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94 Cards in this Set

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What is the normal histology of the female breast
Normal microscopic anatomy includes epithelial and myoepithelial cells. Lobules containing many small ductules and acini when lactating lead to terminal ducts, which join with segmental ducts and then large lactiferous ducts that finally open on the nipple
None
What causes the majority of palpable breast masses
Proliferation of ductal epithelium usually accompanied by increase in fibrous stroma
Into what categories do most breast lesions fall
Inflammatory disorders
Fibrocystic disease
Benign tumors
Carcinoma
None
Name 4 common inflammatory disorders of the breast
Acute mastitis
Chronic mastitis
Duct ectasia
Fat necrosis
None
When does acute mastitis most commonly affect women
During lactation
What are the most common causative agents of acute mastitis
Staphylococci and streptococci
What are the clinical manifestations of acute mastitis
The breast (mastitis is usually unilateral) is swollen, erythematous, and painful
What diseases most commonly lead to chronic mastitis
Systemic granulomatous diseases such as tuberculosis and sarcoidosis
When does duct ectasia most commonly occur
Postmenopause
None
What is the histology of duct ectasia
Dilation of collecting ducts with periductal fibrosis and amorphous material in the lumen of the ducts
What history is usually given in women with fat necrosis of the breast
Preceding injury or traumatic event to the breast
What is the clinical presentation of fat necrosis of the breast
May produce a mass that can stimulate carcinoma
What are the histologic features of fat necrosis
Inflammed, necrotic adipose tissue with areas of calcification. Chronic inflammatory cells and lipid-filled macrophages also are seen
What is the incidence of fibrocystic disease
It is the most common disorder of the breast and most common cause of a palpable breast mass in women 25-50 years of age
What are the clinical manifestations of fibrocystic disease
Lumpy breasts with midcycle tenderness
What is the pathogenesis of fibrocystic disease
The cause is most likely increased activity, or sensitivity to, estrogen or decreased progesterone activity
None
Is fibrocystic disease usually unilateral or bilateral
Usually bilateral
What are some conditions associated with fibrocystic disease
Slightly increased incidence of cancer when epithelial hyperplasia is marked and clearly higher risk of cancer when hyperplastic epithelium demonstrates atypia. However, there is no risk of cancer in nonproliferative fibrocystic disease
What is the morphology of fibrocystic disease
A variety of histologic changes are seen, including:
Fibrosis of variable degree
Cystic dilation of ducts
Epithelial hyperplasia (papillomatosis)
Apocrine metaplasia
Sclerosing adenosis
None
What is adenosis
Proliferation of small ducts and myoepithelial cells
What is the incidence of fibroadenoma
Most common breast tumor in women younger than 18-36 years of age but commonly seen in women 20-35 years of age
Is fibroadenoma benign or malignant
Benign
What are the clinical manifestations of a fibroadenoma
Freely movable, firm, rubbery, painless lesion that is well demarcated from adjacent breast tissue
What percentage of fibroadenomas are multiple
Approximately 10%, either in same breast or bilateral
What is the histology of fibroadenoma
Proliferation of fibrous stroma and lobular epithelium with multiplication of ducts and acini
What are the classifications and distinguishing features of fibroadenoma
Intracanalicular fibroadenoma: stroma compresses and distorts glands into slitlike spaces
Pericanalicular fibroadenoma: glands retain round shape
None
What tissue is involved in intraductal papilloma
Major lactiferous ducts
What age group is most commonly affected by intraductal papilloma
Women 30-50 years of age, but usually at or shortly before menopause
None
What is the clinical presentation of intraductal papilloma
Small masses located near the nipple; however, serous and bloody nipple discharge without a palpable mass is also commonly seen
Are intraductal papillomas benign or malignant
They are benign tumors
What is different about the site of origin for intraductal papilloma as compared with fibroadenoma and fibrocystic disease
