Breast Path

Question 1

acute mastitis

Answer 1

occurs during lactation

• staph most common
• strep

Question 2

fat necrosis

Answer 2

-generally associated with trauma
Clinical Sig: confusion with cancer due to palpable mass or calcification on mammogram
Histology: Necrotic fat cells surrounded by macrophages and neutrophils, then fibroblasts, lymphocytes, and histiocytes

Question 3

What is the single most common breast disorder?

Answer 3

non proliferative fibrocystic changes
(there is also proliferative)
20-40y.o
-no risk

Question 4

Fibroadenoma

Answer 4

most common benign tumor, usually small

-occur during reproductive life (more common

Question 5

Phyllodes tumor

Answer 5

older patients -6th decade
-larger than fibroadenoma
-benign, borderline and malignant types (mostly benign)
phyllodes=leaf life
-distinguished from fibroadenoma on the basis of cellularity, mitotic rate, nuclear pleomorphism, stromal overgrowth, and infiltrative borders
-increased risk both breasts

Question 6

Intraductal papilloma

Answer 6

most common cause of bloody nipple discharge in younger women

• multiple branching fibrovascular cores, each having a connective tissue axis lined by luminal and myoepithelial cells
• increased risk both breasts 1.5-2

Question 7

Atypical ductal hyperplasia

Answer 7

duct expansion
-increased risk
4-5

Question 8

Atypical lobular hyperplasia

Answer 8

TDLU expansion
-increased risk
4-5

Question 9

Where do 50% of breast carcinomas arise in?

Answer 9

upper outer quadrant

Question 10

Lobular carcinoma in situ and ductal carcinoma in situ have how much of an increased risk for carcinoma? both breast or ipsi

Answer 10

8-10
lobular-both
duct-ipsi

Question 11

Paget Disease

Answer 11

Rare manifestation of breast cancer (1-4%)
DCIS arising within ductal system of the breast can extend up the lactiferous ducts into nipple skin without crossing the bm
-underlying invasive carcinoma or DCIS
-prognosis depends on extent of the underlying carcinoma

Question 12

What is the most common type of invasive carcinoma?

Answer 12

ductal carcinoma (no special type)

Question 13

Which invasive carcinomas have better prognosis?

Answer 13

• tubular/cribriform carcinoma
• mucinous carcinoma
• medullary carcinoma

Question 14

How do invasive lobular carcinoma look?

Answer 14

single file

Question 15

What features indicate increased likelihood of having BRCA?

Answer 15

-multiple cases of early onset breast cancer (

Question 16

BRCA1 vs BRCA 2

Answer 16

BRCA1=17q21
-triple negative (basal-like cancers)
BRCA2=13q12.3
-similar to sporadic breast cancers 
both tumor suppressor 
BRCA higher risk ovarian
BRCA2 higher risk male breast

Question 17

Gynecomastia

Answer 17

unilateral or bilateral

• indicator of hyperestrinism (cirrhosis or functioning testicular tumor)
• marked micropapillary hyperplasia of ductal lining occurs
• periductal lymphocytic infiltrate
• fibrosis

Question 18

carcinoma of the male breast

Answer 18

rare
risk factor: 
-first degree relatives with breast ca
-decreased testicular function
-age
-infertility
-obesity
-radiation
-residency in waster countries
-GYNECOMASTIA NOT A RISK FACTOR
-BRCA2 mutation (4-14%)
-the same histologic subtypes of invasive cancer are present

Question 19

Invasive ductal carcinoma luminal A

Answer 19

ER+
PR+
HER2-

Question 20

Invasive ductal carcinoma luminal B

Answer 20

ER+
PR+
HER2+

Question 21

Invasive ductal carcinoma HER2+

Answer 21

ER-
PR-
HER2+

Question 22

Invasive ductal carcinoma basal like

Answer 22

ER-
PR-
HER2-
CK5/6
EGFR+