Breast Pathology

Front 1

what are the two cell types that line the ducts and lobules of the breast

Back 1

myoepithelial
luminal epithelial

Front 2

what is important to know about carcinoma in situ of the breast in reference to the duct system

Back 2

1 duct systems is intertwined with all the others and occupies more than 1 quadrant of the breast. so even though the cancer may only be in one duct it can still be in several quadrants of the breast.

Front 3

what are the lesions of the terminal duct loular unit?

Back 3

cyst
sclerosiing adenosis
small duct papilloma
hyperplasia
atypical hyperplasia
carinoma

Front 4

what are the lesions of the lobular stroma?

Back 4

fibroadenoma
phyllodes tumor

Front 5

what are the lesions of the nipple and areola

Back 5

duct ectasia
recurrent suareolar abscess
solitary ductal papilloma
paget disease

Front 6

what are the lesions of the interlobular stroma

Back 6

fat necrosis
lipoma
fibrosu tumor
firomatosis
sarcoma

Front 7

which type of cancer is more common in the breast ductal or lobular

Back 7

ductal is more common

Front 8

what is a change in the breast that can be confused for malignancy and why?

Back 8

lactation can cause cells to take on an appearance of foamy cytoplasm and enlarged nuclei

Front 9

what are some differences between young breast and older breast

Back 9

younger breast are denser on mammogram and have more lobules

older breast lubules often atrophic and most tissue is adipose.

harder to spot masses in younger patients dense breast tissue. on mammongraphy

Front 10

what are some congenital anomalies of the breast

Back 10

absence
supernumerary nipples or breasts
accessory axillary breast tissue
congenital inversion of niples
macromastia(juvenile hypertrophy)

Front 11

what is the importance of knowing if a patient has the congential anomaly of axillary breast tissue?

Back 11

cancer can spread into that axillary tissue and if a surgeon does a mastectomy they may miss the tissue in the axillary region.

Front 12

what does breast pain usually indicate?

Back 12

benign masses
95% of painful masses are benign

Front 13

what are the stats about palpable masses in the breast

Back 13

under 40 mostly benign

over 50 mostly malignant

Front 14

what does nipple discharge indicate

Back 14

most often nipple discharge is benign but if the discharge is bloody that can be worrisome

Front 15

what is the typical mammographic findings that indicate benign or malignant

Back 15

benign- well circumscribed round and no extensions

malgnant -extensions from lesion. crab like, radial extensions

Front 16

what are the inflammatory disorders of the breast

Back 16

acute mastitis/abscess
periductal mastitis
mammary duct etasia
fat necrosis
granulomatous mastitis

Front 17

when do most cases of acute mastitis occur?

Back 17

during breast feeding

Front 18

what is the most common organism that causes acute mastitis and what type of organism is it?

Back 18

staphylococcus gram positive cocci

Front 19

what is the second most common cause of acute mastitis and what are the implications of it. what type of organism is it

Back 19

streptococccus gram positive cocci

can invovle the entire breast.

Front 20

what is the presentation of periductal mastistis also called zuska disease?

Back 20

presents with painful erythematous subareolar mass

not associatted with lactation

Front 21

what is a common risk factor in most patients with zuska disease?

Back 21

smokers

Front 22

what is the pathology behind zuska disease?

Back 22

squamous metaplasioa of the nipple duct linign leads to keratin pluggin, duct dilation, rupture and associated chronic inflammation to the keratin.

Front 23

who is the common patient with mammary duct etasia

Back 23

50-60yo woman who has given birth several times

Front 24

what is the presentation of mammary duct ectasia

Back 24

poorly defined palpable periareolar mass, often with thick white nipple discharge, skin retraction

Front 25

what is the pathology of mammary duct ectasia

Back 25

dilation of ducts with inspissated secretions, marked periductal chronic and granulomatous inflammatory reaction.

Front 26

what is the presentation of fat necrosis

Back 26

history of traumomr to breast or prior surgery

presents with painless palpable mass, skin thickening or retraction

denisity or calcifications on mammogram

Front 27

what is seen histiologically in fat necrosis

Back 27

fibrosis

histiocytes

fibroblasts

inflammatory cells

Front 28

what is the single most common disorder of the female breast?

Back 28

fibrocytic changes grade 1 non-proliferative

40% of all lumps

probably related to changes from menstrual cycle

Front 29

what is the classic gross pathology of fibrocystic changes

Back 29

blue dome cyst

with local fibrosis surrounding it

Front 30

what is the microscopic pathology found in fibrocytic changes

Back 30

cysts formatiom, fibrosis and adenosis

APOCRINE hyperplasia-cells with low nucleas to cytoplasm ratio, bright pink. prominent nucleus and nucleuolus

Front 31

what are the characteristics proliferative breast disease

Back 31

characterized by proliferation of ductal epithelium and or stroma

small increased risk for cancer

Front 32

what is important for differentiating ductal hyperplasia in proliferative breast disease from cancer

Back 32

if a duct is surrounded by myoepithelial cells it is assumed to be a non invasive process.

