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49 Cards in this Set

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What is a breast and where can it develop?
-modified sweat gland
-can develop anywhere along the milk line
How is the breast divided?
Into lobes (by fibrous septae)
What are within the lobes and what do they produce?
lobules (milk producing portions of the breast)
What do the lobules drain into?
ducts, into bigger ducts (that all meet in the nipple)
Where does breast sit?
on top of fascia for the pectoralis muscle (and beneath that muscle is more muscle and ribs)
Where does most breast tissue drain into?
ipsilateral axilla
Where does a small portion of breast tissue drain into?
-small portion of the superior breast drains to mammary lymph nodes (internal thoracic)
-very small portion drains to supraclavicular nodes
Typical appearance of a non-lactating breast (histology)
acini-->ducts-->bigger ducts
-surrounded by loose CT
Terminal Duct Lobular Unit
-terminal duct and its lobules and their surrounding stroma
-ALL are hormonally responsive
In a series of women presenting with 'breast problems'
-40% fibrocystic changes
-30% no disease
-13% miscellaneous benign
-10% cancer (small!)
-7% fibroadenoma
Is it difficult or easy to distinguish between a benign or malignant disease of the breast?
difficult
Clinical Presentation of Breast Pathology
-palpable mass
-inflammatory lesion (cellulitis)
-nipple secretion (not lactation)
-mammographic abnormality (thickening or calcification)

any can lead to the need for a biopsy
Nipple Inversion
bad sign! often associated with malignancy BUT scars can do the same thing
Inflammatory conditions - acute mastitis and breast abscess
-nipple cracks/fissures allow bacterial entry (lactating period, eczema and other skin conditions are risk factors)
-normal skin flora can lead to infection if they enter the skin
Organisms associated with acute mastitis and breast abscess
-staph aureus most common
-strep
Treatment of acute mastitis and breast abscess
incision
drainage
antibiotics
What are 3 inflammatory conditions of the breast?
acute mastitis and breast abscess
mammary duct ectasia
fat necrosis
Mammary duct ectasia
-5th, 6th decade, multiparous females
-Dilation of ducts and inspissated secretions--granulomas and plasma cells
-Induration with cheesy material in ducts
Fat necrosis
-"inflammatory reaction of fat"
-associated with trauma
-can present as a mass lesion clinically (mimics carcinoma)
Histology of fat necrosis
-Hemorrhage and acute inflammation--then necrosis--then chronic inflammation, foamy macrophages---then scar
3 types of fibrocystic changes
-cyst formation and fibrosis
-epithelial hyperplasia
-sclerosing adenosis
Clinical presentation of fibrocystic changes and mammogram
-clinically may present as a mass
-mammogram can show microcalcifications
Cyst formation and fibrosis
-Most common pattern
-Usually multifocal and bilateral (which is opposite to most tumors)
-Increased stroma and dilated ducts/cysts
-“Blue dome cysts”--appear blue grossly, filled with turbid fluid
-Apocrine metaplasia
-No increased risk for cancer
Epithelial hyperplasia
-Increased layers of cells beyond usual double layer in ducts
-Papillary or solid
-1.5-2 X increased risk for cancer (if moderate to florid)
-If Atypical Ductal Hyperplasia: 5X increased risk
Sclerosing adenosis
-less common but very troublesome
-squeezing of the ducts (lobular arrangement is maintained)
-small ducts proliferate and surrounded by fibrous stroma
-maintain lobular arrangement
-1.5-2 X increased risk for cancer
2 types of stromal tumors of the breast
-fibroadenomas (benign)
-phyllodes tumors (have potential to become malignant)
What is the most common benign tumor of the breast?
fibroadenomas
Fibroadenomas
-new growth of fibrous and glandular tissue (only the fibrous part is clonal)
-more common in women younger than 30 but any age is possible
Clinical presentation of fibroadenomas
-Palpable mass, well circumscribed, movable
Gross and Microscopic presentation of fibroadenomas
-gross: gray-white rubbery, most 2-4 cm, may have slit-like spaces
-microscopic: stromal proliferation with round to slit-like glands
Compared to fibroadenomas, phyllodes tumors show:
More cellularity
More mitoses
More nuclear pleomorphism
-BOTH have squished epithelial cells
Low grade phyllodes tumor
More common
Can recur locally
Rarely metastasize
Behave like fibroadenomas (so surgical removal should work fine)
High grade phyllodes tumor
Rare
Spreads like sarcoma
Where are intraductal papillomas typically found?
-in large lactiferous ducts
Clinical presentation of intraductal papillomas
-Nipple discharge (serous or bloody)
-Small subareolar mass--rarely >1cm
-Nipple retraction rarely
Microscopic presentation of intraductal papillomas
-papillary epithelial projections with vascular connective tissue core
Breast Cancer: cases/year and deaths/year
-183,000 cases/year
-41,000 deaths/year
Breast Cancer: what percentage of cancer deaths in women?
20%
(second to lung cancer)
Chance of women developing breast cancer in their lifetime and lifetime risk of death from breast cancer
-1:9 chance
-3.4% lifetime risk of death from breast cancer
Risk factors for Breast Cancer
Age
Family History
Reproductive history
Estrogen supplementation
Alcohol consumption: more than a drink a day
Breast density
Prior abnormal biopsies
Breast Cancer Risk: age
Rare before 25 years old and may occur anytime after
More common over 50 years old
Peak incidence at or after menopause
Breast Cancer Risk: geographics
5x more common in US than Japan and Taiwan
Breast Cancer Risk: family history
-1.5-2x risk with one first degree relative with breast cancer; 4-6x risk with two
-Maternal and paternal history, male breast cancer, young age, all cancers
-Genetic disorders: 5-10% (BRCA, Li-Fraumeni)
Test Question: (T/F) Most women who get breast cancer DO NOT have inherited genetic risk
true!
Breast Cancer Risk: reproductive history
-length of reproductive life (increased risk with early menarche and late menopause (longer exposure to estrogen))
-parity (nulliparous = no break in pregnancy, increased risk!)
-age at first child (>30 years old, increased risk)
-obesity (fat can lead to increased estrogen
Breast Cancer Risk: estrogen supplementation
Exogenous Estrogen (moderately increased risk for high dose, unopposed estrogens)
Oral Contraceptives (no clear cut increased risk for modern formulations)
Breast Cancer Risk: alcohol consumption
more than one drink/day
Breast Cancer Risk: Prior abnormal biopsies
Atypical Hyperplasia (result in high levels of estrogen)
History of breast cancer (if you've had it once, you are at risk for recurrence)
Genetic and Environmental risk factors for BC
-big part of genetic=unknown (few genes have been connected)
-big part of environmental = estrogen!