My Breast Path

Front 1

breast is derived from the?

Back 1

skin- it is a modified skin gland

Front 2

TDLU?

Back 2

Terminal duct lobular unit

Front 3

The lubules and ducts are BOTH lined by?

Back 3

-2 layers of epithelium
1) luminal cell layer ( 1 layer epithelial cells)
2) myoepithelial cell layer (precursor to epithelial cells that have contractile function) - squeeze milk forward

Front 4

the highest density of breast tissue is found where?

Back 4

The upper outer (lateral) quadrant of breast tissue

Front 5

breast tissue is sensitive to what hormones?

Back 5

Estrogen and progesterone

Front 6

after the corpus luteum degrades, where are hormones to maintain pregnancy?

Back 6

-placenta produces progesterone
-Fetus produces estrogen

Front 7

what drives enlargement of breast in pregnancy?

Back 7

E and P

Front 8

galactorrhea
-define
-etiology

Back 8

-milk production outside of lactation (not breastfeeding)
-Not a symptom of breast cancer
-excess nipple stimulation
-Prolactinoma

Front 9

Fibrocystic change?
-general
-presentation?

Back 9

A clinical term that describes the single most common breast disorder
-BENIGN
-Women aged 20 to 50 years
-Bilateral pain and tenderness during the premenstrual phase, increased breast nodularity.

Front 10

Fibrocystic change
-etiology
-histology
-gross

Back 10

An exaggerated response of breast tissue to ovarian hormones.
-development of fibrosis and cysts
- fluid filled blue dome cyst seen grossly

Front 11

Fibrocystic Change
-Histopathology

Back 11

1) Cysts lined by apocrine metaplastic cells
2) Fibrosis
3) Adenosis (an increase in the number of glands in the lobule)

Front 12

Fibrocystic change
-cancer risk?

Back 12

-by itself does not inc. risk for cancer

-Fibrocystic changes are associated with varying degrees of epithelial hyperplasia. The pathologic term is “usual ductal hyperplasia.”

Front 13

fibrocystic change-
lined by apocrine metaplasia?

Back 13

this metaplasia does NOT lead to cancer is in other metaplasias

Front 14

range of fibrocystic changes?

Back 14

Mild: 3-4 cell layers
Moderate: >4 cell layers
Florid: >4 cell layers with distention of duct

Front 15

findings that inc. breast cancer risk?

Back 15

-Ductal hyperplasia
-Sclerosing adenosis
-Atypical hyperplasia

Front 16

types of fibrocystic changes?

Back 16

Non-proliferative breast disease = Fibrocystic changes associated with only mild epithelial hyperplasia.


Proliferative breast disease =Fibrocystic changes associated with moderate or florid epithelial hyperplasia.

Front 17

Non-proliferative breast disease vs proliferative breast disease in fibrocystic changes?

Back 17

Non-proliferative breast disease = Fibrocystic changes associated with only mild epithelial hyperplasia.
Proliferative breast disease =Fibrocystic changes associated with moderate or florid epithelial hyperplasia.

Proliferative has a 1.5-2.0 Times inc risk for breast cancer, non-prolif has no inc. risk

Front 18

sclerosing adenosis

Back 18

sclerosing (hardening) of the stroma of lobules and calcification

Front 19

Atypical hyperplasia

Back 19

in the duct or lobule (5x inc risk for invasive carcinoma)

Front 20

Atypical Hyperplasia

Back 20

A cellular proliferation resembling ductal carcinoma in-situ or lobular carcinoma in-situ but lacking sufficient features for a diagnosis of carcinoma in-situ.
(does not inc. risk for cancer)

Front 21

in breast tissue hyperplasia (proliferative breast disease) how does this develop into atypical hyperplasia and invasive cancer?

Back 21

Hyperplasia of breast epithelia does NOT lead to atypical hyperplasia and invasive cancer, the invasive cancer develops via a separate route (not fibrocystic hyperplasia)

Front 22

Most common cause of a pathologic nipple discharge?

Back 22

Intraductal Papilloma

Front 23

Intraductal Papilloma?
-define
-histo
-presentation

Back 23

Multiple branching fibrovascular cores within a large duct
-The fibrovascular cores are lined by two cell layers (epithelial and myoepithelial cells).
-bloody nipple discharge due to papillary vasculature

Front 24

Slightly Increased Risk For Invasive Breast Cancer (1.5-2.0 Times

Back 24

Proliferative fibrocystic changes (moderate/severe epithelial hyperplasia).
Fibroadenoma with complex features.
Intraductal papilloma.
Sclerosing adenosis.
Radial scar.

Front 25

Moderately Increased Risk for Invasive Breast Cancer (4.0-5.0 Times)

Back 25

Atypical ductal hyperplasia.
Atypical lobular hyperplasia.

Front 26

Markedly Increased Risk for Invasive Breast Cancer (8.0-10.0 Times)

Back 26

DCIS (only the ipsilateral breast is at risk).
LCIS.

Front 27

Most common benign neoplasm of the female breast?

Back 27

Fibroadenoma

Front 28

Fibroadenoma
-define
-gross

Back 28

tumor of fibrous tissue and glands

-Well-circumscribed nodule.
Bulges above the surrounding tissue.
Contains slit-like spaces.

Front 29

Fibroadenoma
-Histo

Back 29

Histologically well-circumscribed

-compressed slit-like ducts within dense irregular tissue

Front 30

fibeoadenoma
-is it cancerous?

