Diseases Of The Breast

Front 1

What is the functional unit of the breast? What occurs here?

Back 1

TDLU- terminal duct lobular unit

Lactation occurs at the TDLU as well as most breast diseases

Front 2

Two major cell types in the breast. What purpose do they serve?

Back 2

Myoepithelial and epithelial

Myoepithelial cells are contractile (expel milk). Epithelial cells are secretory

Front 3

How does the breast change after ovulation? What causes the change? Does this cause symptoms in the women?

Back 3

The combined effect of progesterone and estrogen causes proliferation, increased # of acini, vacuolization of cytoplasm, stromal edema (may lead to premenstrual "fullness")

Front 4

Physiologic changes of the breast associated with pregnancy?

Associated with aging?

Back 4

Pregnancy --> hyperplasia and terminal differentiation

Aging --> involution, TDLU atrophy and fatty replacement of stroma

Front 5

Examples of benign epithelial lesions

How are they diagnosed?

Back 5

Premenopausal- lumps, pre-menstrual mastalgia, dominant lumps/cysts, non-bloody nipple discharge

Mammography- look for microcalcifications, masses

Front 6

3 types of benign epithelial lesions?

Of these three, what is the relative risk of developing breast cancer?

Back 6

1. Non-proliferative fibrocystic change,

2. Proliferative fibrocystic change without atypia

3. Proliferative fibrocystic change WITH atypia

RR 3>2>1

Front 7

Is the risk increased or decreased by:

Family history?
Younger age at diagnosis?

Back 7

Fm hx- Increased

younger age @ dx- increased

Front 8

Most frequent subtype of benign epithelial lesions?

What is typically seen?

Back 8

Non-proliferative fibrocystic changes.

No proliferation! Increased fibrosis, apocrine metaplasia, small prominent nucleoli

Front 9

Give a few examples of proliferative changes without atypia? What do they look like?

What does the epithelium look like?

Back 9

Ductal hyperplasia, sclerosing adenosis, papillomas, radial scar

Bridging ducts with irregular spaces formed within. Myoepithelial and lumenal proliferation. More than 2 cell layers line the epithelium.

Front 10

Examples of proliferative changes with atypia?

Back 10

Atypical ductal hyperplasia and atypical lobular hyperplasia.

Front 11

What purpose does E cadherin serve? Is it seen in atypical lobular hyperplasia?

Back 11

It is an adhesion molecule.

No- as a result, cells don't adhere, push others out of way

Front 12

What are the 2 most common malignancies in women?

Back 12

1. SqCC
2. Carcinoma of the breast

Front 13

Risk factors for carcinoma of the breast?

Back 13

First child at an older age
Early menarche, late menopause
Obesity
Family hx (BRCA1 or 2)
HRT

Front 14

BRCA-1- function? Where is this gene located? What is it associated with? Elevated in any particular population of people? Chance of developing breast CA?

Back 14

Tumor suppressor gene

On chromosome 17

Pre-menopausal breast/ovarian CA

Slightly elevated in Ashkenazi Jewish

85% chance in carriers

Front 15

BRCA-2- where is it located? Does it cause a lot of breast cancer?

Back 15

On chromosome 13, associated with 5% of breast cancers

Front 16

Can carcinoma in situ metastasize? If removed, is recurrence likely?
2 categories of CIS?

Back 16

NO METS. Hasn't invaded.

Recurrence is rare (unless invasive focus is missed)

Ductal CIS & lobular CIS

Front 17

Most common finding in DCIS?

What other condition is associated with DCIS?

Back 17

mammographic calcifications, may also see central necrosis (comedonecrosis)

Paget's disease of the nipple if DCIS extends to skin, nipple, areola

Front 18

What is the key histological finding in paget's disease of the nipple?

Back 18

Clear cytoplasm, atypical nuclei with prominent nucleoli + CYTOPLASMIC HALO

Front 19

LCIS- typical findings?

Looks like what other condition?

Back 19

Not associated with microcalcifications, no stromal reaction, bilateral in 20-40% of cases

Not a true neoplasm- equal frequency in both breasts

Looks like atypical lobular hyperplasia but involves the entire lobule

Front 20

Difference between CIS and invasive carcinoma?

Main types of invasive carcinoma? Which one is more prevalent?

Back 20

Invasive carcinoma has invaded through basement membrane into the stroma (may have vascular invasion and METS)

Invasive ductal carcinoma (75%)
Invasive lobular carcinoma

Front 21

Puckering of the skin is seen in what type of breast disease?

Back 21

Invasive breast carcinoma that has extended to the skin

Front 22

Invasive ductal carcinomas that infiltrate ducts, glands and tubules are known as?

Back 22

Adenocarcinomas

Front 23

Invasive lobular carcinoma- characteristic histological findings?

Back 23

Small uniform cells with only mild atypia, no glands, no desmoplastic stroma

Front 24

Characteristic gross/micro findings in "inflammatory breast cancer"

Back 24

Gross- Peau d'orange

Micro- dermal/lymphatic/vascular invasion (--> to erythema)

Front 25

Difference between a prognostic and a predictive factor?

Back 25

Prognostic- determine course of disease progression in absence of therapy (intrinsic biologic effect)

Predictive- cues that a tumor might respond to a specific therapy

Many factors are both

Front 26

Classical prognostic/predictive factors?

Back 26

Axillary node status, size, grade, invasion, hormone receptors, HER2, mitotic count

Front 27

True or false, a tumor with several newer prognostic/predictive factors has a better response to chemotherapy?

Back 27

True (but cancer is usually worse)

Front 28

Most specific prognostic indicator for breast cancer?

Back 28

Axillary lymph node status (more nodes involved, worse prognosis)

Front 29

5 year survival rates for node negative breast cancer with sizes of
<1cm
1-3 cm
3-% cm

Back 29

99%
89%
86%

Front 30

When determining tumor grade, what 3 histological features are taken into account?

Back 30

Tubule formation, pleomorphic nuclei, mitoses

Front 31

Is the presence of an estrogen/progesterone receptor in tumor cells likely to make prognosis better or worse?

Back 31

Better

Front 32

Looking at a FISH with chromosome 17, what gene is being tested for which is a prognostic/predictive factor?

Back 32

HER-2 (will treat if ratio is >2.2)

Front 33

Biphasic tumor?

Prognosis?

Back 33

Fibroadenoma- contains stromal and epithelial components. Well circumscribed

Hormonally responsive, but usually regresses post menopausally

Front 34

Gynecomastia (in males) what is the difference between the histological appearance of these "breasts" and those of a woman?

Back 34

There is fibrosis with mild/moderate hyperplasia

Ducts can be seen, but not lobules (no acini in male breast)