Unit 10 - 4 Path

Front 1

cyclic growth of acini

Back 1

acini begin to blossom as pregnancy progresses -> midpregnancy acini have increased in number and volume -> fully maturated when shes lactating in pregnancy, after weening it returns to mature but inactive form

Front 2

two important cells in ducts and lobules

Back 2

myoepithelial and luminal layer; if you lose the dual layer it is probably invasive; important diagnostic factor

Front 3

breast stroma

Back 3

interlobular stroma; DENSE

intralobular stroma; hormone responsive fibroblast like cells; surrounds acini of the lobules

Front 4

breast changes w menstrual cycle

Back 4

first half; quiescent; second half; proliferation

Front 5

breast secretion

Back 5

at first luminal ells secrete colostrum high in protein; over next 10 days they begin to secrete fat

Front 6

milk secretion

Back 6

prolactin promotes milk secretion; oxytocin promotes milk ejection

Front 7

milkline remnants

Back 7

some breast tissue resides along axillary-genital line (embryo);

congenital nipple inversion; can signify underlying traction or inflammation 2 to cancer

Front 8

mastalgia,mastodynia

Back 8

cylinic pn (occurs w menses); noncylic (ruptured cyst, injury, injection)

95% of painful masses are benign, 10% of breast cancer is painful

Front 9

upper outer quadrant

Back 9

greatest chance of carcinoma location

Front 10

worrisome manifestation of nipple discharge

Back 10

unilateral, spontaneous (just flows out)

Front 11

large duct papilloma

Back 11

bloody and serous nipple discharge

Front 12

characteristics of mamographic malignancy

Back 12

clustered, small, irregular, numerous; warning flags that it could be a malignancy

Front 13

desmoplasia

Back 13

proliferation of fibroblasts in tumors, secrete collagen, very very hard

Front 14

acute mastitis

Back 14

breast inflammation; red titty; often seen in women breastfeeding; the baby's saliva can irritate bite barks; often a. aureus (abscess, necrosis), can extend laterally;

pt w fever, red breast, lactating

Front 15

periductal mastitis

Back 15

NOT associated with periductal mastitis; inflammation may result in an inverted nipple

cigarette smoking risk factor

keratinizing squamous metaplasia of the nipple ducts; possible duct rupture -> granulomatous inflammation

Front 16

mammary duct ectasia

Back 16

dilated large ducts w fibrous thickening of the wall

dilated ducts and inspissated breast secretions; periductal inflammation

Front 17

fat necrosis

Back 17

a benign painless lump; forms as a result of injury to the breast; up to 50% of pts report no trauma

gray white nodule with chalky foci (can simulate cancer)

Front 18

nonproliferative breast changes; fibrocystic change

Back 18

lumpy upon palpation

3 morphologic changes
cystic change (lobule dilitation called blue dome cysts)
fibrosis (rupture of cysts induce chronic inflammation -> fibrosis)
adenosis (glands proliferate)

Front 19

proliferative breast disease w/o atypia; epithelial hyperplasia

Back 19

greater than 2 cell layers of ducts/lobules; expands the ducts and lobules

Front 20

proliferative breast disease w/o atypia; sclerosis adenosis

Back 20

inc number of acini with stromal fibrosis (it can look like cancer due to fibrosis)

Front 21

proliferative breast disease w/o atypia; papillomas

Back 21

branching fibrovascular cores lined yb luminal and myoepithelial cells; grow within dilated ducts; solitary and involve the lactiferous sinus

the little papillomas can twist, infarct, and causing bleeding

Front 22

proliferative breast disease with atypia

Back 22

goes from peripheral slits in histology slide to more rounded; athough there are still slits;

Front 23

breast carcinoma (most common NONSKIN malignancy in women)

Back 23

most breast cancers are estrogen receptor positive; ER positive and E rneg positive have different prognosis/therapies

Front 24

breast cancer risk factors

Back 24

risk inc w # of first degree relatives; most who have a family history wont develop breast cancer;

atypical hyperplasia

non-hispanic white women have the highest rate of cancer of breats

incresaed estrogen exposure

late menarche, early menopause

smoking, obesity,

Front 25

BRCA1/2

Back 25

tumor suppressor genes; breast cancer

BRCA1 (17): influence on ovarian cancer AS WELL as breast cancer; inc risk for prostate/pancreas carcinoma (these mutations go into men as well)

BRCA (c13)

Front 26

loss of heterozygosity

Back 26

one cell w tumor supressor gene and another normal; lose second gene

Front 27

comedocarcinomas

Back 27

ductal, caseous necrosis. subtype of DCIS; central necrosis surrounded by cancer cells

Front 28

Pagets disease

Back 28

eczematous patches on nipple; Paget's cells = large cells in epidermis with clear halo (fried egg); suggest underlying carcinoma; also seen on vulva

pagets of vulva = no underlying carcinoma

Front 29

carcinoma in situ

Back 29

fills ductal lumen; arises from ductal hyperplasia (but gone beyond atypia); 'cookie cutter' slits/cribiform holes

Front 30

lobular carcinoma in situ

Back 30

loss of expression of E-cadherin

Front 31

invasive carcinoma

Back 31

dimpling of skin, nipple retraction, peau d'orange is thickening of the skin due to blockage of the lympahtics and causes lymphedema; blocks ducts and causes lymphedema;

force pushing out w/ fluid w point traction spots pulling it down = peau d'orange

Front 32

inflammatory carcinoma

Back 32

swollen and erythematous breasts

dermal lymphatic invasion by breast carcinoma; peau d'orange; neoplastic cells block lymphatic drainage

50% survival at 5 years

Front 33

gene array technology

Back 33

can subdivide cancers into subtypes based on mRNA expression; gives you better prognostic info for the subtypes

Front 34

invasive lobular carcinoma

Back 34

orderly row of cells (single file pattern)

minimal desmoplasia

signet ring cells

Front 35

medullary carcinoma

Back 35

fleshy, cellular, lymphocystic infiltrate

god prognosis

Front 36

mucinous carcinoma

Back 36

older females, slow growth, goopy (gelatinous cut surface, glistening)

islands of cells in lakes of mucin, old women, better prognosis

Front 37

tubular carcinoma

Back 37

women in their late 40s, well formed tubules, apocrine snouts can be seen, teardrop shape

only has one layer of cells (in benign = two layers of cells)

well formed tubules = excellent prognosis

Front 38

metaplastic carcinoma

Back 38

rare, strange stuff (not normal ductal epithelium, lobular, can get squamous, has things that dont belong in the breast, poor prognosis

Front 39

prognostic and predictve factors

Back 39

TNM (tumor, nodes, metastases)

Front 40

HER2/neu

Back 40

overexpression results in poorer survival (growth factor receptor); predict respones to agents such as traztuzumab

hercepdin = antibodies that target HER2/neu R

Front 41

fibroadenoma

Back 41

mc benign tumor of female breast; hormonally sensitive (inc size/tenderness w/ estrogen)

small, mobile, firm mass with sharp edges; freely movable

overproduction of stroma compressing an overproduction of epithelium

Front 42

phyllodes tumor

Back 42

LARGE bulky mass of connective tissue and cysts; similar to fibroadenoma but ramped up w inc cellularity

'leaf like' projections

mc in 6th devade

some may become malignant (so excision w wide margins); much more blue/cellular than fibroadenoma

phyllodes = leaf

Front 43

angiosarcoma w people who have had prior masectomy

Back 43

lymphedema is toxic -> angiosarcoma