Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
46 Cards in this Set
- Front
- Back
|
Hormonal changes of breast
|
Estrogen - ductal epithelial proliferation
Progesterone - ductal proliferation, stromal edema and proliferation |
|
|
Site of most pathology ?
|
terminal duct lobular unit
|
|
|
Know the pathology in Normal duct lobular unit
|
Cyst
Sclerosing adenosis Small duct papilloma Hyperplasia Atypical hyperplasia Carcinoma |
|
|
Lobular stroma
|
Fibroadenoma
Phyllodes tumor |
|
|
Large ducts and lactiferous sinus
|
Duct ectasia
Recurrent subareolar abscess Solitary ductal papilloma Paget's disease |
|
|
Interlobular stroma
|
Fat necrosis
lipoma Fibrous tumor PASH Fibromatosis Sarcoma |
|
|
Staon for myoepithelial cells
|
Calponin
|
|
|
Histological change for lactation
|
Circumscribed hyperplasia. Occurs during pregnancy
|
|
|
Juvernile hypertrophy
|
Occurs as a response to hormones
The histology shows proliferating stroma with edema giving it a characteristic halo |
|
|
Breast lump differentials
|
Fibrocystic changes - 40%
No disease - 30% Fibroadenoma - 7% Miscerallaneous benign - 13% |
|
|
Non proliferative vs Proliferative FCC. Which is more common ?
|
Non proliferative
Fibrosis, Cysts, Apocrine metaplasia - NP Proliferative - Epithelial hyperplasia, sclerosing adenosis, papillomatosis |
|
|
FCC - Blue dome cyst
|
Know what it looks like. Rupture causes irritation. It can also be focal or multifocal
|
|
|
Non proliferative FCC
|
1. Most common
2. Stroma is replaced by small lobules and ducts are dilated. The cysts are now dilated too |
|
|
Aporcrine metaplasia
|
Atypical Nuclei
Benign Combination of changes and is bilateral |
|
|
Prolif FCC without atypia
|
Increase in epithelial cells - Epi hyperplasia
Formation of irregular spaces of heterogenous borders |
|
|
PagF of the above ?
|
Punched out lesions/ Cookie cutter. The tx is different for this !
|
|
|
how do dx sclerosing adenosis
|
Calponin stain
|
|
|
Risk of carcinoma with papillomatosis
Atypical hyperplasia Non proliferative/sclerosing adenosis |
1. 2X
2. 5X 3. None |
|
|
Order of breast cancer incidence
prolif dx without atypica, atypical hyperplasia, atypical + fam hx |
fam hx, atypical hyplerplasia, without atypia
|
|
|
A bacterial infection that occurs in nursing mothers
|
Acute mastitis
|
|
|
Px of acute mastitis
|
Bacterial infection that leads to subareolar abscess - usually staph
|
|
|
Strep mastitis ? Features - what can it mimic ?
|
More diffuse with erythema and tenderness. Inflammatory breast cancer can mimic Strep mastitis
|
|
|
What breast pathology clinically, radiographically and grossly resembles carcinoma ?
|
Fat necrosis
|
|
|
Trauma to the breast - first on diff ?
|
Fat necrosis
|
|
|
Gross early and late features of FN
|
Early 0 necrosis, hemorrhage and granulation tissue
Late - poorly demarcated (stellate) fibrosis |
|
|
Histological appearance of fat necrosis
|
Acute - intense inflamm response, foamy macs and foreign cell bodies
Chronic - fibrosis/scarring, often detected as a mass at this phase |
|
|
This often occurs in older females 40-60 yrs old. It is idiopathic, non infectious. Duct dilatation occurs secondary to proximal obstruction. Inspissated secretions accumulate causing ducts to rupture leading to chronic periductal inflammation, foreign body giant cell reaction and fibrosis
|
Mammary duct ectasia
|
|
|
Most common benign breast tumor
|
Fibroadenoma
|
|
|
Well defined solitary mobile mass - mobile mouse. Possibly related to estrogen sensitivity. Who is this found in and how does it differ in them ?
|
Adolescents and premenopausal women
Increases in size during pregnancy and decreases after menopause. May be large, hypercellular and quickly enlarging in young patients - juvenile fibroadenoma |
|
|
This cancer presents with bloody nipple discharge, occasional with mass/nipple retractions. It is found in women 30-50 yrs old. What does this look like histologically and what is the treatment
|
Intraductal papilloma - It has a fibrovascular stalk lined by columnar/cuboidal cells
IHC for myoepithelial cells is positive (negative in papillary carcinoma) Treated by excision |
|
|
Phyllodes tumor
|
Large, lobulated and bulky tumors
Most are benign but 15% show increased mitosis, stromal overgrowth and anaplasia. These tend to recurrr and metastazie through blood. |
|
|
Know the risk factors for Breast cancer
|
Familial, low parity (<2), etc etc
|
|
|
Genetic factors and hormones that aid in pathogenesis
|
BRCA 1, BRCA 2 and p53 mutations. estrogen aids in progression
|
|
|
What are the four presentations of brca
|
Mass
Nipple discharge Skin retraction Metastasis |
|
|
Intraductal carcinoma in situ
|
More common than LCIS
Detected by mammogram HIgh risk of BrCa Round punched out space lined by cells unsupported by stroma, icropapillary. Tx is local excision. Lumpectomy |
|
|
What is comedo ?
|
Central necrosis with high grade nuclear features
|
|
|
Griss appearance of DCIS comedocarcinoma
|
Poorly definted indurated. comedocarcinoma is more aggressive than non comedo and when extensive may warrant a mastectomy with LN excision. Still limited by M/e cell layer and hence will stain for calponin
|
|
|
LCIS
|
fill and distend lobular units without breaking through basement membrane
marker for development of invasive carcinoma Subsequent carcinoma may be ductal or lobular and may occur in either breast Donot lead to masses. Discovered incidentally |
|
|
Which invasive is more common and aggressive and which ones has a higher incidence of bilaterality ?
|
Invasive ductal
Bilateral - invasive lobular |
|
|
Paget's disease
|
Form of ductal carcinoma
Arise near nipple and extend to involve skin of nipple/areola Eczematoid, scaley, crusting appearance Ductal carcinoma cells migrate up the main ducts and infiltrate the epidermis of the nipple large cells in the epidermis surrounded by clear zones Poor prognosis Upto 40% with LN metastases |
|
|
Histology of Pagets
|
Large atypical cells with halo around them
|
|
|
Invasive lobular carcinoma
|
5-10% of breast cancers
Often multicentric Bilateral in 20% Small cells +/- signet ring cells Indian filling pattern of growth with concentric growth around ducts/blood vessels |
|
|
Know the breast cancer staging
|
Page 46
|
|
|
Predictive factors for breast cancer
|
ER/PR status
HER-2/NEU status - bad prognostic factor Herceptin can be used for the tx of these patients |
|
|
Male breast patholgy
|
Occurs in older men,
Male to female 1:100 Patients often present in high stage prognosis similar if matched by stage |
|
|
What is the most important prognostic factor for breast cancer ?
|
Stage
|
