Pathology - S2B3 - Breast 1

Front 1

Shown is a normal Terminal Duct Lobular Unit
1. Blue arrow?
2. Brown arrow?

Which one is hormonal responsive?

Back 1

Blue = Intralobular Stroma

Brown = Interlobular Stroma

Hormonal responsive = Intralobular Stroma

Front 2

What does a normal Terminal Ductal Lobular Unit look like?

Back 2

1-2 layers of Epithelial cells surrounded by a layer of Myoepithelial cells

Front 3

Definition: Dense fibroconnective tissue admixed with Adipose tissue

Back 3

Interlobular Stroma

Front 4

Definition: An inner ductal epithelium & an outer Myoepithelial layer

Back 4

Functional Secretory Unit = Terminal Duct Lobular Unit

Front 5

Definition: Loose, delicate, myxomatous stroma that is Hormonally responsive & contains scattered lymphocytes

Back 5

Intralobular Stroma

Front 6

In a normal breast during which phase of Menstruation are the lobules quiescent (inactive)?

Back 6

Follicular (proliferative) Phase

Front 7

In the normal breast, when does the number of acini per lobule increase, epithelial cells vacuolize, and marked lobular stromal edema occurs?

Back 7

After Ovulation

Front 8

In the normal breast, what 3 things occur after ovulation?

Back 8

1. # of acini per lobule increases
2. vacuolization of epithelial cells
3. marked lobular stromal edema

Front 9

What happens to the breasts during pregnancy?

Back 9

1. Enlarged lobules by increased # of dilated acini
2. true secretory glands form in the lobule
3. secretory vacuoles of lipid material appear
4. after birth, secretion of milk begins

Front 10

In a normal breast, what happens after cessation of lactation?

Back 10

Lobules regress & atrophy

Front 11

What happens to the breast Post-menopausally?

Back 11

1. Atrohpy of ducts & lobules
2. Shrinkage of Intralobular & Interlobular Stroma
3. Lobular Acini & Stroma may almost totally disappear

Front 12

A = normal pre-menopausal breast
B = same as A
C = Pregnancy
D = Postmenopausal
E = Postmenopausal = less dense due to atrophy

Back 12

What is shown in A, B, C, D, E?

Front 13

When does "Acute Mastitis" almost always occur?
What is the etiologic agent?

Back 13

Lactation period

S. aureus or Streptococci

Front 14

A woman presents with a UNILATERAL, ERYTHEMATOUS PAINFUL, ABSCESS in her left breast. History is positive for BREAST-FEEDING. Dx? Treatment?

Back 14

Dx = Acute Mastitis due to S. aureus or Streptococci infection

Treatment = Antibiotics & complete drainage of milk

Front 15

Benign breast inflammation that has a strong association with Smoking?

Back 15

Periductal Mastitis = Subareolar Abscess

Front 16

Periductal Mastitis = Subareolar Abscess

Smoking

Back 16

What is seen here?

What does it have a strong association with?

Front 17

Describe the pathogenesis of Periductal Mastitis

Back 17

Squamous Metaplasia of Lactiferous Ducts -> Keratin trapped within duct -> dilation -> rupture -> intense inflammatory response

Front 18

What is the clinical presentation of Periductal Mastitis? What is the treatment?

Back 18

Painful erythematous subareolar mass

Surgical Excision

Front 19

Breast inflammation that usually occurs in older age (50-60) & has a greenish-brown, thick cheesy nipple secretion

Back 19

Mammary Duct Ectasia = Plasma Cell Mastitis

Front 20

Describe the pathogenesis of Mammary Duct Ectasia

Back 20

1. Inspissation (thickening) of breast secretions
2. dilation of ducts
3. periductal & interstitial chronic granulomatous inflammatory reaction

Front 21

What pathology is this?

Back 21

Mammary Duct Ectasia = Plasma Cell Mastitis

Front 22

Breast inflammation that often follows trauma or surgery and may possibly be confused with Breast CA as a palpable mass or mammographic calcification

Back 22

Fat Necrosis

Front 23

Describe the pathology seen in Breast Fat Necrosis

Back 23

1. Necrotic fat cells surrounded by lipid-filled macrophages & intense neutrophilic infiltration
2. Fibroblastic proliferation, vascularization, lymphocytes & foamy lipid-laden macrophages
3. Calcification
4. Scar tissue

Front 24

Trauma ("seat-belt injury") or surgery

Fat Necrosis

Back 24

What is usually the cause of this?

Front 25

List the 3 Benign Epithelial Breast lesions

Back 25

1. Non-proliferative breast changes = Fibrocystic Changes

2. Proliferative breast disease without atypia

3. Proliferative breast disease with Atypia

Front 26

What is the single most common breast disorder/mass in women <50 yoa?

Back 26

Fibrocystic Changes

Front 27

What does Fibrocystic Change feel like on breast examination?

Back 27

"lumpy bumpy" feeling

Front 28

What is the pathogenesis of Fibrocystic Changes due to?

Back 28

Hormonal imbalances b/w Estrogen & Progesterone

**increased Estrogen &/or decreases Progesterones

Front 29

List the 3 histologic types of Nonproliferative Fibrocystic Changes

Back 29

1. Cysts
2. Fibrosis
3. Adenosis

Front 30

Describe the Cysts in Nonproliferative Fibrocystic Change

Back 30

1. Dilation & unfolding of ducts & lobules -> larger cysts (Blue-dome cysts) -> ill-defined diffuse increase in consistency or discrete nodularities

2. Secretory products w/in cysts calcify -> microcalcifications

3. Cysts lined by a flattened atrophic epithelium or epithelium w/ Apocrine Metaplasia

Front 31

Describe Apocrine Metaplasia

Back 31

seen in Fibrocystic Changes in which there are large polygonal cells with abundant granular, eosinophilic cytoplasm

Front 32

Describe the pathogenesis of Fibrosis in Fibrocystic Changes

Back 32

Cysts rupture -> chronic inflammation & scarring fibrosis

Front 33

This is a term used to describe an increase in the # of acinar unites per lobule seen in Fibrocystic changes

Back 33

Adenosis

Front 34

Blue-dome cyst in Fibrocystic Change

Back 34

What pathology is seen here?

