Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

52 Cards in this Set

  • Front
  • Back
Fibrocystic Change
Presentation: A 44-year-old female presents with bilateral, diffuse, irregular breast nodularity
Fibrocystic Change: What histologic changes may
you expect to see upon
reviewing the sections?
Varying proportions of
fibrosis, cysts, epithelial
hyperplasia, apocrine
metaplasia and chronic
inflammation; not all need
be present.
Fibrocystic Changes: Gross appearance- -carcinoma vs FCC
Breast tissue with fibrocystic change. Cysts and fibrous tissue are evident. In contrast to the stroma seen in carcinoma, this fibrous tissue is shiny and homogenous. The quantity of collagen present in these areas is not nearly as much as in carcinoma, so that these masses typically feel rubbery (versus scirrhous and chalky in carcinoma).
What histologic features in breast biopsy material may be associated
with INCREASE RISK of developing
breast carcinoma?
Epithelial hyperplasia – moderate
to florid hyperplasia
-Sclerosing adenosis
-Small duct papillomas
-Atypical epithelial hyperplasia,
ductal or lobular
What would you do if the
hyperplasia is atypical?
Follow-up closely…unless: the
lesion is close to an inked margin
of resection, there is strong family
history of breast cancer, or
multiple recurrences of atypical
Intraductal epithelial hyperplasia
associated with slightly higher incidence of subsequent development of carcinoma of the breast). Small duct almost filled by proliferating cells.
How do you tell histologically if ductal tissue is benign or malignant?
To diagnose as benign, must identify two cell populations lining ducts: epithelial and myoepithelial layers. Absence of myoepithelial cells indicates invasive carcinoma. Immunohistochemical stains may be necessary to reveal the presence of myoepithelial cells.
Distinguish epithelia from myoepithelia cells.
Epithelial cells have rounded nuclei. Myoepithelial cells have flattened, spindly nuclei, with often vacuolated cytoplasm (halo).
a. Most common benign breast tumor in women <35
b. Presentation: palpable, round, movable, rubbery mass
c. Gross: well circumscribed, tan, rubbery mass with small, cleftlikespaces
d. Micro: proliferation of benign stroma, ducts, and lobules
Fibradenoma presentation on exam
A 23-year-old female presents with a small 1.5 cm. freely moveable breast lump, located in the upper-outer quadrant of her right breast noted on self examination.
Fibradenoma: Gross appearance compared to carcinoma
“Shelled out” large, well-demarcated lesion. Notice that in contrast to breast carcinoma, this tumor has a very shiny, glistening appearance, has well defined, rounded borders, and no evidence of calcification within it.
Phyllodes tumor
a. Fibroadenoma variant usually involvesan older patient population (50s)
b. Micro: increased cellularity, stromal overgrowth, and irregular margins
c. May locally recur or rarely metastasize
What is the most important microscopic feature in distinguishing
fibroadenoma from phyllodes tumor?
Phyllodes tumors are distinguished from fibroadenoma based on
stromal cellularity, mitotic rate, nuclear pleomorphism, stromal
overgrowth, and infiltrative borders.
Discuss the prognosis of fibroadenoma and phyllodes tumor.
Fibroadenoma is a benign tumor.//

Low-grade phyllodes tumors may locally recur and rarely metastasize.//

High-grade phyllodes tumors behave even more aggressively.
Paget Disease of the nipple
a. Ulceration, oozing, crusting, and fissuring of the nipple and areola
b. Micro
i. Intraepidermal spread of tumor cells (Paget cells)
ii. Tumor cells occur singly or in groups
iii. Often have a clear halo surrounding the nucleus
c. Commonly associated with an underlying invasive or in situ ductal carcinoma
Extramammary vs. mammary paget disease? What's the difference?
In case of one in the nipple, there is underlying invasive or ductal carcinoma in situ

whereas extramammary Paget’s will have no underlying ductal carcinoma in situ (CIS)
What is the Paget cell derived from?
Underlying ductal carcinoma in situ cells (> 95% of cases).
Differential diagnosis, based on the histology with Paget disease?
Melanoma and squamous cell carcinoma in situ (Bowen’s disease).

