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210 Cards in this Set
- Front
- Back
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Is the breast a dynamic or static organ?
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Dynamic--always changing
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What is the breast's normal function?
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Lactation
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What hormones is the breast responsive to?
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Estrogen and Progesterone
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How are glands organized in the breast?
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Into lobules
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What do lobules empty into?
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The terminal duct
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What do terminal ducts empty into?
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The collecting duct
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Where are secretions from the collecting duct carried to?
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The lactiferous ducts--have lactiferous sinuses at the end of the ducts
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Where do the lactiferous sinsuses empty into?
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The areola of the nipple
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Where do most breat tumors arise from?
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Ductule epithelium
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What is the breast composed of?
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Connective tissue
Fat Duct system Glandular epithelium |
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Where do most cysts occur?
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In the lobules beacuse of expansile tissue
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What are glands/lobules made of?
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Specialized connective tissue that allows for expansion
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What are the two types of epithelium seen in breast tissue?
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Glandular epithelium and myoepithelium
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If we see both types of epithelium in a sample, what does this suggest?
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Benign lesions
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Which epithelium do we lose in cancer?
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Myoepithelial epithelium
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What does the breast gear up for every month?
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To produce milk
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If pregnancy doesn't occur, what happens to the secretory product produced during the cycle?
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It gets absorbed
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What kinds of glands are present near the nipple?
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Sebaceous glands--Glands of Montgomery
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What do sebaceous glands produce?
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Lubrication
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What happens to breast tissue at 30-40 years of age?
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The glandular epithelium starts to involute and go away
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What happens to breast tissue as we get older?
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Increases in fat and decreased in glandular epithelium
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When is breast involution complete in most women?
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Menopause--age 55
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What speeds up the process of involution?
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Pregnancy
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What happens to the terminal ducts and collecting duct during involution?
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Nothing--they stay put
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What can delay or prolong the process of involution?
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Supplemental estrogen
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Is pain in the breast usually a benign or malignant sign?
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Usually benign
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Is nipple discharge a sign of benign or malignant disease?
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Usually benign
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What are the most common breat symptoms reported by women?
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Pain, palpable mass, and nipple discharge
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What is the primary way breast cancer typically spread?
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Lymphatics
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What is the most common lymph node site for breast cancer spread?
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The axilla region
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What does the breast gear up for every month?
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To produce milk
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If pregnancy doesn't occur, what happens to the secretory product produced during the cycle?
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It gets absorbed
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What kinds of glands are present near the nipple?
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Sebaceous glands--Glands of Montgomery
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What do sebaceous glands produce?
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Lubrication
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What happens to breast tissue at 30-40 years of age?
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The glandulat epithelium starts to involute and go away
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What happens to breast tissue as we get older?
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Increases in fat and decreased in glandular epithelium
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When is breast involution complete in most women?
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Menopause--age 55
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What speeds up the process of involution?
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Pregnancy
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What happens to the terminal ducts and collecting duct during involution?
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Nothing--they stay put
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What can delay or prolong the process of involution?
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Supplemental estrogen
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Is pain in the breast usually a benign or malignant sign?
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Usually benign
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Is nipple discharge a sign of benign or malignant disease?
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Usually benign
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What are the most common breat symptoms reported by women?
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Pain, palpable mass, and nipple discharge
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What is the primary way breast cancer typically spread?
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Lymphatics
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What is the most common lymph node site for breast cancer spread?
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The axilla region
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What is a needle biopsy?
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Withdrawing fluid and tissue from a lump with a fine needle
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When can needle biopsy be done?
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When there is a palpable lesion
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What is a core needle biopsy?
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Allows you to obtain more tissue than a fine needle biospy
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What is a stereotactic breast biopsy?
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Used when it is not easy to obtain a sample from the lesion; when it is not an obvious lesion
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What is acute mastitis?
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Occurs during lactation; usually 1st month post partum; inflammatory process
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What is the most common bacterial cause of acute mastitis?
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Staphylococcus aureus
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Does acute mastitis usually affect one or both breasts?
