A-Pathology Of The Breast

Front 1

Ducts and lobules contain what two types of cells?

Back 1

Epithelial and myoepithelial(myoepithelial is for contraction in milk ejection and is present when there is no invasion or malignancy)

Front 2

Compare young and postmenapausal breast:

Back 2

Young: well structured lobules and less fat

Post-meno: diminished glandular component and less fat

Front 3

Describe the inflammatory process that is initiated with the implantation of silicone breast implants:

Back 3

Fibrosis (from inflam response) -> capsule formation -> capsule contraction -> deformaty/rupture

Front 4

Describe the process of fat necrosis:

Back 4

1. caused by trauma (including radiation therapy)
2. Gross: early - hemorrhage and fibrotic changes
3. Gross: late - ill-defined nodule of gray and white firm tissue
4. Histology: Early - necrotic fat cells surrounded by macrophages and neutrophils, then fibroblasts, lymphocytes and histiocytes.
5. Histo - Late: foreign body giant cell reaction, calcification and hemosiderin deposition.
6. Important because they are confused with cancer (calfication on mammogram)

Front 5

What are fibrocystic breast changes?

Back 5

1. single most common breast disorder (non-proliferative)
2. clinically relevant when mass is mammographic
3. >50% of all breast surgeries
4. 20-40yo affected

Front 6

Describe the histologic patterns of fibrocystic breast changes: (3)

Back 6

1. Cysts with apocrine metaplasia (dilated ducts and lobules that coalesce to form "blue-dome" cysts)
2. Dense fibrosis can be present (often assoc with cyst rupture)
3. Adenosis (proliferation of small ducts and myoepithelial cells)

Front 7

BRS
What is sclerosing adenosis?

Back 7

The combined changes of fibrosis and adenosis (proliferation of small ducts and myoepithelial cells).

Front 8

BRS and lecture

What is an intraductal papilloma?

Back 8

This is a benign tumor of the major lactiferous ducts that must be distinguished from carcinoma (it can be malignant but not always)

Key: it is clinically manifested by serous or bloody discharge.

Front 9

What is atypical ductal hyperplasia (ADS)?

Back 9

ADH = lesions with some of the features of DCIS

Characteristics:
1. nuclear monomorphism
2. regular cell placement
3. round regular spaces in at least part of the involved space.

Front 10

What is atypical lobular hyperplasia? (ALH)

Back 10

ALH = lesions with some features of LCIS

Characteristics:
1. small, uniform cells filling lobule or distending it

2. cells do not fill or distend > 50% of the acini within the lobule.

Front 11

What is the most common non-skin malignancy in women?

Back 11

Breast Carcinoma

Front 12

VIP

What 9 breast abnormalities cause NO increased risk for breast CA?

Back 12

1. adenosis (other than sclerosing adenosis)
2. duct ectasia
3. fibroadenoma with complex features
4. fibrosis
5. mastitis
6. mild usual hyperplasia without atypia
7. cysts
8. apocrine metaplasia
9. squamous metaplasia

Front 13

What 6 factors of a patients Hx determines their risk for developing breast CA within 5 yrs or by the age of 90?

Back 13

1. age
2. age of first menarche
3. first live birth
4. first-degree relatives with breast CA
5. breast biopsies
6. race

Front 14

What are 6 other factors that contribute to developing breast CA?

Back 14

1. estrogen exposure
2. radiation exposure
3. contralateral breast CA or endometrial CA
4. where you live (geographical)
5. diet/exercise/obesity
6. environmental toxins (smoking)

Front 15

What percentage of newly identifiable diagnosed breast CA occur in women with no identifiable risk factors?

Back 15

75%

Front 16

What is the risk of developing breast CA if you are:
1. 20yo
2. 40yo
3. 50yo
4. 60yo

Back 16

1. 20yo = 1/2000
2. 40yo = 1/70
3. 50yo = 1/40
4. 60yo = 1/30

Front 17

What percentage of breast CA show a hereditary background?

Back 17

13% of all breast CA

Front 18

Describe characteristics of ductal CA insitu?

Back 18

Malignant cells present and confined to the ductal system without microscopic evidence of invasion through the basement membrane.

Myoepithelial cells are present but there may be fewer

Often see a "cribform" pattern that looks like bunches of punched out cells. As well as seeing areas of necrosis.

Front 19

40% of all mammographically detected breast CA is of what kind?

Back 19

Ductal CA in-situ

Front 20

What are the histologic criteria for Lubular CA in-situ?

Back 20

1. small uniform cells (characteristic of LCIS)

2. these cells fill the entire acini with no spaces between them

3. there is marked expansion of at least 1/2 of the acini in the lobular unit

Front 21

What two types of genetic changes often occurs to form breast CA?

Back 21

1. Increased expression of oncogenes HER-2/neu and c-myc

2. Decreased expression or function of tumor suppressor genes p53 and/or NM23

3. Loss of cell adhesion molecules (cadhern and integrins)
4. Increased expression of cell cycle proteins.
5. Increased expression of angiogenic factors (VEGF and FGF)
6. Increased expression of proteases (cathepsin and stromelysins)

Front 22

Describe Invasive lobular CA:

Back 22

1. cells are arranged in a linear fashion ("Indian file")
2. form long cords of cells
3. better prognosis than for invasive ductal CA

Front 23

Describe stage II breast CA?

Back 23

Tumor <5cm with up to 3 postive nodes but no distant metastases.

Front 24

Describe stage I breast CA?

Back 24

Tumor <2cm with no mets

Front 25

Five year survival rate for stages 0, I, and IV breast CA

Back 25

Stage O = 92%
Stage I = 87%
Stage IV = 13%

Front 26

VIP
What are the 6 major prognostic factors in breast CA?

Back 26

1. invasive or insitu CA
2. distant mets?
3. lymph node mets?
4. is disease locally advanced?
5. what is the tumor size?
6. is there inflammation?!? (bad if yes)

Front 27

What are three main types of stromal lesions of the breast?

Back 27

1. fibroadenoma
2. phyllodes tumor
3. sarcoma

Front 28

VIP
Describe a Phyllodes tumor of the breast:

Back 28

Phyllodes:
This tumor is large, bulky mass of variable malignancy and with ulceration of underlying skin (see = think malignancy)

Front 29

What is a fibroadenoma?

Back 29

A tumor with both fibrous and glandular tissue occuring during reproductive life (<30).

Gross: sharply circumscribed nodule
Micro: slit-like glandular spaces

Front 30

What is the most common benign tumor?

Back 30

Fibroadenoma