Back 30

NO its benign its an adenoma NOT carcinoma
-no inc. risk for cancer when it doesnt have complex features

Front 31

classic patient who has breast cancer is what age?

Back 31

post menopausal (menopause occurs 45-55)

Front 32

what drives breast cancer?

Back 32

estrogen (obesity, due to aromatase)

Front 33

types of malignant neoplasms (cancer) in breast?

Back 33

-DCIS
-Paget's disease of nipple (a DCIS who's malignant ductal cells move there way up the duct to the nipple)
-IDC- invasive ductal carcinoma- invasive cells of the duct cells
-LCIS malignant cells of the lobule cells
-Invasive Lobule carcinoma- invasive cells of the lobule cells

Front 34

4 main types of breast cancer?
-all deal with what main structure

Back 34

main structure = TDLU
1) DCIS
2) IDC
3) LCIS
4) ILC

Front 35

DCIS
- most common presentation?

Back 35

-Mammographic calcifications (within ducts)
-a single duct system

Front 36

DCIS
-prognosis if untreated

Back 36

At least 1/3 of cases of untreated DCIS progress within 5 years to invasive breast cancer.

Front 37

DCIS
-treatment?

Back 37

-surgically removed

Front 38

DCIS
-pathophys

Back 38

-malignant proliferation of ductal cells
-no invasion of BM
-

Front 39

why does calcification occur in DCIS?

Back 39

There is no blood supply to the neoplastic cells within the duct, and they die and undergo dystrophic calcification after necrosis

Front 40

Dystrophic calcification?

Back 40

calcification occurring in degenerated or necrotic tissue

Front 41

Paget's disease
-define
-presentation

Back 41

DCIS that extends (walks) to skin of nipple
-presents as nipple ulceration and redness

Front 42

Invasive Ductal Carcinoma
-histo
-presentation

Back 42

-forms duct-like structure
-presents as a mass detected by physical exam or mammography

Front 43

How can you identify a Invasic Ductal Carcinoma?

Back 43

abscence of myoepithelia
-palpable mass (firm, painless)
-mammographic density
-forms ducts

Front 44

most common invasive breast carcinoma?

Back 44

Invasive ductal carcinoma 80%
invasive lobular carcinoma 10%

Front 45

what is cell Differentiation of tumors?

Back 45

-The extent to which neoplastic cells resemble comparable normal cells.
-Well-differentiated tumors are composed of cells resembling mature normal cells of the tissue of origin.
-Poorly differentiated tumors have more primitive-appearing cells.

Front 46

LCIS
-define
-characteristics

Back 46

malignant proliferation of cells in lobules
-no invasion of BM
-No mass, No calcification (always found by accident, mammogram, biopsy)
-Lacks cell adhesion to to loss of E-cadherin

Front 47

LCIS
-lack of adhesion?

Back 47

due to loss of E-cadherin, cell adhesion molecule

-cells appear separated (dyscohesive)
-often multifocal and bilateral

The cells of lobular neoplasia have lost a portion of chromosome 16q that includes the e-cadherin gene which codes for a transmembrane protein responsible for cell adhesion.

Front 48

Lobular Carcinoma In-Situ
-presentation
-prognosis

Back 48

-Incidental finding in a biopsy performed for another reason.
-Tends to be bilateral and involves multiple duct systems.


-one-third of patients with LCIS develop invasive carcinoma over the next 15-20 years; both breasts at risk.

Front 49

Lobular Carcinoma In-Situ
-treatment

Back 49

-Not a surgical disease.
-only a risk factor for invasive caner
-use tamoxifen to protect from estrogen induced progression to invasion

Front 50

Invasive lobular carcinoma
-characteristics

Back 50

-lobular cells that invades BM
--cells invade in "indian lines" single file lines
-no duct formation due to lack of E-cadherin

Front 51

in breast cancers what is the most important measure and most useful measure in TNM?

Back 51

-metastasis is most important
-But axillary lymph node involvement is most USEFULE

Front 52

What is the sentinel lymph node?
how do you determine the sentinel lymph node?

Back 52

The first lymph node that receives drainage from an area of interest (breast)
-identified by injecting a dye in the breast and tracing its path to first lymph node(s) tier

Front 53

predictive factors to predict response to breast cancer Tx?

Back 53

ER, PR, HER2 positive gene amplication
-ER & PR positvie is associated with response to anti-estrogenic agents (tamoxifen)
-Her2 amplification is associated with response to trastuzumab

Front 54

Tamoxifen

Back 54

usual endocrine (anti-estrogen) therapy for hormone receptor-positive breast cancer in pre-menopausal women, and is also a standard in post-menopausal women although aromatase inhibitors are also frequently used in that setting.

Front 55

-ER & PR positvie is associated with

Back 55

esponse to anti-estrogenic agents (tamoxifen)

Front 56

-Her2 amplification is associated with response to?

Back 56

trastuzumab

Front 57

Her2/neu and ER are what types of receptors and how would they be seen in a immunostain for each?

Back 57

Her2 --> stains on outsude b/c its a extracellular receptor

ER --> stains in the nucleus/cytoplasm because these receptors move into nucleus once they bind their logan

Front 58

features suggesting hereditary breast cancers?

Back 58

1) multiple first degree relative with breast cancer
2) tumor at premenopausal age
3) multiple tumors

-BRCA1 and 2 mutation likely

Front 59

psammomas are foun where?

Back 59

usually in papillary of thyroid and endometrium