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40 Cards in this Set

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benign neoplasms involving CALCIFICATIONS

(1) fat necrosis - leads to saponification


(2) sclerosing adenosis

What stain is useful for differentiating between ductal VS lobular breast cancer

E. Cadherin --> lost in LOBULAR, not ductal

Examples of inflammatory conditions of the breast

(1) Acute Mastitis - bacterial infxn of breast commonly causes by STAPH AUREUS, w/ or w/o abscess: erythematous breast w/ nipple discharge. Associated with breast feeding: fissures develop in nipple providing route for microbe entry. Rx with dicloxacillin.




(2) Periductal mastitis - Presents as SUBAREOLAR MASS w/ nipple retraction. Commonly caused by smoking which induces relative vitamin A deficiency, specialized epithelium of duct requires vitamin A. Get squamous metaplasia of the lactiferous ducts (normally columnar?) leading to duct blockage and inflammation [see keratinization within duct].



(3) Mammary Duct ectasia - Presents as PERIOAREOLAR MASS w. green-brown nipple discharge. See chronic inflammation with plasma cells seen on biopsy. Inflammation with dilation (ectasia) of the subareolar duct. Rare, usually arising in MULTIPAROUS post-menopausal women.




(4) Fat necrosis - Necrosis of breast fat caused by trauma. Found as a mass on physical exam OR abnormal calcification in mammography. Biopsy - necrotic fat with associated calcifications and giant cells.

Which breast condition causes green-brown nipple discharge? Is it benign or malignant?




Describe the typical patient that would present this way?




What is the cause?

Mammary Duct Ectasia. Non-neoplastic but rather associated with inflammation.




Multiparous post-menopausal patient




Inflammation with dilatation of subareolar duct, see plasma cells on bx.

Common pathology caused by breast feeding. How do you treat it?

Acute mastitis - infection of breast with S.Aureus. Continue breast feeding and treat with dicloxacillin.

What condition of the breast is associated with squamous metaplasia of the duct? What's the etiology.

Periductal mastitis. Smoker --> Vitamin A deficiency --> squamous metaplasia of duct.

Patient presents with hard mass in physical exam. Patient reports recent car accident. Diagnosis?

Fat necrosis

Benign neoplasms of the breast - list & brief description

(1) Fibrocystic change - fibrosis and cysts in breasts. Vague irregularity of breast in pre-menopausal woman, usually in UOQ. Most common in PREMENOPAUSAL breast. Benign but certain types inc risk cancer (atypical ductal hyperplasia [5X], ductal hyperplasia [2X], and sclerosing adenosis [2X]. This is occurring in the MAJOR DUCT. NO INC RISK FOR FIBROSIS+CYSTS+APOCRINE METAPLASIA)




(2) fibroadenoma - tumor of fibrous tissue & glands located in the STROMA. Presents as small, mobile, firm mass with sharp edges. It is the most common tumor in women <35 (PREMENOPAUSAL). ESTROGEN DEPENDENT: bigger size and tenderness with estrogen. NO MALIGNNANT POTENTIAL.




(3) intraductal papilloma - Presents as serous/bloody nipple discharge. Papillary growth into a LARGE DUCT. Fibrovascular projections lines by EPITHELIAL + MYOEPITHELIAL cells. [vs. PAPILLARY CARCINOMA - no ME cells] Small tumor growing in lactiferous ducts. Typically grows beneath areola. Slight INC RISK CARCINOMA (1.5-2X)




(4) Phyllodes tumor - fibroadenoma-like tumor with OVERGROWTH of fibrous component. Histo - Leaf-like projections. It is a large bulky mass of CT and cysts. Most commonly 6th decade post-menopausal woman. Has malignant potential.

25 y/o woman presents with "marble-like", firm, mobile breast mass. Most likely diagnosis? Potential for cancer?

Fibroadenoma - no malignant potential.

"Leaf-like projections on histology ."




Potential for malignancy?




Premenopause or post menopause?




how would these feel?

Phyllodes tumor.




YES, some may become malignant.




POST




large bulky mass

Three most commonly tested receptors for malignant breast tumors.

(1) Estrogen Receptor


(2) Progesterone receptor


(3) HER2 receptor

What is DCIS?

Ductal carcinoma in situ - an malignant proliferation of cells in ducts WITHOUT INVASION OF BASEMENT MEMBRANE. This arises from ductal atypia.

Mammographic results for DCIS?

