Witrak: Breast Diseases Flashcards
functional unit of breast
TDLU
layers of epithelium that line lobules and ducts
- luminal cell layer> milk production
2. myoepithelial layer> contractile fxn propels milk to nipple
hormones that affect breast tissue
estrogen and progesterone
happens to breast tissue during pregnancy
hyperplasia
bacterial infection of the breast that is usually caused by S. AUREUS and is assoc w/ breast feeding (micro-org enters through fissure)
acute mastitis
erythematous breast w/ purulent nipple discharge that can progress to abscess
acute mastitis
tx for acute masttis
drainage (continue feeding)
DICLOXACILLIN (can continue breast feeding while on this Abx)
breast tissue w/ NECROTIC fat, calcificaitons and GIANT CELLS
Fat necrosis d/t trauma
*see abnormal calcifications on mammography
MC benign neoplasm of BREAST
seen in women <35 (PRE-MW)
Fibroadenoma
tumor of fibrous tissue and glands
ESTROGEN sensitive> painful during menstruation and grows / preg
fibroadenoma
small
well circumscribed
mobile
firm mass
fibroadenoma
bloody nipple discharge
intraductal paipilloma
papillary growth in LARGE duct made up of TWO cell layers
beneath areola
in PRE-MW
intraductal papilloma
can intraductal papilloma increase your risk of carcinoma?
yes!
it’s impt to distinguish intraductal papilloma from…
papillary carcinoma
DOES NOT have myoepithelial layer
overgrowth of fibrous component of breast tissue that leads to “leaf like” projections
occurs in POST-MW
phyllodes tumor
can a phyllodes tumor become malignant?
YES
greater chance of this since it occurs in POST MW
MC cancer in women in US
and 2nd MCC of cancer motrality in women
breast cancer
breast cancer MC affects
POST MW
is it possible to have DCIS and fibrocystic changes at the same time in malignant breast tumors?
YES!
most important prognostic factor for malignant breast tumor
axillary LN involvement–>indicates metastases
MC location of breast cancer
upper OUTER quadrant
medial metastases of cancer goes to what LNs
INTRAthoracic LN chain
breast cancer likes to metastasize to…
bone
lung
skin
CNS
1st degree relative w/ breast cancer
maternal and paternal family hx
both are RF for breast canacer
malignant proliferation of DUCT cells w/ NO INVASION of BM
DCIS
what does DCIS arise from and what is often seen on mammography?
ductal atypia> malignant proliferation of duct cells> DCIS
microcalcifications
Does DCIS usually produce a mass?
NOOOO
2 subtypes of DCIS
comedocarcinoma
paget disease
ductal atypia>
CENTRAL calcification of dead cells>
ductal CASEOUS NECROSIS
comedocarcinoma
underlying DCIS that spreads to involve the skin of the nipple
Paget disease
eczematous patches on nipple
paget disease
large clear cells in epidermis w/ CLEAR halo
Paget disease
MC type of invasive carcinoma in the breast
ICIS
peau d’ orange
inflammatory IDCIS> POOR prognosis
fleshy cellular IDCIS
Medullary
GOOD prognosis
firm fibrous rock hard mass sharp margins \+ small, glandular, duct like cells
Invasive DCIS
stellate infiltration
IDCIS
malignant proliferation of cells in LOBULES w/ NO invasion of BM
LCIS
dyscohesive cells that lack E Cadherin adhesion proprotein
LCIS
often forms bilaterally
multiple lesions int eh SMAE location
does NOT produce a mass or calcifications
LCIS
tx for LCIS
tamoxifen
orderly row of “indian file cells” d/t decrased cadherin expression
bilateral
multiple
Invasive lobular carcionoma
90% of the time a lump is…
benign
clinically can detect lumps
> 2 cm
mammographically dectect masses
<1 cm
results in dimpling of skin/retraction
advanced tumors
detects cancers MUCH earlier than palpation
Mammogarphy
recommended for HIGH risk women
MRI
why is it more difficult to screen young women w/ mammography
increase in fibrous stroma
gold standard dx for breast cancer that defines the EXACT NATURE of abnormality (palpable/mammorgaram)
OPEN SURGICAL BIOPSY
current standard 1st Bx procedure
sterotactic needle core bresat biopsy
used to confirm clinically benign cyst or obvious cancer
FNA
tx for DCIS
lumpectomy
+/- radiation
can lead to lymphadema nad increase risk of angiosarcoma
removing axillary LN
tumor < 2 cm
AN negative
stage I
tumor >2cm
OR
+ but IPSILATERAL mobile axillary nodes
stage II
extensive axillary nodal disease
supraclavicular node involvement
inflammatory breast cancer
stage III
metastatic breast cancer
stage IV
in the past was only used for advanced/recurrent cancer, or pts w/ distant mets
NOW used for in situ, early invasive in conjunction w/ lumpectomy
radiation
herceptin
targets overexpressing Her 2 neu recetpors
*oncogene targeting therapy
why is early detection of BC crucial
> 1cm have high likelihood of CURE
why don’t we do masectomies much anymore
lumpectomy alone has basically the SAME results as a total masectomy
asssoc w/ male breast cancer:
subareolar mass + nipple discharge
BRCA2 mut
klinefelter syndrome
