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Breast Pathology 2005 Test 3


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The functional unit of the breast
Under hormonal influence, terminal buds of breast ductules develop into ______. Milk is produced in response to __________.
acini, prolactin
The breast has many lymphatics that drain into the ______(75%) and the _______ nodes.
axillary, parasternal
Breasts enlarge during _______ & ________, and atrophy in ________ period
pregnancy & lactation, post-menopausal
Breast cancer is most common in _________, especially of _______ ethnicity and is uncommon in __________ women
caucasians, jewish, oriental
Fibroadenomas (benign) generally affect ______ _______
young women
Fibrocystic breast disease generally affects ______ _____
middle age
Breast cancer generally affects age ___ and older
__ in __ women in US will get breast cancer
1, 9
congenital absence of the breast
more that 2 breasts develop
where do supernumerary breasts develop?
along the milk line
invasion by bacteria in the breast is usually caused by ____ or especially ____ in lactating women
strep, staph
______ mastitis: Usually affects _______ females ____ ____ milk provides a good medium edema --> _______ if not treated
Acute, lactating, stagnant milk, abscess
_______ mastitis: Unknown cause may produce small _____
chronic, lumps
Breast changes during puberty are caused by _______
excessive response to estrogen can cause _______ _______, usually an abnormal enlargement of one breast (treated with a ____________)
juvenile hyperplasia, mammoplasty
Post menopausally the breast _________
female-like enlargement of male breast due to excess estrogen
The spectrum of macroscopic and microscopic changes in the breast resulting from an exaggerated uncoordinated response of the mammary ducts and stroma to cyclic hormonal stimulation that occurs during the normal menstrual cycle
Fibrocystic change in the breast
Most common disorder of the breast
Fibrocystic change
Most common cause of a palpable breast mass in patients between 25 and 50
Fibrocystic change
Characterized by lumpy breasts and mid-cycle tenderness
Fibrocystic change
Fibrocystic change in the breast is usually _____, but can be asymmetrical
Fibrocystic change in the breast is most likely to progress to invasive cancer if exhibiting ______ ______ _______ _______ and __________
atypical hyperplastic ductal epithelium, papillomatosis
Fibrocystic Change in the breast is characterized by: _________ - most frequent feature _________ - constant feature; if visible may appear blue & domed _________ _________
Fibrosis, Cysts, Epithelial changes
The epithelial changes that occur in fibrocystic change in the breast are (4):
1. Apocrine metaplasia, flattening, or hyperplasia 2. sclerosis adenosis – proliferation of small ducts, myoepithelial cells, and fibrosis 3. Cellular atypia 4. 10% show intraductal proliferation of cells forming layers (atypical ductal hyperplasia) & small intraductal papillary projections (papillomatosis) -> likely to progress into invasive cancer
Although a mammography may reveal areas of cysts and calcification, a ______ biopsy is the only way to establish a definitive diagnosis
Name the 4 types of benign breast tumors
1. Fibroadenoma 2. Adenoma of the nipple 3. Intraductal papilloma 4. Phyllodes tumor (can also be malignant)
Most common benign breast tumor
Fibroadenoma is the most common breast tumor in women under ___
A firm, rubbery, painless, well-circumscribed 2-5 cm mass
fibroadenoma of the breast
fibroadenoma of the breast does/does not undergo malignant change
does not
Benign tumor that presents with serous or bloody discharge and a palpable mass, can be mistaken for malignancy
Adenoma of the nipple
Benign tumor of the major lactiferous ducts, serous or bloody discharge, can mistaken for malignancy
Intraductal Papilloma
Benign, large, bulky tumor often w/ overlying ulceration of the skin. Cystic spaces w/ leaf like projections from the cyst wall & myxomatous contents
Phyllodes Tumor
most common cancer in women
breast cancer
most common cause of cancer death in women
lung (breast cancer is 2nd)
Most common cause of breast mass in post menopausal women, occurs most frequently in upper outer quadrant of the breast, & metastasizes generally by the lymphatics
malignant breast tumor
malignant breast tumors can demonstrate the presence of _____ & ________ receptors in some tumors which correlates w/ a _______ prognosis
estrogen & progesterone, better
Most common type of malignant breast tumor is _______ ______ _______ (also called invasive ductal or scirrhous)
infiltrating ductal carcinoma
Several breast cancers induce ________ tissue response w/ the CT becoming dense and the tumor is firm and gritty. The dense CT pulls on adjacent tissue and ________ of the skin and ______ of the nipple.
desmoplastic, puckering, retraction
First 4 risk factors of breast cancer
Age; First-degree female familial history (mut. In p53, BRCA-1 or 2); History of cancer in one breast or ovarian/endometrial cancer; Early menarche (menstruation) & late menopause
Other 6 risk factors for breast cancer
obesity, nulliparity (no births), 1st preg. after 30, proliferative fibrocystic breast disease, high animal fat diet, caucasian (jewish)
What is the biggest risk for breast cancer?
Age (0-39 yrs: 1 in 231, 40-59yrs: 1 in 25, 60-79 yrs: 1 in 15, 90yrs: 1 in 7)
Name the 8 types of breast cancer.
1. Intraductal carcinoma in situ 2. Invasive ductal carcinoma 3. Paget’s disease of the breast 4. Lobular carcinoma in situ 5. Invasive lobular carcinoma 6. Medullary carcinoma 7. Mucinous carcinoma 8. Inflammatory breast carcinoma
Name the breast cancer type: Pre-invasive; Tumor cells fill ducts; Necrosis has cheese-like consistency
Intraductal carcinoma in situ
Name the breast cancer type: Most common type (2/3 of all breast cancers); Tumor cells in cords, islands, & glands in dense CT stroma; Dense CT is firm and is white and gritty on sectioning
Invasive (infiltrative) ductal carcinoma (scirrhous carcinoma)
Name the breast cancer type: Exzematous lesion of the nipple or areola; Underlying infiltrating ductal carcinoma almost always present; Large cells w/ clear halo invade epidermis
Paget’s disease of the breast
Name the breast cancer type: Clusters of neoplastic cells fill intralobular ductules & acini; May lead to invasive carcinoma; Often bilateral
Lobular carcinoma in situ
Name the breast cancer type: Multicentric or bilateral; Cells arranged in linear fashion; Better prognosis than infiltrating ductal
Invasive lobular carcinoma
Name the breast cancer type: Soft, bulky tumor w/ almost no CT; Sheets of tumor cells infiltrated by lymphocytes; Better prognosis than infiltrating ductal
Medullary carcinoma
Name the breast cancer type: Gelatinous consistency; Usually older women; Extracellular mucous material; Better prognosis than infiltrating ductal
Mucinous (colloid) carcinoma
Name the breast cancer type: Red, swollen, hot skin; Skin may be pitted; Lymphatic involvement of skin; Poor prognosis
Inflammatory breast carcinoma
The most accurate prognostic factor of breast cancer is
5 prognosis factors for breast cancer
1. Stage; 2. histologic subtype; 3. histologic grading; 4. presence of estrogen & progesterone receptors (w/ receptors will be responsive to anti-estrogen chemo); 5. males 100x less likely
What percentage of breast biopsies are cancerous?
______ ______ asperation is 95% accurate by qualified cytopathologist
fine needle
5 yr survival rates: Stage 1, < 2.5 cm ___ %; Stage 2, <=2.5 cm ___ %; Stage 3, >5 cm w/o metastases ___ %; Stage 4, any size w/ metastases ___ %
80%; 65%; 40%; 10%

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