Intraductal papillomas arises from the large ducts, whereas all fibroadenomas and fibrocystic changes originate from lobules
What is the incidence of breast carcinoma
It is the second most common malignancy in women (after lung cancer), and the leading cause of death in women over 40 years of age
What is the most common cause of breast mass in the postmenopausal patient
Carcinoma of the breast
What is the most common site of the mass in breast carcinoma
Upper outer quadrant of the breast
What are the most common sites of breast cancer metastases
Lung, liver, bone, and brain
What are risk factors for breast cancer
Increasing age, particularly over 40 years of age
Positive family history, particulary in first-degree female relatives
Prior history of breast cancer
Early menarche
Late menopause
Nulliparity
First pregnancy after 30 years of age
None
What are the clinical features of breast cancer
Palpable, fixed lump or mass
Pain
Edema, erythema, and dimpling of overlying skin
Nipple retraction
Lympadenopathy
None
What are the histologic types of breast cancer
Intraductal carcinoma in situ
Lobular carcinoma in situ
Infiltrating ductal carcinoma
Infiltrating lobular carcinoma
Medullary carcinoma
Mucinous (colloid) carcinoma
Tubular carcinoma
Invasive cribiform
Paget disease of the breast
Inflammatory carcinoma
None
Which histologic types of breast cancer are non-invasive
Intraductal carcinoma in situ and lobular carcinoma in situ
What characteristics make a breast cancer invasive
Invasion beyond the basement membrane, therefore allowing access to lymphatics and blood vessels and creating potential for distant metastases
Which of the invasive histologic types of breast cancer are potentially lethal
Infiltrating ductal, infiltrating lobular, medullary, mucinous
What are 3 important prognostic factors for invasive carcinoma
Histologic type/grade
Size of tumor
Presence or absence of lymph node metastases
None
How many breast carcinomas contain estrogen-receptor proteins
About 50%
Why are estrogen-receptor proteins important
Patients with estrogen-receptor proteins are more likely to respond to endocrine therapy (eg tamoxifen) which can lead to objective remissions and a better prognosis
What age group is more likely to have tumors with estrogen-receptor status
Postmenopausal women (Premenopausal women have high levels of endogenous estrogen, which blocks the receptor sites)
What is the incidence of intraductal carcinoma in situ of the breast
5-10% of all breast cancers
What are the 2 subtypes of intraductal carcinoma in situ of the breast
Comedocarcinoma
Cribiform or micropapillary carcinoma in situ
None
What is the subsequent risk of developing invasive carcinoma of the breast for the subtypes of intraductal carcinoma in situ
Comedocarcinoma is thought to have a 100% chance of becoming invasive if untreated, while cribriform or micropapillary carcinoma in situ has only about a 30% chance
None
What are the histological differences between comedocarcinoma and cribriform or micropapillary carcinoma in situ
Comedocarcinoma contains large pleomorphic tumor cells with a central area of necrosis (comedone), whereas cribriform or micropapillary carcinoma in situ has small, uniform cells that lack an area of necrosis
What other characteristic features have been seen in comedocarcinoma
High S phase and aneuploidy
None
What percentage of non-invasive carcinomas progress to invasive cancer
Only about 30% of most subtypes; the exception is comedocarcinoma, in which almost 100% will progress to invasive cancer if left untreated
In what percentage of breast biopsy specimens taken for a suspicious mass will lobular carcinoma in situ be found
About 3%
Why is lobular carcinoma in situ so often an incidental, unsuspected finding on biopsy
Because it cannot be palpated on physical examination or felt at operation
None
What percentage of women with lobular carcinoma in situ go on to develop invasive carcinoma
About 33%
Of the women with lobular carcinoma in situ who go on to develop invasive carcinoma, what is the chance that it will develop in the breast contralateral to the one that had the lobular neoplasia
50%
What is the histology of lobular carcinoma in situ
Clusters of neoplastic cells fill intralobular ductules and acini
What percentage of invasive carcinoma is infiltrating ductal carcinoma
80% of the invasive carcinomas
What is the histology of infiltrating ductal carcinoma
