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Terms in this set (28)
1. what type of gland?
2. embryologically what is it derived from?
3. where can breast tissue develop?
4. To pathologic consequences of #3?
1. modified sweat gland
2. from skin
3. can develop anywhere along the milk line which runs from the axilla to the vulva
4. Supernumerary nipples and this is a reason that pts w BRCA mutations who undergo prophylactic mastectomy must still be closely followed
1. What is the functional unit of the breast?
2. What does it contain/what is each pieces fx?
3. What is it lined by?
1. Terminal duct lobular unit
2. TDLU -> terminal duct drains milk, lobule contains lobular spaces which make milk
3. Lobules & ducts are lined by
luminal cell layer
: inner cell layer lining ducts & lobules, milk production
myoepithelial cell layer
: outer cell layer lining ducts & lobules, ctxs to propel milk towards nipple
Epithelium of breast (TWO LAYERS)
1. inner cell layer lining ducts & lobules, milk production?
2. outer cell layer lining ducts & lobules, ctxs to propel milk towards nipple ?
3. papillary growth that still has both layers?
4. papillary growth that only has one layer?
5. what is the common presentation between #3 & #4
1. Luminal cell layer
2. Myoepithelial cell layer
3. Intraductal papilloma: both layers
4. Papillary carcinoma: just epithelial cells, no myopeithelial cells present
5. both present w bloody nipple discharge
Where is the highest density of breast tissue in females? In males?
F: upper outer quadrant
M: underneath the nipple
Causes of galactorrhea? (x3)
1. Nipple stimulation (common physiologic cause)
2. Prolactinoma of the anterior pituitary
a sx of breast cancer)
Pt w erythematous breast that has purulent nipple discharge
-if it progresses what can it be confused with?
-bacteria infection (s. aureus) from fissure in nipple with breast-feeding
-may form an abscess (mass) -> may be confused with inflammatory carcinoma
-tx: continued drainage (feeding) and antibiotics (dicloxaciallin)
if pt doesn't recover from antibiotics, check for inflammatory carcinoma
D/o in breast due to smoker with a vitamin A deficiency presenting w a subareolar mass w nipple retraction
-vit A deficiency -> unable to maintain the normal highly specialized epithelium of the subareolar ducts -> undergoes squamous metaplasia of lactiferous ducts -> duct blockage and inflammation -> subareolar mass w nipple retraction (ctx'ing granulation tissue)
Multiparous postmenopausal woman presenting with a periareolar mass and green-brown nipple discharge
-name of d/o?
-cell seen on biopsy?
Mammary Duct Ectasia
-inflammation w dilation (ectasia) of the subareolar ducts
-discharge = inflammatory debris
-biopsy: chronic inflammation w plasma cells
Abnormal calcification on mammogram but biopsy shows necrosis, calcifications, giant cells (no malignancy)
-name of problem and cause?
-related to trauma
-calcification is due to saponification that occurs
Most common change in the premenopausal breast? (hormone mediated)
1. name of change?
2. presents w what on physical exam?
3. gross exam?
1. Fibrocystic change
-development of fibrosis and cysts in breast
2. Lumby breast on physical exam (vague irregularity of breast tissue), usually in the upper outer quadrant (Highest density)
3. Cysts w a blue-dome appearance on gross exam
1. which features are associated with no increased risk for invasive carcinoma (3 of the options)
2. which give a 2x risk (2 of the options)
3. which give a 5x risk (1 of the options)
Options: ductal hyperplasia, apocrine metaplasia, fibrosis, sclerosing adenosis, atypical hyperplasia, cysts
1. Fibrosis, cysts, and
= NO risk
2. Ductal hyperplasia, sclerosising adenosis = 2x increased risk
3. Atypical hyperplasia = 5x increased risk
(atypical cells can be in the duct or the lobule)
(the increased risk applies to both breasts)
Bloody nipple discharge:
-in a premenopausal woman?
-in a postmenopausal woman?
-whats a key difference between these 2 on histology?
Pre: intraductal papilloma
-contains both layers that line it
Post: papillary carcinoma
-lined by just epithelial cells,
Most common tumor in premenopausal women?
-benign or malignant? increased risk?
-changes w pregnancy?
-presents as what on physical exam?
-benign with no increased risk of carcinoma
-estrogen sensitive: grows during pregnancy, may be painful during menstrual cycle
-presents as a well-circumscribed, mobile marble-like mass
Fibroadenoma-like tumor with overt worth of the fibrous component, leaf-like projections on biopsy?