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Usually just one breast
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What is periductal mastitis?
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Inflammatory process usually seen in smokers and NOT lactating
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What is periductal mastitis frequently known as?
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Subareolar abscess
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What is the major finding in periductal mastitis?
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Squamous metaplasia of lactiferous ducts
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What is the treatment for peiductal mastitis?
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SURGICAL; remove fistual tract and drain abcess
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What is mammary duct ectasia?
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Secretions plug ducts and spill into the surrounding stroma elicting a granulomatous inflammatory response
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Who is usually affected by mammary duct ectasia?
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Women in their fifth and sixth decade
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What does mammary duct ectasia mimic?
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Carcinoma--clinically and on mammogram
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Where is mammry duct ectasia usually seen in the breast?
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Localized to the periareoloar portion of the breast
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What is a needle biopsy?
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Withdrawing fluid and tissue from a lump with a fine needle
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When can needle biopsy be done?
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When there is a palpable lesion
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What is a core needle biopsy?
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Allows you to obtain more tissue than a fine needle biospy
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What is a stereotactic breast biopsy?
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Used when it is not easy to obtain a sample from the lesion; when it is not an obvious lesion
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What is acute mastitis?
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Occurs during lactation; usually 1st month post partum; inflammatory process
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What is the most common bacterial cause of acute mastitis?
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Staphylococcus aureus
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Does acute mastitis usually affect one or both breasts?
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Usually just one breast
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What is periductal mastitis?
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Inflammatory process usually seen in smokers and NOT lactating
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What is periductal mastitis frequently known as?
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Subareolar abscess
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What is the major finding in periductal mastitis?
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Squamous metaplasia of lactiferous ducts
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What is the treatment for peiductal mastitis?
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SURGICAL; remove fistual tract and drain abcess
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What is mammary duct ectasia?
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Secretions plug ducts and spill into the surrounding stroma elicting a granulomatous inflammatory response
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Who is usually affected by mammary duct ectasia?
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Women in their fifth and sixth decade
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What does mammary duct ectasia mimic?
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Carcinoma--clinically and on mammogram
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Where is mammry duct ectasia usually seen in the breast?
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Localized to the periareoloar portion of the breast
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What is a needle biopsy?
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Withdrawing fluid and tissue from a lump with a fine needle
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When can needle biopsy be done?
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When there is a palpable lesion
|
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What is a core needle biopsy?
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Allows you to obtain more tissue than a fine needle biospy
|
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What is a stereotactic breast biopsy?
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Used when it is not easy to obtain a sample from the lesion; when it is not an obvious lesion
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What is acute mastitis?
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Occurs during lactation; usually 1st month post partum; inflammatory process
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What is the most common bacterial cause of acute mastitis?
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Staphylococcus aureus
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Does acute mastitis usually affect one or both breasts?
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Usually just one breast
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What is periductal mastitis?
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Inflammatory process usually seen in smokers and NOT lactating
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What is periductal mastitis frequently known as?
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Subareolar abscess
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What is the major finding in periductal mastitis?
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Squamous metaplasia of lactiferous ducts
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What is the treatment for peiductal mastitis?
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SURGICAL; remove fistual tract and drain abcess
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What is mammary duct ectasia?
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Secretions plug ducts and spill into the surrounding stroma elicting a granulomatous inflammatory response
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Who is usually affected by mammary duct ectasia?
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Women in their fifth and sixth decade
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What does mammary duct ectasia mimic?
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Carcinoma--clinically and on mammogram
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Where is mammry duct ectasia usually seen in the breast?
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Localized to the periareoloar portion of the breast
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What is a needle biopsy?
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Withdrawing fluid and tissue from a lump with a fine needle
|
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When can needle biopsy be done?
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When there is a palpable lesion
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|
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What is a core needle biopsy?
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Allows you to obtain more tissue than a fine needle biospy
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|
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What is a stereotactic breast biopsy?
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Used when it is not easy to obtain a sample from the lesion; when it is not an obvious lesion
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What is acute mastitis?
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Occurs during lactation; usually 1st month post partum; inflammatory process
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What is the most common bacterial cause of acute mastitis?
