Pathology - Exam 3 - Breast

Front 1

At about _____ _____ _________, bilateral thickening of the epidermis forms ridges (milk lines) running between the upper and lower limb buds along ventral surface of body. These ridges progressively atrophy except for the superior portions which give rise to nipples.

Back 1

six weeks gestation

Front 2

At _____, rudimentary branching ducts have developed from the basal epithelium of the nipple.

Back 2

birth

Front 3

Prepubertal ductal development progresses slowly, and at _______, essentially ceases in the male. Female breasts however, in response to increasing sex hormone levels, undergo rapid ductal proliferation and branching ultimately producing rudimentary gland buds emanating from small terminal ductules. This yields 15-20 separate wedge shaped lobes each of which drain to the nipple by a lactiferous (collecting) duct.

Back 3

puberty

Front 4

Under ______ influence, the epithelium of the terminal ductules and gland buds proliferate.

Back 4

estrogen

Front 5

Increased ______ levels during the latter part of menstrual cycle stimulate intralobular stromal growth and edema (clinically resulting in swollen, tender breasts).

Back 5

progesterone

Front 6

Under the influence of _______ ________, numerous secretory glands branch out from gland buds so that with increased gestational age, the breast lobules become packed with secretory glands which obscure the stromal component of the breast parenchyma.

Back 6

placental hormones

Front 7

During the 3rd trimester, increasing _______ levels initiate secretory activity and immediately following birth, milk secretion begins. After lactation the glands regress and atrophy, but the breast does not completely revert back to the pre-parous state.

Back 7

prolactin

Front 8

At ________, there is further ductular and glandular atrophy which may result in the appearance of small cysts (cystic atrophy) and replacement of the fibrous stroma by adipose tissue.

Back 8

menopause

Front 9

During gestation, maternal hormones stimulate proliferation of ductal epithelium and periductal connective tissue and, on occasion, there may be abortive secretory activity. These changes quickly regress after birth due to withdrawal of hormonal support.

Back 9

neonatal hypertrophy

Front 10

Usually bilateral, this suggests excess estrogen activity (ovarian or adrenal disease, pituitary tumors, etc). These changes usually regress with correction of the underlying problem and lowering of hormone levels.

Back 10

prepubertal hypertrophy

Front 11

Although of obscure etiology, this may be related to increased sensitivity of breast tissue to hormonal stimulation. It may be unilateral or bilateral, generally does not regress, and may require reduction mammoplasty.

Back 11

Virginal hypertrophy

Front 12

This refers to hypertrophy/hyperplasia of the male breast and is usually due to excess estrogen levels (most often due to hepatic cirrhosis, lung carcinoma, estrogen therapy, testicular tumors, aging, etc) or high prolactin levels (pituitary tumors).

Back 12

Gynecomastia hypertrophy

Front 13

A family history of _____ ______ (especially premenopausal cancer in a mother or sister) greatly increases an individual's risk. Aberrations of chromosome 17 are present in over half of the patients.

Back 13

breast cancer

Front 14

Although of obscure etiology, this may be related to increased sensitivity of breast tissue to hormonal stimulation. It may be unilateral or bilateral, generally does not regress, and may require reduction mammoplasty.

Back 14

Virginal hypertrophy

Front 15

- The incidence of breast carcinoma is higher in patients who have received _______ _________, particularly during puberty.

Back 15

ionizing radiation

Front 16

Breast cancer is more common in those patients whose breasts have not achieved full anatomic _______ and ________ function.

Back 16

maturity and physiologic

Front 17

This refers to hypertrophy/hyperplasia of the male breast and is usually due to excess estrogen levels (most often due to hepatic cirrhosis, lung carcinoma, estrogen therapy, testicular tumors, aging, etc) or high prolactin levels (pituitary tumors).

Back 17

Gynecomastia hypertrophy

Front 18

A family history of _____ ______ (especially premenopausal cancer in a mother or sister) greatly increases an individual's risk. Aberrations of chromosome 17 are present in over half of the patients.

Back 18

breast cancer

Front 19

- The incidence of breast carcinoma is higher in patients who have received _______ _________, particularly during puberty.

Back 19

ionizing radiation

Front 20

Breast cancer is more common in those patients whose breasts have not achieved full anatomic _______ and ________ function.

Back 20

maturity and physiologic

Front 21

A role of unopposed _______ activity over a long reproductive life span as an etiologic factor. This is supported by increased incidence of breast carcinoma in women with early menarche and/or delayed menopause and post-menopausal women with abnormally high estrogen levels.

Back 21

estrogen

Front 22

These tend to be firm, non-tender, non-mobile masses with ill-defined borders that may be fixed to ____ or _____ _______.

Back 22

skin or deep muscle

Front 23

Fibrous desmoplastic response may cause dimpling of _____ or deviation or retraction of ______.

Back 23

skin
nipple

Front 24

Lymphatic involvement of skin may result in edema and "____________" appearance in breast cancer patients.

Back 24

peau d'orange

Front 25

The most common locations of breast cancer from greatest incidence to least.

Back 25

upper outer quadrant
nipple area
upper inner quadrant
lower outer quadrant
lower inner quadrant

Front 26

Almot all malignant tumors arise from the ______ _________ _____ and are therefore adenocarcinomas.