Front 33

what are the findings in proliferative conditions that are associated with a slight increased risk of cancer(1.5-2 times)

Back 33

sclerosing adenosis, moderate to florid ductal hyperplasia, papillomatosis(marked)

Front 34

what are the findings in proliferative conditions that are associated with signficantly increased risk (4-5 timse)

Back 34

atypical hyperplasia(ductal or lobular)

Front 35

what characterizes atypical ductal hyperplasia

Back 35

monoclonal hyperplasia population of ductal cells that take up part of but not the entire duct

Front 36

what characterizes atypical lobular hyperplasia

Back 36

monotonization of entire lobule

Front 37

what is the most common benign neoplasm

Back 37

fibroadenoma

Front 38

what are the benign neoplasms of the breast

Back 38

fibroadenoma
intraductal (large duct) papilloma
nipple adenoma

Front 39

what makes up fibroadenoma?

Back 39

ducts and stroma

Front 40

what is the typical presentation of fibroadenoma?

Back 40

20-40
aries from introalobular stroma
frequently mulitple and bilateral
may calcify
sperical nodules, sharply circumscribed and mobile

Front 41

what distinguishes a phyllodes tumor from a fibroandenoma?

Back 41

loss of biphasic pattern(ie ratio of duct to stroma), infiltrative borders, stromal cellulartity, nuclear pleomorhpism and mitoses

Front 42

what is the prognosis for phyllodes tumor

Back 42

most are benign but reccurent

high grade ones are malignant with frequent local recurrance and distant hematogenous metastastes

Front 43

what is the typical description of a phyllodes tumor?

Back 43

leaf like

Front 44

what are the benign stromal lesions

Back 44

pseudoangiomatous stromal hyperplasia(PASH)
myofibroblastoma
fibroma
fibromatosis

Front 45

what is the most common non-skin maliganancy in women

Back 45

carcinoma of the breast

Front 46

what are the risk factors that increase risk for breast cancer

Back 46

age
age of menache(earlier start increased risk)

age of first live birth(increased later)

BRCA, p53 mutations

prior breast biopsies with atypical hyperplasia

nonhispanic caucasian women have highest rate

exposure to estrogen or radiation

obesity

Front 47

which type of BRCA related cancer is estrogen receptor positive?

Back 47

BRCA 1

Front 48

what are the common genetics causes of breast cancer

Back 48

BRCA1-2
p53
CHECK2
PTEN
LKBI/STK11
ATM

Front 49

what is P53 associated with

Back 49

most common mutated gene in sporadic breast cancer

Front 50

what is PTEN associated with

Back 50

Cowden syndrome

Front 51

what is LKBI/STK11 associated with?

Back 51

PJ syndrome

Front 52

what is ATM associated with

Back 52

Ataxia telangiectasia

Front 53

what is the stepwise progession of low grade invasive carinoma of breast

Back 53

normal/nonproliferative
proliferative
atypical hyperplasi
low/moderate grade DCIS
low/moderate grad invasive carcinoma

Front 54

what are the classifications of breast cancer

Back 54

noninvassive(in situ)
-ductal carcinoma in situ(DCIS)
-lobular carcinoma in situ(LCIS)

invasive(infiltrating

Front 55

what are the subtypes of invasive carcinoma

Back 55

invasive ductal carcinoma
invasive lobular carcinoma
medullary carcinoma
colloid/munious carcinoma
tubular carcinoma
adenoid cystic carcinoma
apocrine carcinoma
invasive papillary carcinoma.

Front 56

what stain can be used to differentiate ductal and lobular carcinoma?

Back 56

e-cadherin

absent in lobular

Front 57

what type of cancer has the most normal RNA

Back 57

lobular

Front 58

what cancer has the more abnormal RNA

Back 58

triple negative basal like carcinoma

Front 59

what is seen on mammography in ductal carcinoma in situ

Back 59

calcification
linear and pleomorphic
clustered

Front 60

what is ductal carcinoma in situ(DCIS) defined as?

Back 60

consist of a malignant clonal population of cells limited to ducts and lobules by the basement membrane, myoepithelial cells are preserved.