Front 35

Fibrocystic change
-Cysts are visible
-fibrosis surrounds the cysts
-sometimes the secretions w/in cysts will calcify

Back 35

What pathology is this?

Front 36

Apocrine Metaplasia in Fibrocystic Change = pink/eosinophilic staining cells

Back 36

What pathology is this?

Front 37

Apocrine Metaplasia in Fibrocystic Change

Back 37

What pathology is seen here?

Front 38

What characterizes "Proliferative Breast Disease without Atypia"?

Back 38

Proliferation of ductal epithelium &/or stroma without cellular abnormalities

Front 39

What 3 entities does "Proliferative Breast w/out Atypia" include?

Back 39

1. Moderate or florid epithelial hyperplasia w/out atypia

2. Sclerosing Adenosis

3. Papillomas

Front 40

What 3 entities does "Proliferative Breast w/out Atypia" include?

Back 40

1. Moderate or florid epithelial hyperplasia w/out atypia

2. Sclerosing Adenosis

3. Papillomas

Front 41

Describe "Epithelial Hyperplasia"

Back 41

1. more than 4 cell layers are present

2. Florid, but architecturally & cytologically benign, hyperplasia

Front 42

Left = normal

Right = Ductal Hyperplasia w/out Atypia

Back 42

Left = ?

Right = ?

Front 43

Epithelial Hyperplasia without Atypia

Back 43

What pathology is seen in both of these pictures?

Front 44

Describe "Sclerosing Adenosis?

Back 44

1. increased # of acinia per Terminal Duct Lobular Units

2. acini are compressed & distorted by the surrounding dense stroma

3. well-circumscribed outer border

4. calfifications are common

Front 45

Sclerosing Adenosis = increased # of acini/TDLU but each acini is still 1-2 layers of epithelium

Back 45

What pathology is this?

Front 46

Papilloma in Proliferative Breast Disease w/out Atypia

Back 46

What pathology is this?

Front 47

What 2 entities does Proliferative Breast Disease WITH Atypia include?

Back 47

1. Atypical Ductal Hyperplasia

2. Atypical Lobular Hyperplasia

Front 48

Benign breast lesion characterized by proliferation of ductal epithelium with cellular and architectural abnormalities

Back 48

Atypical Ductal Hyperplasia seen in Proliferative Breast Disease w/ Atypia

Front 49

Benign breast lesion that has a monomorphic cell population, regular cell placement, and round lumina. Is qualitatively & quantitively short of ductal carcinoma in-situ

Back 49

Atypical Ductal Hyperplasia

Front 50

Benign breast lesion characterized by a population of monomorphic small round cells partially filling a lobule

Back 50

Atypical Lobular Hyperplasia

Front 51

Atypical Ductal Hyperplasia seen in Proliferative Breast Disease w/ Atypia

Back 51

What pathology is this?

Front 52

Atypical Lobular Hyperplasia

Back 52

What pathology is this?

Front 53

Benign breast lesion that confers no increased risk of developing invasive breast cancer

Back 53

Non-proliferative Fibrocystic Change
-Cysts
-Fibrosis
-Adenosis

Front 54

Benign breast lesions that confer a 1.5 - 2 fold increased risk of developing invasive Breast CA

Back 54

Proliferative Breast Disease without Atypia
-Epithelial Hyperplasia w/out Atypia
-Sclerosing Adenosis
-Papillomas

Front 55

Benign breast lesion that confers a 4-5 fold increased risk of invasive Breast CA

Back 55

Proliferative Breast Disease w/ Atypia
-Atypical Ductal Hyperplasia
-Atypical Lobular Hyperplasia

**the risk is equal in both breasts

Front 56

What is the rank of Breast CA as a cause of death in women?

Back 56

2nd to Lung CA

Front 57

T or F: Breast CA is the most common non-skin malignancy of women

Back 57

True

Front 58

When is breast CA uncommon?

When does incidence peak?

Fraction of women who will develop Breast CA in lifetime

Back 58

before age of 35

around Menopause

1/9

Front 59

What is the strongest associated risk factor for Breast CA?

Back 59

+ family history, especially in first-degree relative

Front 60

BRCA that is associated with hereditary Breast & Ovarian Cancers

Back 60

BRCA-1

Front 61

BRCA that is associated with a younger age of onset & has a greater incidence of Medullary CA's & higher grade tumors

Back 61

BRCA-1

Front 62

BRCA that is associated with an older age of onset & an increased CA risk in Male breasts

Back 62

BRCA-2

Front 63

BRCA that has similar pathology as sporadic carcinomas

Back 63

BRCA-2

Front 64

List the races who have higher risk factors for Breast CA

Back 64

Caucasians > AA's > Asian > Hispanic

Front 65

Explain how "hormonal influences" are risk factors for Breast CA

Back 65

Early menarche, late menopause, older age at 1st kid, nulliparity -> increase imbalanced exposure to estrogen -> estrogen receptors -> growth factors secretion -> unregulated cell growth & tumor progression

Front 66

What environmental factors are risk factors for Breast CA?

Back 66

1. Geographic distribution

2. Dietary fat content

3. Environmental contaminant (organochlorine pesticides)

*Smoking is NOT a risk factor