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35 Cards in this Set

  • Front
  • Back

Paget disease of nipple

Paget disease of nipple (malignant cells circled)

Invasive ductal carcinoma (DS = desmoplastic stroma); tubular carcinoma

Invasive ductal carcinoma; Mucinous carcinoma

Invasive ductal carcinoma; inflammatory carcinoma

Invasive ductal carcinoma; inflammatory carcinoma; cancer (circled) within dermal lymphatics

Invasive lobular carcinoma (note single file structure)

What is the functional unit of the breast?

The terminal duct lobular unit

Acute mastitis

  • Bacterial infection of breast (usually Staph. aureus)
  • Associated with breast-feeding; fissures develop in nipple providing a route of entry for microbes
  • Presents as an erythematous breast with purulent nipple discharge; may progress to abscess formation
  • Treatment involves continued draining (e.g. feeding) and antibiotics (e.g. dicloxacillin)

Periductal mastitis

  • Inflammation of subareolar ducts
  • Usually seen in smokers (relative vitamin A deficiency results in squamous metaplasia of lactiferous ducts, producing duct blockage and inflammation)
  • Clinically presents as a subareolar mass with nipple retraction

Mammary duct ectasia

  • Inflammation with dilatation (ectasia) of subareolar ducts
  • Rare; clinically arises in multiparous postmenopausal women
  • Presents as periareolar mass with green-brown nipple discharge
  • Chronic inflammation with plasma cells is seen on biopsy

How does fat necrosis of breast present?

  • Mass on physical exam
  • Abnormal calcification on mammography (due to saponification)
  • Biopsy shows necrotic fat with associated calcifications and giant cells

Fibrocystic change

  • Development of fibrosis and cysts in breast
  • Most common change in premenopausal breast; thought to be hormone mediated
  • Presents as vague irregularity of breast tissue, usually in upper outer quadrant
  • Cysts have blue-dome appearance on gross exam

Fibrocystic changes associated with increased risk for invasive carcinoma

  • Fibrosis, cysts, and apocrine metaplasia - NO RISK
  • Ductal hyperplasia and sclerosing adenosis - 2X increased risk
  • Atypical hyperplasia - 5X increased risk

Intraductal papilloma

  • Benign papillary growth, usually into large duct
  • Characterized by fibrovascular projections lined by epithelial (luminal) and myoepithelial cells
  • Classically presents as bloody nipple discharge in premenopausal women

How is intraductal papilloma distinguished from papillary carcinoma?

  • Papillary carcinoma is characterized by fibrovascular projections lined by epithelial cells without underlying myoepithelial cells
  • Risk of papillary carcinoma increases with age; thus, it is more commonly seen in postmenopausal women


  • Tumor of fibrous tissue and glands
  • Most common benign neoplasm of the breast; usually seen in premenopausal women
  • Presents as well-circumscribed, mobile marble-like mass
  • Estrogen sensitive--grows during pregnancy and may be painful during menstrual cycle
  • Benign, with no increased risk of carcinoma

Phyllodes tumor

  • Fibroadenoma-like tumor with overgrowth of fibrous component; characteristic 'leaf-like' projections are seen on biopsy
  • Most commonly seen in postmenopausal women
  • Can be malignant

Ductal carcinoma in situ (DCIS)

  • Malignant proliferation of cells in dust with no invasion of basement membrane
  • Often detected as calcification on mammography; doesn't usually produce mass
  • Histologic subtypes are based on architecture

Histological appearance of Comedo type DCIS

comedo type is characterized by high-grade cells with necrosis and dystrophic calcification in the center of ducts

Paget disease of breast

DCIS that extends up the ducts to involve skin of nipple

  • presents as nipple ulceration and erythema
  • almost always associated with an underlying carcinoma

Most common type of invasive carcinoma in breast

Invasive ductal carcinoma

How does invasive ductal carcinoma present?

  • As a mass that is usually 2 cm or greater
  • Mammographically detected masses are usually 1 cm or greater
  • Advanced tumors may show dimpling of skin or retraction of nipple
  • Biopsy shows duct-like structures in desmoplastic stroma

Special subtypes of invasive ductal carcinoma

  • Tubular carcinoma
  • Mucinous carcinoma
  • Medullary carcinoma
  • Inflammatory carcinoma

Tubular carcinoma

Characterized by well-differentiated tubules that lack myoepithelial cells; good prognosis

Mucinous carcinoma

  • Characterized by carcinoma with abundant extracellular mucin
  • Tends to occur in older women (average age is 70)
  • Relatively good prognosis

Medullary carcinoma

  • Characterized by large, high-grade cells growing in sheets with associated lymphocytes and plasma cells
  • Grows as well-circumscribed mass that can mimic fibroadenoma on mammography
  • Relatively good prognosis
  • Increased incidence in BRCA1 carriers

Inflammatory carcinoma

  • Characterized by carcinoma in dermal lymphatics
  • Presents classically as an inflamed, swollen breast (tumor cells block drainage of lymphatics) with no discrete mass; can be mistaken for acute mastitis
  • Poor prognosis

Lobular carcinoma in situ (LCIS)

  • Malignant proliferation of cells in lobules with no invasion of the basement membrane
  • Does not produce a mass or calcifications and is usually discovered incidentally on biopsy
  • Characterized by dyscohesive cells lacking E-cadherin adhesion protein
  • Often multifocal and bilateral
  • Treatment is tamoxifen + follow up (low risk of progression to invasive carcinoma)

Invasive lobular carcinoma

  • Characteristically grows in single-file pattern
  • Cells may exhibit signet-ring morphology
  • No duct formation due to lack of E-cadherin

Most important vs. most useful prognostic factors in breast cancer

  • Most important: metastasis
  • Most useful: spread to axillarly lymph notes


This gene is associated with response to transtuzumab (Herceptin), a designer antibody directed against the HER2 receptor; HER2/neu is a growth factor receptor present on the cell surface

Which mutation is associated with breast and ovarian cancers?


Which mutation is associated with male breast cancer?


Male breast cancer

  • Usually presents as subareolar mass in older males
  • Most common histological subtype is invasive ductal carcinoma
  • Associated with Klinefelter syndrome