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40 Cards in this Set
- Front
- Back
benign neoplasms involving CALCIFICATIONS |
(1) fat necrosis - leads to saponification (2) sclerosing adenosis |
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What stain is useful for differentiating between ductal VS lobular breast cancer |
E. Cadherin --> lost in LOBULAR, not ductal |
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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. |
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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. |
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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. |
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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. |
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Patient presents with hard mass in physical exam. Patient reports recent car accident. Diagnosis? |
Fat necrosis |
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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. |
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25 y/o woman presents with "marble-like", firm, mobile breast mass. Most likely diagnosis? Potential for cancer? |
Fibroadenoma - no malignant potential. |
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"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 |
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Three most commonly tested receptors for malignant breast tumors. |
(1) Estrogen Receptor (2) Progesterone receptor (3) HER2 receptor |
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What is DCIS? |
Ductal carcinoma in situ - an malignant proliferation of cells in ducts WITHOUT INVASION OF BASEMENT MEMBRANE. This arises from ductal atypia. |
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Mammographic results for DCIS? |
Microcalcifications |
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Subtype of DCIS involving ductal caseous necrosis. See high grade cells with necrosis and dystrophic calcification at the center of the ducts. |
Comedocarcinoma |
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Distinct disease resulting as a complication of DCIS. |
Paget Disease |
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Results when ductal cells migrate from a site of DCIS up to the nipple. |
Paget disease |
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Causes nipple ulceration and erythema. |
Paget disease |
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Malignant proliferation of cells in lobules with no invasion of BM |
LCIS - lobular carcinoma in situ |
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Dis-cohesive cells that lack E-Cadherin is the hallmark of this pathology. |
Lobular carcinoma (LCIS or invasive lobular carcinoma) |
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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. |
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The worst and most invasive form of breast cancer. |
Invasive ductal carcinoma |
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The most common form of breast cancer |
Invasive ductal carcinoma |
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60 y/o patient presents w/ non-painful, non-tender, 3x4cm rock hard mass in UOQ. Most likely diagnosis? |
Invasive ductal carcinoma |
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"rock-hard mass" w/ sharp margins classic "stellate" infiltration. advanced tumors cause skin dimpling and retraction of nipple. |
invasive ductal carcinoma |
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this carcinoma grows in a "single-file pattern" and cells may have signet ring morphology. |
invasive lobular carcinoma |
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This form of invasive breast carcinoma is often bilateral. |
Invasive Lobular carcinoma |
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This breast malignancy is triple negative, but has a good prognosis. |
MEdullary carcinoma. |
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breast malignancy involving a fleshy, cellular, lymphocytic infiltrate. |
medullary carcinoma |
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"Peau d'orange --> breast skin resembles orange-peel. 50% survival @ 5 yrs. |
Inflammatory breast cancer |
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Get an inflamed, swollen breast. caused when neoplastic cells block lymphatic drainage. |
Inflammatory breast cancer |
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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 |
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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 |
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This type of breast cancer is common in patients with BRCA1 mutations |
Medullary carcinoma |
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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! |
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3 cancers associated with desmoplasia? |
invasive ductal carcinoma and pancreatic adenocarcinoma + diffuse gastric adenocarcinoma |
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What about invasive ductal carcinoma makes it feel "rock hard." |
Desmoplastic reaction to invasion of stroma. Stroma proliferates and feels "rock hard." |
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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. |
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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% |
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BRCA1 increases risk of developing which types of cancer? |
Breast Ovarian (serous cystadenocarcinoma) Prostate Pancreatic |
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Li Fraumeni increases risk for which main types of cancer? |
Sarcoma, breast, leukaemia and adrenal gland (SBLA) syndrome. |