Robbins Breast Pathology

Front 1

What is the most common breast symptom?

Back 1

Pain (mastalgia or mastodynia). It may be cyclical with menses or non-cyclical.

Front 2

Cyclical vs. non-cyclical pain.

Back 2

diffuse cyclical pain has no pathologic correlate and most effective Tx target hormone levels. Non-cyclical pain is usually associated with a focal site in the breast. Causes include ruptured cysts or areas of prior injury or infections but more often, no specific lesion can be identified.

Front 3

What percentage of breast cancers present with pain?

Back 3

10%

Front 4

What is the second most common breast symptom?

Back 4

discrete palpable masses

Front 5

Discrete palpable masses must be distinguished from what?

Back 5

from the normal nodularity of the breast

Front 6

What size mass is palpable?

Back 6

A breast mass usually does not become palpable until it is about 2 cm in diameter.

Front 7

Discrete palpable masses are most common in what age group?

Back 7

pre-menopausal women and become less frequent with age.

However, the likelihood that a palpable mass is malignant increases with the age of the patient.

Front 8

Most carcinomas occur in what region of the breast?

Back 8

50% of carcinomas arise in the upper outer quadrant.

Front 9

When is nipple discharge a concerning symptom?

Back 9

When it is spontaneous and unilateral.

Front 10

A milky discharge (Galactorrhea) is associated with what?

Back 10

increased production of prolactin (pituitary adenoma), hypothyroidism, or endocrine anovulatory syndromes. Also patients taking OCPs, tricyclic antidepressants, methyldopa, or phenothiazines.

Front 11

Is milky discharge associated with malignancy?

Back 11

no

Front 12

What kind of nipple discharge is associated with benign lesions (and rarely malignancy)?

Back 12

bloody or serous

Front 13

Can a bloody discharge be normal

Back 13

Yes, a normal bloody discharge can occur during pregnancy, possibly due to rapid formation of new lobules.

Front 14

The risk of malignancy with discharge increases with age. T/F?

Back 14

True

Front 15

What are the most common etiologies for nipple discharge?

Back 15

solitary large duct papilloma, cysts, or carcinoma.

Front 16

Mammography is recommended at what age?

Back 16

40

Women younger than 40 should undergo mammography only if they are at a high risk for developing carcinoma, owing to a prior palpable cancer or to a strong family history.

Front 17

Why does the sensitivity and specificity of mammography increase with age?

Back 17

As the dense, fibrous interlobular tissue of the young woman is replaced by the fatty tissue of older woman, it becomes easier to detect small masses and calcifications. Also, with increasing age benign lesions become less frequent and malignant lesions become more frequent.

Front 18

What are the principal mammographic signs of breast carcinoma?

Back 18

densities and calcifications

Front 19

What are the most common lesions that are detected as densities?

Back 19

invasive carcinomas, fibroadenomas, and cysts.

Front 20

What carcinoma rarely presents as a density of a mammogram?

Back 20

DCIS

Front 21

What is the most common malignancy associated with calcifications?

Back 21

DCIS

Front 22

What are some benign lesions associated with calcifications on a mammogram?

Back 22

Apocrine cysts, hyalinized fibroadenomas, and sclerosing adenosis

Front 23

The inability to image a palpable mass indicates benignity. T/F?

Back 23

False.

All palpable masses require further investigation.

Front 24

Palpable masses that cannot be imaged by mammography are usually detectable by what other imaging modality?

Back 24

Ultrasound

Front 25

When is an MRI useful?

Back 25

detecting cancer in women with dense breasts, in determining the extent of chest wall invasion in locally advanced cancers, for detection of mammographically occult cancers, and for the evaluation of breast implant rupture.

Front 26

What should you suspect in a non-lactating woman who presents with mastitis?

Back 26

Inflammatory breast cancer.

it mimics inflammation by obstructing dermal vasculature with tumor emboli, resulting in an enlarged erythematous breast.

Front 27

Almost all cases of acute mastitis occur during lactation? T/F?

Back 27

True

Front 28

Clinical presentation of acute mastitis?

Back 28

erythematous painful breast and fever

Front 29

Pathogenesis of acute mastitis

Back 29

during early weeks of nursing (usually the first month of nursing), the breast is vulnerable to bacterial infection because of the development of cracks and fissures in the nipples.

Front 30

Which bacteria is the common pathogen is acute mastitis?

Back 30

S. aureus

less commonly, streptococci

Front 31

A tissue biopsy in a patient with acute mastitis shows a localized area of acute inflammation and an abscess. What is the etiology?

