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66 Cards in this Set

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

Which one is hormonal responsive?
Blue = Intralobular Stroma

Brown = Interlobular Stroma

Hormonal responsive = Intralobular Stroma
What does a normal Terminal Ductal Lobular Unit look like?
1-2 layers of Epithelial cells surrounded by a layer of Myoepithelial cells
Definition: Dense fibroconnective tissue admixed with Adipose tissue
Interlobular Stroma
Definition: An inner ductal epithelium & an outer Myoepithelial layer
Functional Secretory Unit = Terminal Duct Lobular Unit
Definition: Loose, delicate, myxomatous stroma that is Hormonally responsive & contains scattered lymphocytes
Intralobular Stroma
In a normal breast during which phase of Menstruation are the lobules quiescent (inactive)?
Follicular (proliferative) Phase
In the normal breast, when does the number of acini per lobule increase, epithelial cells vacuolize, and marked lobular stromal edema occurs?
After Ovulation
In the normal breast, what 3 things occur after ovulation?
1. # of acini per lobule increases
2. vacuolization of epithelial cells
3. marked lobular stromal edema
What happens to the breasts during pregnancy?
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
In a normal breast, what happens after cessation of lactation?
Lobules regress & atrophy
What happens to the breast Post-menopausally?
1. Atrohpy of ducts & lobules
2. Shrinkage of Intralobular & Interlobular Stroma
3. Lobular Acini & Stroma may almost totally disappear
A = normal pre-menopausal breast
B = same as A
C = Pregnancy
D = Postmenopausal
E = Postmenopausal = less dense due to atrophy
What is shown in A, B, C, D, E?
When does "Acute Mastitis" almost always occur?
What is the etiologic agent?
Lactation period

S. aureus or Streptococci
A woman presents with a UNILATERAL, ERYTHEMATOUS PAINFUL, ABSCESS in her left breast. History is positive for BREAST-FEEDING. Dx? Treatment?
Dx = Acute Mastitis due to S. aureus or Streptococci infection

Treatment = Antibiotics & complete drainage of milk
Benign breast inflammation that has a strong association with Smoking?
Periductal Mastitis = Subareolar Abscess
Periductal Mastitis = Subareolar Abscess

Smoking
What is seen here?

What does it have a strong association with?
Describe the pathogenesis of Periductal Mastitis
Squamous Metaplasia of Lactiferous Ducts -> Keratin trapped within duct -> dilation -> rupture -> intense inflammatory response
What is the clinical presentation of Periductal Mastitis? What is the treatment?
Painful erythematous subareolar mass

Surgical Excision
Breast inflammation that usually occurs in older age (50-60) & has a greenish-brown, thick cheesy nipple secretion
Mammary Duct Ectasia = Plasma Cell Mastitis
Describe the pathogenesis of Mammary Duct Ectasia
1. Inspissation (thickening) of breast secretions
2. dilation of ducts
3. periductal & interstitial chronic granulomatous inflammatory reaction
What pathology is this?
Mammary Duct Ectasia = Plasma Cell Mastitis
Breast inflammation that often follows trauma or surgery and may possibly be confused with Breast CA as a palpable mass or mammographic calcification
Fat Necrosis
Describe the pathology seen in Breast Fat Necrosis
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
Trauma ("seat-belt injury") or surgery

Fat Necrosis
What is usually the cause of this?
List the 3 Benign Epithelial Breast lesions
1. Non-proliferative breast changes = Fibrocystic Changes

2. Proliferative breast disease without atypia

3. Proliferative breast disease with Atypia
What is the single most common breast disorder/mass in women <50 yoa?
Fibrocystic Changes
What does Fibrocystic Change feel like on breast examination?
"lumpy bumpy" feeling
What is the pathogenesis of Fibrocystic Changes due to?
Hormonal imbalances b/w Estrogen & Progesterone