Front 61

what is the gross finding in DCIS

Back 61

caseating necrosis

Front 62

what are the 4 subtypes of DCIS

Back 62

solid
micropapillary
papillary
cribriform

Front 63

what are the two main things that determine prognosis in DCIS

Back 63

nuclear grade and presence of comedonecrosis(central necrosis)

Front 64

how are nuclei graded in DCIS

Back 64

how pleomorphic the nuclei are.

Front 65

what is the stain to tell if DCIS is invasive

Back 65

p63 and smooth muscle myosine

screening for myoepithelial cells completely surrounding the ducts

Front 66

what is pagets disease?

Back 66

DCIS tumor cells that extend from nipple ducts into the contiguous skin

Front 67

what is the hallmark of pagets disease

Back 67

involvment of the epidermis by malignant cells

ulceration, fissures and ooxin of the skin of the nipple

Front 68

what is a difference in the presentation of lobular carcinoma in situ(LCIS) as compared to DCIS

Back 68

LCIS does not present with calcification and is usually detected as an incidental finding in biopies done for other reasons

Front 69

what does it mean to a patient to have LCIS?

Back 69

there is no real treatment, you cant cut it out like you can with DCIS.

there is an increaseing risk of 1% per year with LCIS for subsequent risk of carcinoma.

patient can opt for bilarteral mastectomy but most just opt to increase screening.

Front 70

what are the grading criteria for infiltrating ductal carcinoma?

Back 70

ductal formation-more ducts lower score
nuclear pleomorphism-more pleomorphism higher score
mitosis-more mitosis higher score

all graded out of 3

Front 71

what are the characteristics of infiltrating lobular carcinoma?

Back 71

difficult to detect on PE or radiology

more often bilateral
multicentric within same breast

frequent metastasize

cells lack E-cadherin

Front 72

where do infiltrating lobular carcinoma usually metastasize to

Back 72

CSF, serosal surfaces, ovary and uterus.

Front 73

what is the typical score of a infiltrating lobular carcinoma

Back 73

5/9

3-no duct formation

1-little nuclear pleomorphism

1-low mitosis number

Front 74

what is the typical arrangements of infiltrating lobular carcinoma

Back 74

targetoid arranging around the duct or in sheets

Front 75

what are the cell types found in medullary carcinoma

Back 75

lymphocytes

Front 76

what is the tumor grade for all medullary carcinoma?

Back 76

9/9 poorly differentiated

Front 77

what is the prognosis of medullary carcinoma?

Back 77

slighlty better than NST despite presence of poor prognostic factors

Front 78

discribe colloid carcinoma

Back 78

presence of multiple colloidal areas full of mucus

slow growing occuring mostly in older women

little metastic potential

good overal prognosis

typically grade 5

Front 79

what is the character of tubular carcinoma

Back 79

very well differentiated 3/9 score

good prognosis

frequenlty associated with ALH, LCIS, or low grad DCIS

seldom can this be diagnosed occuring alone

Front 80

what are the major prognostic indicators in breast cancer

Back 80

invasive vs in siitu

distant metastases

lymph nod involvement

size

locally advanced(hard to find borders if it has spread to skind or pectoralis muscle)

inflammatory carcinoma(ulceration and poe de orange) not good

Front 81

what are the predicative markers and what do they indicate

Back 81

ER-estrogen receptor if positive can treat with estrogen

PR-progesterone receptor if positive can treat with progesterone

Her2/Neu- only positive in poorly differentiated cancers, nuclear membrane staining, can be treated with herceptin

if Her2/Neu positive usually ER/PR neg

triple negative breast cancer is the worst associated with highest level or RNA and no real treatments

Front 82

what type of cancer is associated with post radiation?

Back 82

vascular tumor(angiosarcoma)

not good prognosis

Front 83

what is gynecomastia?

Back 83

enlargments of male breast

Front 84

what are the causes of gynecomastia

Back 84

puberty or the very aged

klinefelter syndrome

functioning testicular tumors

cirrhosis of the liver

drugs-alcohol, marijuana, heroin and some psychoactives

morticians: an estrogen containing embalming cream has been reported to cause gynecomastin in morticians

Front 85

what are the characteristics of male breast cancer

Back 85

very rare
0.11% chance for average male
occurs usually in the older
strongly associated with BRCA2
acillary lymph nodes involvement common on presentation
distant metastases to lungs, brain, bone, and liver are common

Front 86

what is EIC

Back 86

extensive intraductal component
seen in ductal carcinoma in situ, indicating that there is a lot of diffuse ductal involvment and bc this cannot be felt by the surgeon its often difficult to ensure the entire margin of the tumor has been removed often with high EIC mastectomy is the best option

Front 87

what are tram tracks on mammogram?

Back 87

clacification of vessels benign finding no indication of cancer