Microcalcifications

Subtype of DCIS involving ductal caseous necrosis. See high grade cells with necrosis and dystrophic calcification at the center of the ducts.

Comedocarcinoma

Distinct disease resulting as a complication of DCIS.

Paget Disease

Results when ductal cells migrate from a site of DCIS up to the nipple.

Paget disease

Causes nipple ulceration and erythema.

Paget disease

Malignant proliferation of cells in lobules with no invasion of BM

LCIS - lobular carcinoma in situ

Dis-cohesive cells that lack E-Cadherin is the hallmark of this pathology.

Lobular carcinoma (LCIS or invasive lobular carcinoma)

Patient's breast mass tested negative for E-Cadherin and she was treated with TAMOXIFEN.


(a) what was her most likely diagnosis?


(b) what is the mechanism of action of tamoxifen. Risks?

(a) LCIS - lobular carcinoma in situ


(b) Tamoxifen is a estrogen receptor antagonist in breast tissue. However, it is an estrogen receptor AGONIST on the uterus and bone and thus increases risk for endometrial cancer and thromboembolic events.

The worst and most invasive form of breast cancer.

Invasive ductal carcinoma

The most common form of breast cancer

Invasive ductal carcinoma

60 y/o patient presents w/ non-painful, non-tender, 3x4cm rock hard mass in UOQ. Most likely diagnosis?

Invasive ductal carcinoma

"rock-hard mass" w/ sharp margins




classic "stellate" infiltration.




advanced tumors cause skin dimpling and retraction of nipple.

invasive ductal carcinoma

this carcinoma grows in a "single-file pattern" and cells may have signet ring morphology.

invasive lobular carcinoma

This form of invasive breast carcinoma is often bilateral.

Invasive Lobular carcinoma

This breast malignancy is triple negative, but has a good prognosis.

MEdullary carcinoma.

breast malignancy involving a fleshy, cellular, lymphocytic infiltrate.

medullary carcinoma

"Peau d'orange --> breast skin resembles orange-peel. 50% survival @ 5 yrs.

Inflammatory breast cancer

Get an inflamed, swollen breast. caused when neoplastic cells block lymphatic drainage.

Inflammatory breast cancer

Patient experiences nipple retraction.




(1) If this were non-neoplastic what could be the cause?


(b) which cancer is associated with nipple retraction?

(a) periductal mastitis




(b) invasive ductal carcinoma

Patient receives treatment for acute mastitis but it does not resolve. Blood tests for pathogens come back negative. What is another likely etiology?




How would you confirm this?

Inflammatory carcinoma of breast




--> clinical signs of inflammation + finding of tumor cells in DERMAL LYMPHATICS

This type of breast cancer is common in patients with BRCA1 mutations

Medullary carcinoma

Patient has a well-circumscribed mass. On histology you see high-grade tumor cells growing in sheets with lymphocytes and plasma cells. Most likely diagnosis?

Medullary carcinoma!

3 cancers associated with desmoplasia?

invasive ductal carcinoma and pancreatic adenocarcinoma + diffuse gastric adenocarcinoma

What about invasive ductal carcinoma makes it feel "rock hard."

Desmoplastic reaction to invasion of stroma. Stroma proliferates and feels "rock hard."

Important risk factors for invasive ductal carcinoma?

Gender is the most important risk factor although breast cancer can alsodevelop in men. Other risk factorsinclude inherited genetic mutations, personal history of breast cancer, age(higher risk > 65 years-old, but average age 46-61), age at menarche(<11), age at first live birth (younger better), first-degree relatives withbreast cancer – especially two or more first degree relatives diagnosed youngerthan 55 years old, atypical hyperplasia, non-Hispanic white women,postmenopausal hormone replacement therapy, high breast density, radiationexposure, and carcinoma of the contralateral breast or endometrium. Fibrocysticdisease does not increase risk (relative risk = 1.0). Either DCIS or lobular carcinoma in situleads to a relative risk of developing invasive carcinoma of 8.0-10.0 (25%-30%lifetime risk). Although family historyis important, over 87% of women with a family history will not develop breastcancer.


For women with BRCA1 mutations, what is the relative risk of developing breast cancer?

For women with BRCA1 mutations, the risk of developing breast cancerrisk by age 70 is 40-90%


BRCA1 increases risk of developing which types of cancer?

Breast


Ovarian (serous cystadenocarcinoma)


Prostate


Pancreatic

Li Fraumeni increases risk for which main types of cancer?

Sarcoma, breast, leukaemia and adrenal gland (SBLA) syndrome.