**increased Estrogen &/or decreases Progesterones
List the 3 histologic types of Nonproliferative Fibrocystic Changes
1. Cysts
2. Fibrosis
3. Adenosis
Describe the Cysts in Nonproliferative Fibrocystic Change
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
Describe Apocrine Metaplasia
seen in Fibrocystic Changes in which there are large polygonal cells with abundant granular, eosinophilic cytoplasm
Describe the pathogenesis of Fibrosis in Fibrocystic Changes
Cysts rupture -> chronic inflammation & scarring fibrosis
This is a term used to describe an increase in the # of acinar unites per lobule seen in Fibrocystic changes
Adenosis
Blue-dome cyst in Fibrocystic Change
What pathology is seen here?
Fibrocystic change
-Cysts are visible
-fibrosis surrounds the cysts
-sometimes the secretions w/in cysts will calcify
What pathology is this?
Apocrine Metaplasia in Fibrocystic Change = pink/eosinophilic staining cells
What pathology is this?
Apocrine Metaplasia in Fibrocystic Change
What pathology is seen here?
What characterizes "Proliferative Breast Disease without Atypia"?
Proliferation of ductal epithelium &/or stroma without cellular abnormalities
What 3 entities does "Proliferative Breast w/out Atypia" include?
1. Moderate or florid epithelial hyperplasia w/out atypia

2. Sclerosing Adenosis

3. Papillomas
What 3 entities does "Proliferative Breast w/out Atypia" include?
1. Moderate or florid epithelial hyperplasia w/out atypia

2. Sclerosing Adenosis

3. Papillomas
Describe "Epithelial Hyperplasia"
1. more than 4 cell layers are present

2. Florid, but architecturally & cytologically benign, hyperplasia
Left = normal

Right = Ductal Hyperplasia w/out Atypia
Left = ?

Right = ?
Epithelial Hyperplasia without Atypia
What pathology is seen in both of these pictures?
Describe "Sclerosing Adenosis?
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
Sclerosing Adenosis = increased # of acini/TDLU but each acini is still 1-2 layers of epithelium
What pathology is this?
Papilloma in Proliferative Breast Disease w/out Atypia
What pathology is this?
What 2 entities does Proliferative Breast Disease WITH Atypia include?
1. Atypical Ductal Hyperplasia

2. Atypical Lobular Hyperplasia
Benign breast lesion characterized by proliferation of ductal epithelium with cellular and architectural abnormalities
Atypical Ductal Hyperplasia seen in Proliferative Breast Disease w/ Atypia
Benign breast lesion that has a monomorphic cell population, regular cell placement, and round lumina. Is qualitatively & quantitively short of ductal carcinoma in-situ
Atypical Ductal Hyperplasia
Benign breast lesion characterized by a population of monomorphic small round cells partially filling a lobule
Atypical Lobular Hyperplasia
Atypical Ductal Hyperplasia seen in Proliferative Breast Disease w/ Atypia
What pathology is this?
Atypical Lobular Hyperplasia
What pathology is this?
Benign breast lesion that confers no increased risk of developing invasive breast cancer
Non-proliferative Fibrocystic Change
-Cysts
-Fibrosis
-Adenosis
Benign breast lesions that confer a 1.5 - 2 fold increased risk of developing invasive Breast CA
Proliferative Breast Disease without Atypia
-Epithelial Hyperplasia w/out Atypia
-Sclerosing Adenosis
-Papillomas
Benign breast lesion that confers a 4-5 fold increased risk of invasive Breast CA
Proliferative Breast Disease w/ Atypia
-Atypical Ductal Hyperplasia
-Atypical Lobular Hyperplasia

**the risk is equal in both breasts
What is the rank of Breast CA as a cause of death in women?
2nd to Lung CA
T or F: Breast CA is the most common non-skin malignancy of women
True
When is breast CA uncommon?

When does incidence peak?

Fraction of women who will develop Breast CA in lifetime
before age of 35

around Menopause

1/9
What is the strongest associated risk factor for Breast CA?
+ family history, especially in first-degree relative
BRCA that is associated with hereditary Breast & Ovarian Cancers
BRCA-1
BRCA that is associated with a younger age of onset & has a greater incidence of Medullary CA's & higher grade tumors
BRCA-1
BRCA that is associated with an older age of onset & an increased CA risk in Male breasts
BRCA-2
BRCA that has similar pathology as sporadic carcinomas
BRCA-2
List the races who have higher risk factors for Breast CA
Caucasians > AA's > Asian > Hispanic
Explain how "hormonal influences" are risk factors for Breast CA
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
What environmental factors are risk factors for Breast CA?
1. Geographic distribution

2. Dietary fat content

3. Environmental contaminant (organochlorine pesticides)

*Smoking is NOT a risk factor