PATHOLOGY > BREAST > Flashcards

BREAST Flashcards

(75 cards)

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1
Q

Functional unit of the breast

A

Lobule

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2
Q

What breast structure have a contractile function that aid in milk ejection and also support the basement membrane

A

Myoepithelial cells

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3
Q

What breast cell produce milk during lactation

A

Inner luminal epithelial cells

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4
Q

What structure determines the size of the breast

A

Interlobular stroma

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5
Q

How many percent of symptomatic breast lesions are benign

A

90%

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6
Q

Predominant signs and symptoms of breast disease

A

-pain
-inflammatory changes
-nipple discharge
-lumpiness
-palpable mass

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7
Q

Most common benign breast lesion producing a nipple discharge

A

Papilloma

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8
Q

What size of the breast mass where it can generally be detected by palpation

A

2-3 cms

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9
Q

The average size of invasive carcinomas detected by mammography is about

A

1 cm

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10
Q

The only infectious agent to cause breast disease with any frequency, which typically gains entry via fissures in nipple skin during the first weeks of breastfeeding

A

Staphylococcus aureus

-“lactational abscess”

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11
Q

What are the two types of stroma in the breast

A

Intralobular
Interlobular

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12
Q

What breast tumors derived from intralobular stroma

A

-Fibroadenoma
-Phyllodes tumor

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13
Q

Tumor mass with circumscribed borders, low cellularity, and mitoses are rare

A

Fibroadenoma

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14
Q

Tumor mass whereby the stromal cells outgrow the epithelial cells, resulting in bulboes nodules of proliferating stromal cells that are covered by epithelium

A

Phyllodes tumor

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15
Q

Which stroma is comprised of both stromal cells and epithelial cells (biphasic)

A

-intralobular stroma

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16
Q

Lesions of what stroma are monophasic (only comprised of mesenchymal cells) and include benign soft tissue tumors (eg hemangioma and lipoma)

A

Interlobular stroma

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17
Q

The only malignancy derived from interlobular stromal cells of note is

A

Angiosarcoma

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18
Q

Bening breast changes is divided into 3 :

A

-non-proliferative disease
-proliferative without atypia
-proliferative with atypia

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19
Q

This benign breast changes encompasses polyclonal hyperplasias that are associated with a slightly increased risk of breast ca

A

Proliferative without atypia

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20
Q

This benign breast changes included monoclonal “precancers” that are associated with modest increase risk of breast cancer in both breast

A

Proliferative with atypia

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21
Q

3 major morphologic changes of nonproliferative disease (single layer epithelial cells)

A

-cysts
-fibrosis
-adenosis

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22
Q

Most common nonproliferative breast lesions

A

Simple cysts

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23
Q

When the cyst rupture, chronic inflammation and fibrosis in response to spilled debris may produce palpable nodularity called