-more in postmenopausal women
-can be malignant in some cases
RFs for breast cancer (x6)
Mostly related to
3. early menarche/late menopause
4. obesity (peripheral conversion to estrogen)
5. Atypical hyperplasia: special feature that increases risk in variant of fibrocystic change, increases risk on either breast (not just the one it grew in)
6. First-degree relative w breast cancer (mother/sister/daughter)
4 main subtypes of breast cancer?
1. Ductal carcinoma in situ (DCIS): malignant but no invasion of BM
-if goes to nipple -> Pagets dz
2. Invasive ductal carcinoma: invade past membrane to stroma
3. LCIS: malignant cells but no invasion of BM
4. Invasive lobular carcinoma: invade past membrane
Pt w calcifications on mammogram, biopsy shows high-grade cells w necrosis and dystrophic calcification in center of ducts
-name of d/o?
Comedy type ductal carcinoma in situ (DCIS)
-doesnt usually produce a mass
-blood vessels are outside of duct -> center often dies -> dystrophic calcification occurs on top of these dead cells
Pt w nipple ulceration and erythema?
Paget dz of the breast -> DCIS that extends up the ducts, so almost always associated w an underlying carcinoma (unlike extramammary pagets)
Most common type of invasive carcinoma in the breast?
-how is it usually detected? (x3..one only if advanced)
Invasive ductal carcinoma
-mass detected by physical exam (2 cm or greater) or by mammography (1 cm or greater)
-advanced tumor may be detected due to dimpling of skin or retraction of the nipple
Mass detected on mammogram, then biopsy with duct-like structures in a desmoplastic stroma?
Invasive ductal carcinoma
Subtypes of invasive ductal carcinoma: (name and good or poor prognosis?)
1. well-differentiated tubules that lack myoepithelial cells
2. tumor cells floating in a mucus pool
3. large, high grade cells growing in sheets w associated lymphocytes and plasma cells, well-circumscribed mass
4. carcinoma in the dermal lymphatics, inflamed breast
5. which of the has an increased incidence in BRCA1 carriers (even though its not the most common w/in this population)
1. Tubular carcinoma: relatively good prognosis
2. Mucinous carcinoma: relatively good prognosis (in older women usually...avg age is 70)
3. Medullary carcinoma: relatively good prognosis, increased incidence in
4. Inflammatory carcinoma: poor prognosis (already in lymphatic spaces)
5. medullary carcinoma
What type of breast cancer lacks E-cadherin and what does this lead to?
Lobular carcinoma in situe (LCIS)/invasive lobular carcinoma
-leads to dyscohesive cells
-in invasive carcinoma: grows in a
, may exhibit signet-ring morphology
(ductal is in a round duct pattern and still connected bc it has E-cadherin)
Most important factor for prognosis in breast cancer?
Most useful prognostic factor?
What are predictive factors for response to treatment?
Most important: metastasis
Most useful: spread to axillary lymph nodes
(bc most pts present before metastasis occurs)
Predictive factors: estrogen rec (ER), progesterone rec (PR), HER2/neu gene amplification
-if ER(+) -> will respond to anti-estrogen tx like tamoxifen
Estrogen rec and progesterone rec: where are they located, what do you tx w if (+) in these?
Both receptors are in the nucleus, tx w antiestrogenic agent like tamoxifen
-what is it?
-where is it located?
-what happens in cancer?
-tx if (+) for it?
Growth factor receptor on the cell surface
-if amplified -> excess growth of cell -> drives tumor proliferation
-tx if (+) = trastuzumab (Herceptin)
Who is most likely to have a 'triple-negative' breast tumor? what does this mean for their prognosis?
African american women, poor prognosis
BRCA1 mutation is associated with? (x2)
BRCA2 mutation is associated with?
BRCA1: breast and ovarian carcinoma
-serous ovarian carcinoma -> can also arise in the fallopian tube
BRCA2: breast carcinoma in males
(if + for these may choose to do bilateral matesctomy to decrease risk of developing carcinoma, but a small risk still remains since breast tissue sometimes extends into the axilla or subQ tissue of the chest wall -> still need to monitor)
Male breast cancer:
1. location of mass?
2. other possible presenting sx?
3. is ductal or lobular carcinoma more common? why?
4. associated w what 2 things?
1. Subareolar mass (highest density is underneath the nipple for males)
2. May also produce nipple discharge (bc tumor develops right under the nipple)
3. Invasive ductal carcinoma is more common bc male breasts develop very few lobules
4. Assoc w BRCA2 mutations and Klinefelter syndrome
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