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210 Cards in this Set

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