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Flashcards in Breast CA Deck (24)
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1
Q

Acute mastitis

A

First month of lactation when breast vulnerable to bacterial infections through nipple cracks and fissures
- antibiotics and continued feeding

2
Q

Periductal mastitis

A

Squamous metaplasia of nipple ducts results in keratin shedding and subsequent ductal plugging

  • duct dilation and rupture then leads to intense chronic and granulomatous inflammation
  • painful subareolar mass
  • recurrent subareolar abscess, squamous metaplasia of lactiferous ducts, zuska disease

Smoking associated

3
Q

Mammary duct ectasia

A

Ill defined painless eriareolar mass with viscous white nipple secretions

  • occurs in multiparous women between ages 50-70
  • not associated with smoking
  • inspissation of secretions, duct dilation without squamous metaplasia, periductal inflammation leading to fibrosis and skin retraction
4
Q

fat necrosis

A

painless palpable mass, skin thickening or retraction, mammographic density or calcifications

  • associated with prior trauma or surgery
  • progress from hemorrhage with acute inflammation and liquefactive necrosis to chronic inflammation with giant cells and hemosiderin to scar tissue
5
Q

Sclerosing lymphocytic lobulitis

A

Single or multiple, rock hard, palpable masses

  • collagenous stroma around atrophic ducts with prominent lymphocytic infiltrate
  • association with type I diabetes and autoimmune thyroid disease
6
Q

Granulomatous mastitis

A

systemic diseases, foreign bodies, granulomatous infections

- parous women, hypersensitivit to lactational epithelium

7
Q

Nonproliferative breast changes (fibrocystic changes)

A

No malignant potential
- lumpy bumpy breasts
Morph: lobular dilation and unfolding and coalesce to form larger lesions
- lined by flattened atrophic epithelium or metaplastic apocrine cells
- fibrosis secondary to cyst rupture and inflammation
- adenosis defined as increased numbers of acini per lobule, pregnancy and can be a local finding in non-pregnant breasts

8
Q

Proliferative breast disease without atypia

A

epithelial or stromal proliferation without cytologic or architectural atypia
Morph:
- epithelial hyperplasia defined by more than two cell layers around ducts and lobules
- sclerosing adenosis - increased numbers of acini per lobule, central distortion and compression and peripheral dilation
- complex sclerosing lesions - sclerosing adenosis, papiloomas, epithelial hyperplasia
- papillomas - epithelial growth and associated fibrovascular cores within dilated ducts

9
Q

Proliferative breast diseases with atypia

A

Atypical ductal and atypical lobular hyperplasia

Morph: atypical ductal hyperplasia shares features with DCIS, atypical lobular hyperplasia shares features with LCIS

10
Q

Breast CA

A
Most common non-skin malignancy in women
- 1/8 chance of developing CA
Risk: 
- gender
- age
- age at menarche/ menopause
- age at first live birth
- relatives with breast CA
- atypical hyperplasia
- race/ethnicity
- estrogen exposure
- breast density, radiation, CA of endometrium or contralateral breast
- geographic influence
- diet
- obesity
- breast feeding

hereditary - BRCA1 and BRCA2, CHEK2, p53, PTEN, LKB1/STK11
sporadic - hormone exposure, most estrogen receptor positive in postmenopausal women

11
Q

Ductal carcinoma in situ

A

Incidence: 15-30% of all breast CA
Morph:
- comedocarcinoma - ducts and lobules dilated by sheets of high grade pleomorphic cells with zones of central necrosis
- noncomedo DCIS - monomorphic population of cells of varying nuclear grades
- paget disease: rarely, malignant cells extend from ductal DCIS into nipple skin
- microinvasion - stromal invasion

12
Q

Lobular carcinoma in situ

A
No calcifications or stomal responses
- bilateral 
- age premenopausal
- progresses to invasive cancer
Morph: discohesive cells from loss of E-cadherin, intracellular mucin forming signet ring cells
13
Q

Invasive infiltrating carcinomas

A

Palpable masses or lesions

Sx: peau d’orange, nipple retraction

14
Q

Inflammatory carcinoma

A

Tumors that present with swollen erythematous breast due to extensive lymphatic invasion and destruction

15
Q

Invasive carcinoma, no special type

A

70-80% of cancers
Classifications:
- luminal A: ER pos, HER2/neu neg
–> well differentiated, postmenopausal women, slow growing, respond to hormone therapy
- luminal B: ER pos HER2/neu pos
–> nodal metastases and may respond to chemo
- Normal breast: ER pos, HER2/neu neg, well differentiated
- basal like: ER, PR, HER2/neu neg
–> express myoepithelial cell markers in BRCA1
–> high grade and proliferative and pursue aggressive course
- HER2 pos: ER neg, HER2/neu pos, poorly differentiated and aggressively metastatic

Morph: gross - irregular border and gritty sensation, firm and hard tumors
micro - well differentiated with tubule formation, small nuclei, rare mitoses

16
Q

Invasive lobular carcinoma

A
palpable mass or density
- invades with little desmoplasia
- well differentiated, ER pos
Morph: discohesive infiltrating tumor cells arranged in single file or loose clusters
- signet ring appearance
17
Q

Medullary carcinoma

A

Age: after 60
Path: BRCA1
- rapidly growing well circumscribed masses
Morph: Grossly - soft and fleshy with pushing border
micro - lesions exhibit solid sheets of large cells with vesicular pleomorphic nuclei and prominent nucleoli

18
Q

Mucinous carcinomas

A

Slow growing well differentiated ER pos tumors
- no metastases
Age: 71
Morph: soft to rubbery with gel like consistency, malignant cells in clusters

19
Q

Tubular carcinoma

A
Small irregular densities 
- multifocal or bilat
- ER pos, HER2/neu neg
Age: women in 40s
Good prognosis
20
Q

Fibroadenomas

A

Most common benign tumor of female breast
Age: reproductive years
- regresses and calcifies after menopause
Sx: rubbery, well circumscribed palpable masses
Morph: hormone responsive, can grow during pregnancy

21
Q

Phyllodes tumor

A

Common after age 60

  • presents as palpable masses
  • stroma overgrows epi component forming clefts and slits and bulbous protrusions, increased cellularity, mitotic activity, stromal overgrowth
22
Q

Benign stromal lesions

A

Tumors of interlobular stroma, no epi component

Ex: pseudoangiomatous stromal hyperplasia, fibromatosis, myofibroblastoma

23
Q

Angiosarcoma

A

malignant stromal tumor

Age: young women after radiation therapy or after mastectomy

24
Q

Male breast CA

A

BRCA2, similar risk factors to women

- estrogen risk