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Staphylococcus aureus
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Does acute mastitis usually affect one or both breasts?
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Usually just one breast
|
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What is periductal mastitis?
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Inflammatory process usually seen in smokers and NOT lactating
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What is periductal mastitis frequently known as?
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Subareolar abscess
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What is the major finding in periductal mastitis?
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Squamous metaplasia of lactiferous ducts
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What is the treatment for peiductal mastitis?
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SURGICAL; remove fistual tract and drain abcess
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What is mammary duct ectasia?
|
Secretions plug ducts and spill into the surrounding stroma elicting a granulomatous inflammatory response
|
|
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Who is usually affected by mammary duct ectasia?
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Women in their fifth and sixth decade
|
|
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What does mammary duct ectasia mimic?
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Carcinoma--clinically and on mammogram
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|
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Where is mammry duct ectasia usually seen in the breast?
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Localized to the periareoloar portion of the breast
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|
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What is a needle biopsy?
|
Withdrawing fluid and tissue from a lump with a fine needle
|
|
|
When can needle biopsy be done?
|
When there is a palpable lesion
|
|
|
What is a core needle biopsy?
|
Allows you to obtain more tissue than a fine needle biospy
|
|
|
What is a stereotactic breast biopsy?
|
Used when it is not easy to obtain a sample from the lesion; when it is not an obvious lesion
|
|
|
What is acute mastitis?
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Occurs during lactation; usually 1st month post partum; inflammatory process
|
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What is the most common bacterial cause of acute mastitis?
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Staphylococcus aureus
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Does acute mastitis usually affect one or both breasts?
|
Usually just one breast
|
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What is periductal mastitis?
|
Inflammatory process usually seen in smokers and NOT lactating
|
|
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What is periductal mastitis frequently known as?
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Subareolar abscess
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What is the major finding in periductal mastitis?
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Squamous metaplasia of lactiferous ducts
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|
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What is the treatment for peiductal mastitis?
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SURGICAL; remove fistual tract and drain abcess
|
|
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What is mammary duct ectasia?
|
Secretions plug ducts and spill into the surrounding stroma elicting a granulomatous inflammatory response
|
|
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Who is usually affected by mammary duct ectasia?
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Women in their fifth and sixth decade
|
|
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What does mammary duct ectasia mimic?
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Carcinoma--clinically and on mammogram
|
|
|
Where is mammry duct ectasia usually seen in the breast?
|
Localized to the periareoloar portion of the breast
|
|
|
What is a needle biopsy?
|
Withdrawing fluid and tissue from a lump with a fine needle
|
|
|
When can needle biopsy be done?
|
When there is a palpable lesion
|
|
|
What is a core needle biopsy?
|
Allows you to obtain more tissue than a fine needle biospy
|
|
|
What is a stereotactic breast biopsy?
|
Used when it is not easy to obtain a sample from the lesion; when it is not an obvious lesion
|
|
|
What is acute mastitis?
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Occurs during lactation; usually 1st month post partum; inflammatory process
|
|
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What is the most common bacterial cause of acute mastitis?
|
Staphylococcus aureus
|
|
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Does acute mastitis usually affect one or both breasts?
|
Usually just one breast
|
|
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What is periductal mastitis?
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Inflammatory process usually seen in smokers and NOT lactating
|
|
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What is periductal mastitis frequently known as?
|
Subareolar abscess
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|
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What is the major finding in periductal mastitis?
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Squamous metaplasia of lactiferous ducts
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|
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What is the treatment for peiductal mastitis?
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SURGICAL; remove fistual tract and drain abcess
|
|
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What is mammary duct ectasia?
|
Secretions plug ducts and spill into the surrounding stroma elicting a granulomatous inflammatory response
|
|
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Who is usually affected by mammary duct ectasia?
|
Women in their fifth and sixth decade
|
|
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What does mammary duct ectasia mimic?
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Carcinoma--clinically and on mammogram
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|
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Where is mammry duct ectasia usually seen in the breast?