Tumor cells larger than normal epithelium and arranged in cords, islands, and glands embedded in a dense fibrous stroma with abundant fibrous tissue giving it a firm consistency
What is the incidence of infiltrating lobular carcinoma
10% of the invasive carcinomas
What is the histology of infiltrating lobular carcinoma
Small, uniform cells about the same size as normal epithelium and usually arranged in single-file rows of cells
What features are used in determining the grading system for infiltrating ductal and lobular carcinomas of the breast
Tubule formation; Nuclear pleomorphism; Mitotic counts
What is the single most important prognostic factor for infiltrating ductal carcinoma and infiltrating lobular carcinoma
Status of the lymph nodes
What is the incidence of medullary carcinoma
2% of the invasive carcinomas
What is the histology of medullary cancer
Mixture of malignant epithelial cells and many plasma cells and lymphocytes
What is the incidence of mucinous carcinoma
2% of the invasive carcinomas
What is the histology of mucinous cancer
Pools of extracellular mucus surrounding clusters of tumor cells
What features are characteristic on palpation of a medullary or mucinous carcinoma mass
Sharply circumscribed, soft and gelatinous consistency due to lack of fibrous tissue in both types
Is the prognosis for both medullary and mucinous carcinoma worse or better than that of invasive ductal carcinoma
Better
What is the incidence of tubular carcinoma
2% of the invasive carcinomas
What are the histology findings of tubular carcinoma
Well-formed glands
What is the incidence of invasive cribriform carcinoma
2% of the invasive carcinomas
What are the histology fingings of invasive cribriform carcinoma
Well-formed lumens surrounded by broader nests of cells
What percentage of tubular carcinomas and invasive cribriform carcinomas have lymph node metastases
5-10%
Why are tubular carcinomas and invasive cribriform carcinomas usually only locally invasive and thus non-lethal
Neither type is able to metastasize hematogenously
What is the incidence of Paget disease of the breast
1-2% of all breast cancers
What are the clinical features of Paget disease of the breast
Eczematous, excoriated lesion involving the nipple and adjacent skin
What do Paget cells look like histologically
Large cells with prominent nuclei and abundant eosinophilic cytoplasm
Name an associated underlying condition of Paget disease of the breast
Infiltrating intraductal carcinoma is almost always present
What is the histology of inflammatory carcinoma
Lymphatic involvement of skin by underlying carcinoma
What are the clinical manifestations of inflammatory carcinoma
Red, swollen, hot skin resembling an inflammatory process or lymphatic edema resembling an orange peel
What are the clinical manifestations of cystosarcoma phylloides
Rapidly growing large, bulky mass with ulceration of overlying skin
Is cystocarcoma phylloides benign or malignant
Variable malignancy
What are the histologic features of cystosarcoma phylloides
Very cellular stroma composed of atypical spindle cells, abundant mitotic figures, and cystic spaces containing leaf-like projections from the cyst walls
What is the most common breast mass in a woman less than 18-36 years of age
Fibroadenoma
What is the most common breast mass in a woman 25-50 years of age
Fibrocystic disease
What is the most common breast mass in a woman over 50 years of age
Carcinoma of the breast
What is the histology of fibroadenoma
Pattern of compressed glands and young fibrous stroma
What histologic feature is the hallmark of invasive lobular carcinoma of the breast
Small, uniform cells arranged in single-file rows
What is the most likely diagnosis for a woman who presents with bloody discharge from one nipple
Intraductal papilloma
What is the most common type of invasive carcinoma of the breast
Infiltrating ductal carcinoma
Which type of breast carcinoma is associated with involvement of the contralateral breast in 50% of cases
Lobular carcinoma in situ
What type of breast carcinoma is associated with distant metastases consisting of malignant stromal cells
Cystosarcoma phylloides
What is the single most important prognostic factor for infiltrating carcinomas
Status of the lymph nodes
What type of carcinoma in situ of the breast progresses to invasive cancer in almost 100% of cases
Comedocarcinoma