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