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Localized to the periareoloar portion of the breast
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What is the usual cause of fat necrosis?
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Trauma--iatrogenic or accidental trauma
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What can fat necrosis mimic?
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Carcinoma--clinically and on mammogram
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What happens to the overlying skin in fat necrosis?
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It retracts
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How is fibrocystic change classified?
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As a benign breast disease
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What are the important considerations of fibrocystic change in the breasts?
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Pain and can present as a palpable lump--include cancer in differential
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When does fibrocystic change usually cease?
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During menopause
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How can the symptoms of fibrocystic disease be ameliorated?
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Oral contraceptives
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Where do the cysts in fibrocystic change usually arise from?
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The lobules--NOT from ducts
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What are the three patterns of change seen in fibrocystic change?
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Cyst formation
Fibrosis Adenosis |
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What kind of calcification can be a sign of neoplasm and needs to be watched?
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Microcalcification
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What is proliferative breast disease without atypia?
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Epithelial ductal hyperplasia
Sclerosing Adenosis |
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In mild proliferative breast disease without atypia, is there an increased risk of cancer?
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No increased risk
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In florid proliferative breast disease without atypia, is there an increased risk of cancer?
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Yes---1.5-2 times increased invasive cancer risk
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Is there an increased risk of developing cancer in sclerosing adenosis?
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Yes--1.5-2 times increased risk
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What are the variants of sclerosing adenosis?
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Sclerosing papilloma and complex sclerosing lesion (radial scar)
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What is proliferative breast disease with atypia?
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Atypical hyperplasia
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What are the two types of atypical hyperplasia?
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Atypical ductal hyperplasia and Atypical lobular hyperplasia
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What is the new term for atypical ductal hyperplasia?
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Ducatl Intraepithelial Neoplasia
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What is the new term for atypical lobulua hyperplasia?
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Lobular intraepithelial neoplasia
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How many women will develop breast cancer if live to be age 90+?
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One in nine
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Does breast carcinoma in situ have signs and symptoms?
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No--it is picked up by mammogram
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What are the risk factors associated with breast cancer?
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Genetic predispostion
Never being pregnant Being pregnany w/ 1st child after age of 30 Early menarche Late menopause Increasing age Proliferative breast changes |
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What type of cancer, besides breast, is BRCA 1 associated with?
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Ovarian
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Which BRCA gene is associated with a higher incidence of male breast cancer?
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BRCA 2
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What is "in situ" carcinoma?
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Stops at the basement membrane--located in the TDLU
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What are the in situ breast cancer types?
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Ductal carcinoma in situ
Lobular carcinoma in situ |
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What is ductal carcinoma in situ?
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Malignant cells confined to ducts--no spread beyond basement membrane
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What is significant about ductal carcinoma in situ?
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It is half of all mammographically detected cancers
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What are the ductal carcinoma in situ patterns?
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High grade (Comedo) or Low grade (Noncomedo)
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What is typically seen histologicallly in high grade DCIS?
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Ducts packed with calcifications
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What are the types of low grade/noncomedo DCIS?
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Solid
Cribiform Papillary Micropapillary |
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How is lobular carcinoma in situ usually diagnosed?
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Accidentally---usually looking for something else
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Is LCIS associated with calcifications?
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Rarely
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What is Paget Disease of the nipple usually associated with?
|
DCIS
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How does paget disease of the nipple present?
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Roughened red ecaematous apperance of the nipple
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What is Paget Disease of the Nipple?
|
Malignant epithelial cells migrating from the underlying DCIS
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Is infiltrating ductal carcinoma invasive or noninvasive?
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Invasive
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How do infiltrating ductal carcinomas usually spread?
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Lymphatics
Venous Direct invasion of adjacent structures |
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What is the grade of carcinomas measuring?
