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25 Cards in this Set

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Most pathology in breast occurs where?
In the ducts

Since males have ducts too, males can get breast cancer too.
Mastitis
staph aureus, fissuring and ulceration, redness of nipple
Fat Necrosis
YOUNG PERSON, very ACTIVE, trauma or prior surgery. Dected on mammagoraphy
Fibrocystic changes
aka fibrocystic dz. Palpable mass.

often involves upper outer quadrant.
MOST COMMON CAUSE OF BREAST MASS.

2. Normal breast

3. Cancer

4. Fibroadenoma
Non-proliferative Fibrocystic changes
Fibrosis, cysts (blue domed), apocrine metaplasia, microcalcifications
Proliferative Changes
Ductal hyperplasia {PM} atypia.

sclerosing adenosis, small duct papillomas
Relative risk increase due to fibrocystic changes in devp cancer?
1.5-2x: Fibrosis, cysts, apocrine metaplasia, adenosis.

4-5x atypical ductal or lobular hyperplasia
Fibrocystic vs. cancer?
Fibrocystic: bilateral, multiple nodules, menstrual variation, cyclic pain and engorgement, regress during pregnancy.

Cancer: opposite of above.
Benign Neoplasm
Fibroadenoma, Phyllodes tumor (a type of fibroadenoma), Intraductal papilloma
Fibroadenoma
most common benign tumor in women < 35, palpable, movable, rubbery mass w/ cleft-like spaces.

prolif. of benign stroma, ducts and lobules.
Phyllodes tumor (cystosarcoma phyllodes)
fibroadenoma variant. Older pts (50s)

Micro: increase cellularity, stromal overgrowth and irregular margins. They rarely metastasize.
Intraductal papilloma
presentation: BLOODY NIPPLE DISCHARGE

occur in lactiferous sinuses or ducts (benign papillary growth).
Malignant Neoplasms of the breast
Carcinoma of the breast, inflammatory carcinoma, Paget dz of the nipple.
Carcinoma of the breast
rising incident (1 in 9 women).

Risk factors: age, first degree relative with breast cancer.

Genetic: 5-10%: BRCA 1 (17q11), BRCA 2 (13q12), Li Fraumeni Syndrome: p53 germline mutation

nulliparity, obesity, exogenous estrogen, fibrocystic changes with atypical hyperplasia
Carcinoma of the breast: cinical presenation
mammographic calcification or architectural distrotion.

solitary, painless mass, nipple retration, skin dimpling, fixation to chest wall, most common in outer upper quadrant.

Gross: STELLATE, white-tan, gritty mass (if you scrap it)
Preinvasive Lesions of breast
DCIS: linear microcalcification

Lobular carcinoma in situ (LCIS).

LCIS is incidental finding, not palpable, multifocal, bilateral

Paget's Dz
Invasive (infiltrating) Ductal Carcinoma
most common, >80%

has STELLATE, finger-projecting, appearance on the mammorgraphic image

tumor from duct within desmoplastic stroma
Invasive (infiltrating) Lobular carcinoma
5-10%, SINGLE FILE PATTERN, (indian file pattern),

high incidence of multifocal and bilateral disease.
Mucinous (colloid) carcinoma
POOLS OF MUCINS with malignant cells floating in it. so better prognosis

Older Women, ER pos tumor
Tubular Carcinoma
round tubular, NO myoepithelial cells, rarely metastasize, good px.
Medullary Carcinoma of breast
Not stellate, but circumscribed border with lymphocytes.

sheets of cells, high in BRCA 1 pts.
Inflammatory Carcinoma
red, warm edematous skin, PEAU D' ORANGE, extensive dermal lymphatic invasion by tumor.

Poor Px
Breast Cancer Px
lymph node status, size, histologic type, grade, ER/PR pos/Neg status (trt with tamoxifen.

Overexpression of c-erbB2 (Her2/neu). (Herceptin: Ab against this receptor)

S-phage and DNA ploidy in flow cytometry.
Paget Dz of the Nipple
Dz of nipple and areola.

ulceration, oozing, crusting and fissure of the nipple and areola.

Intraepidermal spread

CLEAR HALO surrounding nucleus
They can occur singly or in multiples

assoc. w/ underlying invasive or in situ ductal carcinoma.

When you have this, you need to find the underlying dz.

Paget's Dz of vulva, no underlying dz.

Paget's Dz of bone: that's a metabolic bone dz.
Cystosarcoma Phyllodes
if metastasizes, chemo or radiation doesn't work. In elderly women.