Rule in melanoma if HMB-45 positive.
Paget Dz Histo
absence of intercellular bridges and a mitosis. The DCIS crawls up the epithelium to niple... disrupting juctions, resulting in leaking.
Carcinoma of the breast: case history
A healthy 42-year-old woman comes to you for a routine physical examination.
Her family history reveals that her mother died of breast cancer 5 years ago and that an older sister had a radical mastectomy for breast cancer 3 years ago.
A mammogram is performed and demonstrates a suspicious area in the upper outer quadrant of the left breast.
A breast biopsy is performed, and based upon the pathologic findings, estrogen/progesterone receptor analysis and Her-2/neu expression analysis are done.
Additionally, because of her family history, you request testing for alterations in BRCA-1 and BRCA-2 genes.
Assume she has breast cancer. Why is age and family history important?
Young age at presentation and significant family history suggests a
genetic predisposition.
What percentage of breast cancers appear to be associated with an
inherited predisposition?
Carcinoma of the breast: mammogram
star-shaped mass or rounded mass with calcifications or architecturla distortions.
At what age should yearly screening mammograms begin?
At 40-50 years age.
What is the most common area of origin for breast carcinoma?
Why is it important? Is primary tumor size important?
Malignant tumors are most frequent in the upper outer quadrants of the breast. From this location they metastasize early to axillary lymph nodes.
Depending on primary tumor size and location, metastases may also involve internal mammary and supraclavicular nodes. The larger the primary, the more likely you are to find positive nodes.
Why are the upper outer quadrants involved most frequently by
breast cancer?
They contain a larger amount of breast tissue.
Why were the estrogen/progesterone receptor analysis and Her-2/neu expression analysis performed?
Tumors lacking estrogen or progesterone receptors are less likely to respond to hormonal manipulation. Breast carcinomas that overexpress Her-2/neu have a worse prognosis, may be less responsive to certain chemotherapeutic agents, yet may respond to therapy targeting this protein (Herceptin).
What are implications of detecting BRCA1 or BRCA2 mutations?
increased risk of breast and ovarian cancer esp. in women under age of 50.
Role of BRCA1 and BRCA2 in men?
BRCA1: increase prostate cancer.//

BRCA2: increased breast cancer
What is inflammatory carcinoma?

It is a clinical diagnosis when the breast is reddened and warm (mastitis-like),
with diffuse, firm cutaneous edema producing an orange-skin appearance. Most have carcinomatosis of the dermal lymphatics, a poor prognostic sign. buzzword: 'Peau d'orange' (orange peel)
Breast Carcinoma: Gross
The tumor is not as shiny as the breast tissue secondary fibrous replacement of glandular tissue. This explains the firm, hard feeling of breast carcinomas on exam. The tumor has irregular, white finger-like projections extending out into the fat. This is why the tumors feel poorly demarcated.
Breast Carcinoma: Histo
monotonous, atypical and enlarged intraductal cells and central necrosis. Necrosis is often associated with microcalcifications. You may also see mitotic figures.
Name three breast carcinoma types with a better prognosis than
breast carcinoma of no specific type (NOS).
1. Medullary carcinoma

2. Colloid carcinoma

3. Tubular carcinoma
Histo: Ductular vs. Lobular
The presence of small ductular structures define this tumor as
ductal type (versus lobular).//