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The degree of differentiation
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What are Nottingham/Scarff-Bloom-Richardson's grading crtieria based on?
|
Tubule Formation
Nuclear Pleomorphism Mitotic count |
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What is stage?
|
Refers to the extent of the disease at the time of diagnosis
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What are the major stage groupings of breast cancer?
|
Tumor
Axillary Lymph Node Involvement Distant Metastisis |
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What is a stage 1 tumor?
|
Tumor less than 2 cms
No axillary node involvement No distant mestastisis |
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What is a stage 2 tumor?
|
Tumor greater than 5 cms
No axillary node involvement No distant metastisis OR Tumor less than 5 cms 1-3 Axillary nodes involved No distant mestastisis |
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What is a stage 3 tumor?
|
Collateral spread
Any axillary node involvement No distant metastisis OR Any size tumor Greater than 4 lymph nodes involved No distant metastisis |
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What is a stage 4 tumor?
|
Any tumor size
Any lymph node involvement Distant Metastisis Present |
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Which invasive cancer is known for propensity to spread hematogenously, CNS, ovaries, and peritoneum?
|
Infiltrating Lobular Carcinoma
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Which invasive carcinoma has less microcalcifications?
|
Infiltrating Lobular Carcinoma
|
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Which invasive carcinoma is more likely to be estrogen receptor positive?
|
Infiltrating Lobular Carcinoma
|
|
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What is the hallmark of infiltrating lobular carcinoma?
|
"Single (Indian) file" cells
|
|
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What type of invasive carcinoma typically has lymphocytes present in histo slide?
|
Medullary Carcinoma
|
|
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What is medullary carcinoma thought to be a subset of?
|
Ductal carcinoma
|
|
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What types of invasive breast cancer have an excellent prognosis?
|
Mucinous (Colloid) Carcinoma
Tubular Carcinoma |
|
|
Are myoepithelial cells present in tubular carcinoma?
|
No
|
|
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Are myoepithelial cells present in sclerosing adenosis?
|
Yes
|
|
|
What is inflammatory carcinoma of the breast?
|
Diffuse spread to dermal lymphatics and to small blood vessels
|
|
|
What stage is usually associated with inflammatory carcinoma of the breast?
|
Stage 3 or 4
|
|
|
How does inflammatory breast carcinoma usually present?
|
Breast swollen, reddened, and skin appears inflamed--often mistaken for a bacterial infection
|
|
|
What is a very common finding of inflammatory breast carcinoma?
|
Tumor emboli in superficial vessles
|
|
|
What is HER-2/neu?
|
A proto-oncogene that is overexpressed in some cancers--growth factor receptor
|
|
|
What drug can improve prognosis in HER-2?neu positive patients?
|
Herceptin--decreased HER-2/neu
|
|
|
What drugs are used for estrogen receptor positive patients?
|
Tamoxifen and Arimidex (only used in post-menopausal women)
|
|
|
What should be done if calcifications on dense breast are picked up?
|
MRI
|
|
|
What is a fibroadenoma?
|
Common, benign neoplasm of the breast composed of connective tissue and glanular elements
|
|
|
Who usually gets fibroadenomas?
|
Reproductive age women (15 to 30)
|
|
|
How do fibroadenomas usually appear?
|
Bulging, circumscribed white firm nodule
|
|
|
What is a Phyllodes tumor?
|
Composed of neoplastic proliferation of the stromal cellular elements in breast tissue that surround the glandular and ductal parts of the breast
|
|
|
Is a Phyllodes tumor malignant or benign?
|
Can be both--benign is usually a firboadenoma
|
|
|
How do Malignant Phyllodes tumors usually spread?
|
Hematogenously
|
|
|
What is idiopathic gynecomastia?
|
Seen in pubertal or immediate post pubertal males--can be unilateral or bilateral
|
|
|
What is hyperestrogen states gynecomastia?
|
Frequently seen in males with cirrhosis
|
|
|
Where does male breast cancer typically occur?
|
Subadjacent to the nipple and surrounding areola
|
|
|
What is a common symptom seen in male breast cancer?
|
Nipple discharge
|
|
|
What are the risk factors for male breast cancer?
|
Genetic
Decreased testicular function BRCA2 mutations Exposure to radiation Exposure to exogenous estrogens |
|
|
Does gynecomastia in adolescents confer an increased risk of male breast cancer?
|
No
|