Back 26

terminal duct-lobular unit

Front 27

______ _________ occurs after menopause, patients may present with a cloudy nipple discharge, but currently most cases are identified by biopsy because of suspicious areas (microcalcifications, etc) identified on mammography.

Back 27

Intraductal carcinoma-in-situ

Front 28

_______ _________ does not cause mass lesions and usually is discovered in tissue biopsied for other reasons or because of suspicious mammographic findings.

Back 28

Lobular carcinoma-in-situ

Front 29

______ __________ may be multifocal within the involved breast and is bilateral in about 25%. It is, however, considered a marker of cancer risk and as such, it does imply a high risk of developing subsequent carcinoma (of any type) in either breast.

Back 29

Lobular carcinoma-in-situ

Front 30

_______ ____________ is considered a precursor lesion to subsequent infiltrating carcinoma at that site.

Back 30

Intraductal carcinoma-in-situ

Front 31

The most common form of breast cancer (75%), this has a peak incidence in the perimenopausal age range and presents as a hard, gritty, gray-white mass with irregular or indefinite borders.

Back 31

Infiltrating ductal, NOS, scirrhous

Front 32

Although there is microscopic variability, there is usually a reactive dense fibrous tissue stroma (desmoplasia) punctuated by nests and strands of malignant cells which may infiltrate the skin or pectoral muscles to produce fixation, skin dimpling, or retraction of the nipple.

Back 32

Infiltrating ductal, NOS, scirrhous

Front 33

There is a more insidious onset and the tumors tend to be larger when first discovered. They do show a somewhat greater incidence of axillary, GI, ovarian, peritoneal, and bone marrow metastases.

Back 33

Infiltrating lobular carcinoma

Front 34

This usually occurs in older women who give a history of fissuring, weeping, and ulceration of the nipple. These changes are associated with an underlying ductal adenocarcinoma (often of the larger lactiferous ducts) which may or may not be clinically evident.

Back 34

Paget disease of the breast

Front 35

The principal route of metastasis is via ________, especially the axillary lymph nodes since the majority of lesions are found in the upper outer quadrant. Distant metastases are found most frequently in the lung, bone (osteolytic), liver, adrenal, brain, and ovaries.

Back 35

lymphatics

Front 36

______ is based on tumor size and the presence or absence of axillary nodal and distant metastases.

Back 36

staging

Front 37

The result of focal hypersensitivity to estrogen, ___________ is the most common benign breast tumor.

Back 37

fibroadenoma

Front 38

__________ typically present as a solitary, well defined, discrete, rubbery, mobile 2-4 cm mass arising in the upper outer quadrant. Large (10-15 cm), bulky, lobulated, may deform the breast causing pressure necrosis and ulceration of overlying skin.

Back 38

fibroadenoma

Front 39

______ ______ tend to have a more cellular stroma and, in a minority of cases, may become malignant resulting in a sudden and rapid increase in size. Even malignant cystosarcomas tend to remain localized for prolonged periods and will eventually metastasize to distant sites in only 10-15% of cases.

Back 39

phyllodes tumor

Front 40

_______ _______ occur in the lactiferous duct of middle aged to elderly females, these are solitary papillary neoplasms. They may produce a watery or bloody nipple discharge and a small subareolar mass.

Back 40

intraductal papilloma

Front 41

This is a common denominator in most patients with fibrocystic disease but when occurring as an isolated lesion (an infrequent occurrence), it often presents as a unilateral, upper outer quadrant, poorly defined, rubbery, mobile mass which may be tender to palpation (especially prior to menses). There is no predisposition to subsequent malignancy.

Back 41

Fibrosis (increased stromal fibrous tissue)

Front 42

Intralobular fibrosis with proliferation of terminal ducts and gland buds results in a firm, relatively well defined, possibly tender or painful, mass lesion that tends to manifest unilaterally in the upper outer quadrant. Often, but not always, it is associated with other cystic changes. This carries a very small risk for subsequent development of carcinoma.

Back 42

Adenosis

Front 43

_____ __________ of the terminal duct and intralobular ductular epithelium may cause increased thickness of the epithelium or produce papillary projections into the lumens which may be focal or more generalized (ductal papillomatosis). In general, these changes do not cause discrete mass lesions but are often associated with other fibrocystic changes that do. Microcalcifications may be present.

Back 43

Epithelial hyperplasia

Front 44

The association between fibrocystic disease and breast cancer is proportional to the degree of _______ ________ and ______.

Back 44

epithelial hyperplasia and atypia

Front 45

______ ______ is a stromal hypertrophy and progressive hyperplasia and dilatation of terminal ducts without complete regression after menses results in a diffuse ill-defined increase in tissue consistency punctuated by discrete nodules.

Back 45

cystic change

Front 46

With ______ ______, usually multifocal and often bilateral, these macrocysts (>0.3 cm) may produce pain and tenderness (especially prior to menses). Solitary cysts, however, may be clinically confused with cancer especially if microcalcifications develop in the wall. Grossly, cysts may be brown or blue (blue dome cysts) depending on the fluid contained within. The presence of cysts does not imply any increased risk for the development of subsequent malignancy.

Back 46

cystic change