Lobular carcinomas invade in characteristic single cell rows (Indian-file type of infiltration).
Leukoplakia (vulval)
The white appearance of this vulvar lesion is caused by an increased number of cells and keratin.
Leukoplakia is a descriptive clinical term, is not a diagnosis.
Many lesions of the vulva may present as leukoplakia, so a biopsy is always necessary to establish the diagnosis of carcinoma in situ.
What is the erythroplasia of Queyrat?
Red-colored vulvar intraepithelial neoplasia (carcinoma in situ) lesions involving the nonkeratinized squamous epithelium of the vestibule.
What is the bowenoid papulosis?
Pigmented and papular or verrucoid vulvar intraepithelial neoplasia (carcinoma in situ) lesions involving the keratinized vulvar skin.
Vulvar Intraepithelial Neoplasia: grading
VIN 1 - immature cells, cellular disorganisation, mitotic activity in the lower one- third of the epithelium,
VIN 2 - immature cells with scanty cytoplasm and severe chromatinic alterations occupy most of the epithelium (changes of HPV info : perinuclear halos with displacement of the muclei by the intracytoplasmic viral protein, thickened cell borders, binucleation, multinucleation)
VIN 3 - unifocal or multifocal: small hyperpigmented lesions on the labia major,
(clinically: multiple small, pigmented papules less than 5 mm - 40% cases (bowenoid papulosis = dysplasia)
histologic features of carcinoma in situ (VIN III).
There is an increase in the thickness of the epithelium, with lack of maturation towards the surface.

lack of maturation towards the surface. There is dyskeratosis: individual cells are keratinizing before reaching the mucosal surface

mitotic figures extending close to the surface
What is the evidence that suggests that HPV infection is involved in the pathogenesis of VIN III and is not just a secondary or unrelated event?
Viral sequences are present within keratinocytes, are transcriptionally active and encode proteins which interfere with cell cycle control.
In vitro studies demonstrate that viral genes are capable of cellular
What HPV are involved?
Only some HPV types, e.g. HPV 16/18, are associated with VIN III.
Others, e.g. HPV 6/11, are associated with vulval warts.
Is vulvar squamous carcinoma always associated with HPV?
no, also could be associated with lichen sclerosus and squamous hyperplasia
Treatment of VIN
Unifocal VIN III:
- local excision//

Multifocal VIN III:
- Patients should always have vulvoscopy and vulval mapping biopsies to determine the extent of the disease. Surgical excision or laser ablation can then be planned according to the distribution of the lesions.
- If very extensive, a conservative policy is often adopted. Patients are followed up carefully with regular vulvoscopy and biopsy and surgical intervention is reserved for the development of invasive disease.
Abnormal Pap smear
Pap smear with numerous koilocytes. The nuclei are somewhat enlarged, hyperchromatic, and wrinkled (raisinoid). There is a perinuclear halo void of cytoplasm (accumulation of virus particles), and the cytoplasm is condensed at the periphery of the cell.
Which HPV types are considered high risk?
HPV types 16, 18, 31, 33, 35
Is there an association between HPV types and cervical
Yes. HPV types 16, 18
What the heck is SIL?
CIN may progress to squamous intraepithelial lesion (SIL; condition that precedes cervical cancer) or to carcinoma in situ (cancer that does not extend beyond the epithelial membrane). SIL is also classified as low-grade or high-grade. High-grade SIL and carcinoma in situ may progress to invasive carcinoma
Symptomology: Cervical carcinoma vs. endometrial cancer.
Cervical carcinoma symptoms
Early: asymptomatic
Late: includes spotting or, more ominous, may be related to invasion of adjacent tissues and structures (bladder and rectum).//

Endometrial cancer symptoms
Early: bleeding
Prognosis: Cervical vs. endometrial cancer
Cervical carcinoma prognosis: stage dependent, i.e. screen-detected lesions are often microinvasive (stage Ia) and are curable by excision, hence similar to endometrial tumors prognostically. Symptomatic tumors present at a late stage, poorer prognosis
Endometrial cancer prognosis: good prognosis because it presents early: most tumors are stage I at diagnosis.
CIN: Histo
Most of the epithelial surface contains cells with enlarged hyperchromatic nuclei and irregular nuclear borders that do not become smaller towards the epithelial surface. There is a perinuclear halo.
What evidence supports that most of
these high-grade SIL are neoplastic?
They tend to be aneuploid, monoclonal,progressive, usually associated with the
oncogenic types of HPV (16, 18, 45, 56,38), and usually 1 type of HPV is identified in the lesion.
CIN Progression
takes about 10-15 years

CIN I (mild dysplasia)

. CIN II (moderate dysplasia)

. CIN III (severe dysplasia)

. CIS (carcinoma in situ)

. Invasive squamous-cell carcinoma