Back 31

S. Aureus

Front 32

A tissue biopsy in a patient with acute mastitis shows a diffuse infection that involves the entire breast. The tissue is necrotic and is infiltrated by neutrophils. What is the etiology

Back 32

Steptococci

(S. Aureus: local and abscesses, Strep: diffuse, entire breast)

Front 33

Most common Tx of acute mastitis?

Back 33

Antibiotics and complete drainage of milk from the breast.

Front 34

Which inflammatory disease of the breast is most commonly seen with smokers?

Back 34

periductal mastitis (aka recurrent subareolar abscess, squamous metaplasia of lactiferous ducts, Zuska disease)

Front 35

Clinical presentation of periductal mastitis.

Back 35

painful erythematous subareolar mass. Most common seen in smokers

Front 36

A fistula tract under the smooth muscle of the nipple is seen in which inflammatory disease of the breast?

Back 36

periductal mastitis

A fistula tract under the smooth muscle of the nipple and opens into the skin at the edge of the areola

Front 37

Many women presenting with periductal mastitis also have which congenital breast anamoly?

Back 37

an inverted nipple

Front 38

What is the pathogenesis behind the association of smoking and periductal mastitis?

Back 38

Vitamin A deficiency associated with smoking or toxic substances in tobacco smoke alter the differentiation of the ductal epithelium.

Front 39

Histology: keratinizing squamous epithelium extending to an abnormal depth into the orifices of the nipple ducts. Ducts are also dilated. What is the diagnosis?

Back 39

periductal mastitis.

keratin is trapped within the ductal system.

Front 40

A 60 year old woman who has three children presents with a palpable periareolar mass. She also complains of thick, white nipple secretions. What is the most likely Dx?

Back 40

Mammary duct ectasia

MC in fifth or sixth decade of life, usually in multiparous women. Presents with a poorly defined palpable periareolar mass, sometimes with skin retraction, often accompanied by thick, white nipple secretions.

Front 41

A 55 year old woman present with a palpable mass. The tissue biopsy shows dilation of ducts, inspissation of breast secretions, and a marked periductal and interstitial chronic granulomatous inflammatory reaction. The dilated ducts are filled by granular debris that contains lipid laden macrophages. What is the most likely diagnosis?

Back 41

Mammary duct ectasia

Front 42

A 45 year old woman who has a prior history of breast surgery presents with a painless palpable mass? The mass appears dense and calcified on a mammogram. What is the most likely diagnosis?

Back 42

Fat Necrosis.

Can be confused with breast carcinoma but the history of surgery provides a clue. The mass should be biopsied.

Front 43

A 55 year old woman present with a palpable mass. The tissue biopsy shows dilation of ducts, inspissation of breast secretions, and a marked periductal and interstitial chronic granulomatous inflammatory reaction. The dilated ducts are filled by granular debris that contains lipid laden macrophages. What is the most likely diagnosis?

Back 43

Mammary duct ectasia

Front 44

A 45 year old woman who has a prior history of breast surgery presents with a painless palpable mass? The mass appears dense and calcified on a mammogram. What is the most likely diagnosis?

Back 44

Fat Necrosis.

Can be confused with breast carcinoma but the history of surgery provides a clue. The mass should be biopsied.

Front 45

Grrenish brown nipple discharge is most commonly associated with which inflammatory condition?

Back 45

mammary duct ectasia

Front 46

The most common physiologic cause of galatorrhea?

Back 46

mechanical stimulation of the nipple

Front 47

the most common pathologic cause of galactorrhea?

Back 47

prolactinoma

Front 48

The most common nonpituitary endocrine disorder causing galactorrhea?

Back 48

Primary hypothyroidism

Decreased serum thyroxine increases TRF which stimulated prolactin

Front 49

A woman presents with painless indurated mass and has a prior history of trauma to breast tissue. Microscopic findings include lipid laden macrophages with foreign body giant cells, fibrosis, and dystrophic calcification. Most likely Dx?

Back 49

Fat necrosis

Front 50

A diabetic woman presents with multiple hard palpable masses that are detected as mammographic densities. A Biopsy shows collagenized stroma surrounding atrophic ducts and lobules and a thick basement membrane. A prominent lymphocytic infiltrate surrounds epithelium and blood vessels. What is the most likely Dx?

Back 50

Sclerosing lymphocytic lobulitis (aka lymphocytic mastopathy)

MC in women with Type 1 diabetes and autoimmune thyroid disease