer
- this gene is member of the epidermal growth factor receptor
family
Carcinoma
- Describe the BRCA I and BRCA 2 genes!
1.
- 1/3 of women with hereditary breast cancer have these mutations
- they are classic tumor supressor genes
- cancer arises only when both alleles are inactivated
- these gens are believed to function in a common DNA repair pathway
Carcinoma
- Why is estrogen causing breast cancer?
1.
Estrogen stimulates the production of growth factors, such as transforming growth factor-Alpha or fibroblast growth factor
–> these may promote tumor development through paracrine and autocrine mechanisms
Cancer
- Name factors which increase estrogen?
Increased Exposure to Estrogen due:
- long duration of reproductive life
- nulliparity
- late age at birth
- ovarian tumors!!
Cancer
What are the two major categories of breast cancer?
Breast cancers are classified according to wether they have or have not penetrated the limiting basement membrane:
Those that remain within this boundary are termed in situ carcinomas, and those that have spread beyond it are designated invasive or infiltrating carcinomas.
Thus:
- Noninvasive
- Invasive (Infiltrating)
Cancer
Name all Noninvasive carcinomas!
- Ductal carcinoma in situ (DCIS)
- Lobular carcinoma in situ (LCIS)
