Breast Pathology 2005 Test 3
Terms
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- The functional unit of the breast
- lobule
- 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
- 45
- __ in __ women in US will get breast cancer
- 1, 9
- congenital absence of the breast
- amastia
- more that 2 breasts develop
- polymastia
- 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 _______
- estrogen
- excessive response to estrogen can cause _______ _______, usually an abnormal enlargement of one breast (treated with a ____________)
- juvenile hyperplasia, mammoplasty
- Post menopausally the breast _________
- atrophy
- female-like enlargement of male breast due to excess estrogen
- Gynocomastia
- 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
- bilateral
- 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
- biopsy
- 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
- Fibroadenoma is the most common breast tumor in women under ___
- 25
- 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
- stage
- 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?
- 10%
- ______ ______ 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%