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30 Cards in this Set

  • Front
  • Back
Ducts and lobules contain what two types of cells?
Epithelial and myoepithelial(myoepithelial is for contraction in milk ejection and is present when there is no invasion or malignancy)
Compare young and postmenapausal breast:
Young: well structured lobules and less fat

Post-meno: diminished glandular component and less fat
Describe the inflammatory process that is initiated with the implantation of silicone breast implants:
Fibrosis (from inflam response) -> capsule formation -> capsule contraction -> deformaty/rupture
Describe the process of fat necrosis:
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)
What are fibrocystic breast changes?
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
Describe the histologic patterns of fibrocystic breast changes: (3)
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)
What is sclerosing adenosis?
The combined changes of fibrosis and adenosis (proliferation of small ducts and myoepithelial cells).
BRS and lecture

What is an intraductal papilloma?
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.
What is atypical ductal hyperplasia (ADS)?
ADH = lesions with some of the features of DCIS

1. nuclear monomorphism
2. regular cell placement
3. round regular spaces in at least part of the involved space.
What is atypical lobular hyperplasia? (ALH)
ALH = lesions with some features of LCIS

1. small, uniform cells filling lobule or distending it

2. cells do not fill or distend > 50% of the acini within the lobule.
What is the most common non-skin malignancy in women?
Breast Carcinoma

What 9 breast abnormalities cause NO increased risk for breast CA?
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
What 6 factors of a patients Hx determines their risk for developing breast CA within 5 yrs or by the age of 90?
1. age
2. age of first menarche
3. first live birth
4. first-degree relatives with breast CA
5. breast biopsies
6. race
What are 6 other factors that contribute to developing breast CA?
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)
What percentage of newly identifiable diagnosed breast CA occur in women with no identifiable risk factors?
What is the risk of developing breast CA if you are:
1. 20yo
2. 40yo
3. 50yo
4. 60yo
1. 20yo = 1/2000
2. 40yo = 1/70
3. 50yo = 1/40
4. 60yo = 1/30
What percentage of breast CA show a hereditary background?
13% of all breast CA
Describe characteristics of ductal CA insitu?
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.
40% of all mammographically detected breast CA is of what kind?
Ductal CA in-situ
What are the histologic criteria for Lubular CA in-situ?
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
What two types of genetic changes often occurs to form breast CA?
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)
Describe Invasive lobular CA:
1. cells are arranged in a linear fashion ("Indian file")
2. form long cords of cells
3. better prognosis than for invasive ductal CA
Describe stage II breast CA?
Tumor <5cm with up to 3 postive nodes but no distant metastases.
Describe stage I breast CA?
Tumor <2cm with no mets
Five year survival rate for stages 0, I, and IV breast CA
Stage O = 92%
Stage I = 87%
Stage IV = 13%
What are the 6 major prognostic factors in breast CA?
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)
What are three main types of stromal lesions of the breast?
1. fibroadenoma
2. phyllodes tumor
3. sarcoma
Describe a Phyllodes tumor of the breast:
This tumor is large, bulky mass of variable malignancy and with ulceration of underlying skin (see = think malignancy)
What is a fibroadenoma?
A tumor with both fibrous and glandular tissue occuring during reproductive life (<30).

Gross: sharply circumscribed nodule
Micro: slit-like glandular spaces
What is the most common benign tumor?