A

Fibrocystic changes

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24
Q

Proliferative disease without atypia includes

A
  • epithelial hyperplasia
  • sclerosing adenosis
  • complex sclerosing lesion
  • papilloma
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25
Proliferative disease with atypia includes
-ADH (atypical ductal hyperplasia) -ALH (atypical lobular hyperplasia)
26
ADH cells
- uniform in appearnce - form sharply marginated spaces or rigid bridges
27
Common feature of nonproliferative breast disease
Apocrine cyst
28
29
Social changes that increase risk of breast cancer
-delayed child-bearing -few pregnancies -reduced breastfeeding
30
Most common breast malignancy
Adenocarcinomas (>95%)
31
Hormone receptors:
• ER positive (HER2 negative; 50%–65% of cancers) • HER2 positive (ER positive or negative; 10%–20% of cancers) • Triple negative (ER, PR, and HER2 negative; 10%–20% of cancers)
32
Alternative classification system that relies on gene expression profiling divides breast ca into 4 major types:
• Luminal A. The majority are lower-grade ER-positive cancers that are HER2 negative • Luminal B. The majority are higher-grade ER-positive cancers that may be HER2 positive • HER2-enriched. The majority overexpress HER2 and do not express ER • Basal-like. The majority by gene expression profiling resemble basally located myoepithelial cells and are ER-negative, HER2-negative
33
ER positive (HER 2 negative) is mostly associated with what germline mutation
BRCA2 mutation carriers
34
HER 2 positive (either ER positive or negative) is most associated with what germline mutation
TP3 mutation carriers
35
Triple negative is most associated with what germline mutation
-BRCA1
36
37
Most common metastatic site
Bone Viscera Brain
38
What genetic mutation is frequently found in sporadic ER-positive and HER-2 positive breast cancers
-mutations that activate PI3K-AKT signaling
39
A common clinically important driver mutation in breast cancer is
Amplication of HER2 gene
40
Most common location of tumors within the breast
Upper outer quadrant (50%) -central portion (20%)
41
Most common invasive breast carcinoma
-Invasive ductal carcinoma (70-80%)
42
2 morphological types of noninvasive breast carcinoma
Ductal carcinoma in situ (DCIS) Lobular carcinoma in situ (LCIS) * both respect the basement membrane and do not involve the stroma or lymphovascular channels
43
Calcifications is most commonly associated with what type of breast ca
DCIS
44
This is caused by the extension of DCIS up the lactiferous ducts and into the contiguous skin of the nipple, producing a unilateral crusting exudate over the nipple and areolar skin.
Pagets disease of the nipple *stems from in situ extension of underlying carcinoma
45
This noninvasive breast carcinoma is both a marker of an increased risk of carcinoma in both breast and a direct precursor of some cancers
LCIS *rarely associated with calcification *has a uniform appearance; The cells are monomorphic, have bland, round nuclei, and are found in loosely cohesive clusters within the lobules
46
This invasive breast carcinoma produce a desmoplastic response, which replaces normal breasr”t fat ( resulting in mammographic density) and eventually leads to appearance of hard, palpable, irregular mass
Invasive ductal carcinoma
47
This invasive carcinoma invade the stroma individually and often are aligned in “single-file” and invade without producing a desmoplastic response hence can be clinically occult and hard to detect by imahing
Invasive lobular carcinoma
48
Pattern of metastatis of invasive lobular carcinoma
CSF Serosal surface GIT Ovaries Uterus Bone marrow
49
These carcinomas typically grow as rounded masses that can be difficult to distinguish from benign tumors on imaging. They consist of sheets of large anaplastic cells associated with pronounced lymphocytic infiltrates composed predominantly of T cells
Carcinomas with medullary features
50
Carcinoma with medullary features is seen frequently in what germline mutation
BRCA 1
51
Carcinoma with medullary fetures
-Triple negative cancer (special type)
52
Mucinous (colloid) is associated with what hormone-receptor expression
ER positive (HER2 negative)
53
Invasive breast carcinoma grading
Grade 1 (low grade) Grade 2 Grade 3 (high grade) *grading is based on nuclear polymorphism, tubule formation, proliferation
54
In TNM staging, which has the very strong prognostic factor?
Nodal involvement
55
Stages of breast cancer
Stage 0: CIS Stage 1: smaller cancers, free nodes or with only very small micrometastases Stage 2: larger tumor; 2-3 positive nodes Stage 3: large tumor; skin or chest wall involvement; 4 or more nodes Stage 4: distant metastases
56
Her2 positive and triple negative cancers usual site of metastases
Viscera
57
Er positive cancer usual site of metastases
Bones
58
It is a proliferation of small ducts and myoepithelia cells
Adenosis
59
Adenosis plus fibrosis
Sclerosing adenosis
60
Most common disorder of the breast and cause of palpable breast mass in women 25-50 yrs of age
Fibrocystic change
61
Most common breast tumor in women younger than 25 years of age
Fibroadenoma
62
Fibroadenoma characteristics of lesion
-firm -ruberry -painless -well-circumscribed
63
Type of fibroadenoma where the stroma compresses and distorts glands into slitlike spaces
Intracanalicular fibroadenoma
64
Type of fibroadenoma where the galnds retain its round shape
Pericanalicular adenoma
65
This tumor is a large, bulky mass of variable malignancy with ulceration of overlying skin. Cystic spaces containing leaflike projections from the cyst walls and myxoid contents are characteristic.
Phyllodes tumor
66
This tumor presents with serous or bloody discharge and palpable mass
Adenoma of the nipple
67
Second most common malignancy of the women (carcinoma of the lung is most common)
-Breast CA
68
Invasive ductal carcinoma is graded using what system
Bloom-richardson (Nottingham Histoloc Grading system) “TNM” -tubule formation -nuclear atypia -mitotic activity Scored as 1-2-3 score 2: 10-75 tubule formation, moderate variablity in size and shape of nucleus, intermediate number of mitosis 3-5: GRADE I well- differentiated 6-7: GRADE II moderately differentiated 8-9: GRADE III poorly differenriated
69
E-cadherin negative
lobular lesions (ALH/LCIS)
70
E-cadherin positive
ductal lesions
71
Extent: Partially fills duct Cytology: Uniform, ductal-type cells E-cadherin: Positive Cancer risk: ~4–5× increased
Atypical Ductal Hyperplasia
72
Completely fills the duct
DCIS
73
Which of the following confers the highest risk of developing invasive carcinoma? A. Nonproliferative change B. Proliferative disease without atypia C. Atypical hyperplasia D. Carcinoma in situ
74
Acute hypoxic-Ischemic neuronal injury
75
Completely fills the duct
DCIS
PATHOLOGY
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