Pathoma - 16 (Breast)

vogidoyi's version from 2016-05-31 23:44

Section 1

Question Answer
Where does the milk line run from?axilla to vulva
Whats the functional unit of the breast?terminal duct lobular unit = lobules make milk that drains via ducts to nipples
What are the 2 epithelial layers lining the lobules and ducts?1) Luminal cell layer = produces milk
2) Myoepithelial layer = contractile that propels milk toward nipple
which part of the breast hypertrophies during pregnancy?breast LOBULES undergo hyperplasia --> driven by E and P
whats the treatment of acute mastitis?continued drainage (feeding) and Dicloxacillin
what are lactiferous ducts?ducts going into the nipple
subareolar mass with nipple retractionperiductal mastitis = vit A deficiency results in columnar --> squamous metaplasia of lacteriferous ducts --> produces duct blockade and inflammation --> fibrosis--> granulation tissue --> nipple retraction
whats a risk factor for periductal mastitis?SMOKING! which causes vit A deficiency --> loss specialized epithelium (columnar --> squamous)
inflammation with dilation of subareolar ductsmammary duct ectasia (dilation)
POST-MENOPAUSAL WOMAN with periareolar mass with green-brown nipple dischargemammary duct ectasia
green brown nipple dischargemammary duct ectasia
biopsy shows necrotic fat with calcifications and GIANT cellsfat necrosis --> will see giant cells
blue-dome cystsfibrocytic change
what type of metaplasia has NO increased risk for cancer?APOCRINE metaplasia
what is sclerosing adenitis?too many glands in the lobule that are calcified - type of fibrocystic change
bloody nipple discharge in PREMENOPASUAL women vs. POSTMENOPASUAL womenpremenopausal women = intraductal papilloma
post-menopausal women = papillary carcinoma of the breast
whats the difference btw papillary adenoma vs. papillary carcinoma of the breast?Papillary adenoma: premenopausal women and HAS myoepithelial layer.

Papillary carcinoma of breast: post-menopausal women with NO myoepithelial layer
POST-MENOPAUSAL women with bloody nipple dischargepapillary carcinoma of the breast
leaf like projection of breast tissue on histophylloides tumor = fibroadenoma like tumor with overgrowth of fibrous component

Section 2

Question Answer
why is obesity a risk factor for breast cancer?adipose tissue converts androgen to ESTRONE
why is early menarche/late menopause a risk factor for breast cancer?increased exposure to estrogen
name 3 breast conditions that show calcification on mammomgraphy (hence not all maligannt)fibrocytic change (sclerosing adenitis), fat necrosis, DCIS
name 2 BENIGN conditions that cause calcification on mammography?sclerosing adenitis and fat necrosis
what is pagets disease of the breastDCIS that walked its way up the duct and into skin of nipple
isolated malignant cells in the epidermis layer of the nipplepagets disease of the breast
whats the most common type of invasive carcinoma of the breast?invasive DUCTAL carcinoma
biopsy shows duct-like structures in a desmoplastic stroma (connective tissue growing with tumor for structural support)invasive ductal carcinoma
what are the 4 subtypes of invasive ductal carcinoma1) Tubular carcinoma (lacks myoepithelial layer)
2) Mucinous carcinoma (tumor cells floating in mucus)
3) Medullary carcinoma (a/w BRCA1 carriers)
4) inflammatory carcinoma
which invasive ductal carcinoma subtype is a/w BRCA1?medullary carcinoma
what is inflammatory carcinoma?invasive ductal carcinoma in the DERMAL LYMPHATICS --> causing decreased draniage
pt with inflammed swolllen breast....ddx?acute mastitis or inflammatory carcinoma - invasive ductal carcinoma (doesnt get better with Abx)
what is LCIS characterized by?dyscohesive cells lacking E-cadherin
whats the tx for LCIS?Tamoxifen
which invasive carcinoma of the breast grows in a SINGLE-FILE PATTERN?invasive LOBULAR carcinoma = no duct formation due to lack of E-cadherin
whats the tx for HER/neu + breast cancer?Trastuzumab (Herceptin)
describe the HER/neu receptor?HER/neu growth factor receptor present on the CELL SURFACE (its a protoncogene = cell surface receptors)

Section 3

Question Answer
which carcinomas are a/w BRCA1?breast and ovarian carcinoma
BRCA2male breast cancer
what type of breast cancer do men develop?invasive DUCTAL carcinoma
what are 2 HY conditions a/w male breast cancer?BRCA2 mutations and Kleinfeler syndrome