Term
|
Definition
- Modified Sweat gland
- Embrylogically derived from the skin
- Breast tissue can develop anywhere along the milk line which runs from the axilla to the vulva (supernumerary nipples)
- Terminal duct lobular unit is the functional unit of the breast
- Lobules make milk that drains via ducts to the nipple
- Lobules and ducts are lined by two layers of epithelium
- Luminal cell layer-inner cell layer lining the ducts and lobules, responsible for milk production in the lobules
- Myoepithelial cell layer- outer cell later lining ducts and lobules; contractile function propels milk towards the nipple
- Breast tissue is hormone sensitive
- Before puberty, male and female breast tissue primarily consists of large duts under the nipple
- Development after menarche is primarily driven by estrogen and progesterone; lobules and small ducts are formed and are present in highest density in the upper quadrant
- Breast tenderness during the mentrual cycle is a common complaint, especially prior to mensturation
- During pregnancy breast lobules undergo hyperplasia
- Hyperplasia is driven by estrogen and progesterone produced by the corpus luteum (early first trimester), fetus and placenta (later in pregnancy)
- After menopause, breast tissue undergoes atrophy
- Galactorrhea refers to milk production outside of lactation
- It is not a symptom of breast cancer
- Causes include nipple stimulaion (common physiologic cause)
- Prolactinoma of the anterior pituitary (common pathologic cause) and drugs
|
|
|
Term
|
Definition
- Bacterial infection of the breast usually due to S. aureus
- Associated with breast feeding
- Fissures develop in the nipple providing a route of entry for microbes
- Presents as an erythematous breast with purulent nipple discharge which may progress to abscess formation
- Treatment involved continued drainage (feeding) and antibiotics
|
|
|
Term
|
Definition
- Inflammation of the subareolar ducts
- Usually seen in smokers
- Relative vitamin A deficiency results in squamous metaplasia of lactiferous ducts, producing duct blockage and inflammation
- Clinically presents as a subareolar mass with nipple retraction
|
|
|
Term
|
Definition
- Inflammation with dilation (ectasia) of the subareolar ducts
- Rare
- Classically arises in muciparous postmenopausal women
- Presents as periareolar mass with green-brown nipple discharge (inflammatory debri)
- Chronic inflammation with plasma cells is seen on biopsy
|
|
|
Term
|
Definition
- Necrosis of breast fat
- Usually related to truama; however a history of trauma may not always be evident
- Presents as a mass on physical exam or abnormal calcification on mammography (due to saponification)
- Biopsy shows necrotic fat with associated calcifications and giant cells
|
|
|
Term
|
Definition
- Development of fibrosis and cysts in the breast
- Most common change in the premenopausal breast
- Thought to be hormone mediated-changes with menstrual cycle
- Presents as vague irregularity of the breast tissue usually in the upper outer quadrant
- Cysts have a blue-dome appearance on gross exam
- Benign but some fibrocystic-related changes are associated with an increased risk for invasive carcinoma (increased risk applies to both breasts)
- Fibrosis, cysts, and apocrine metaplasia- no increased risk
- Ductal hyperplasia and sclerosing adenosis- 2X increased risk
- Atypical hyperplasia-5X increased risk
|
|
|
Term
|
Definition
- Papillary growth, usually into a large duct
- Characterized by fibrovascular protections lined by epithelial (luminal) and myoepithelial cells
- Classically presents as bloody nipple discharge in a premenopausal woman
- Must be distinguished from papillary carcinoma which also presents as bloody nipple discharge
- Papillary carcinoma is characterized by fibrovascular projections lined by epithelial cells without underlying myoepithelial cells
- Risk of papillary cancer increases with age: More common in post menopausal women
|
|
|
Term
|
Definition
- Tumor of fibrous tissue and glands
- MC benign neoplasm of the breast
- Usually seen in premenopausal women
- Presents as a well-circumscribed mobile "marble like" mass
- Estrogen sensitive-grows during pregnancy and may be painful during the menstrual cycle
- Benign with no increased risk o carcinoma
|
|
|
Term
|
Definition
- Fibroadenoma like tumor with overgrowth of the fibrous component
- Characteristic "leaf like" projections are seen on biopsy
- MC in post menopausal women
- Can be malignant in some cases
|
|
|
Term
| Breast Cancer Basic Principles |
|
Definition
- MC carcinoma in women by incidence (excluding skin cancer)
- 2nd MCC of cancer mortality in women
- Risk Factors are mostly related to estrogen exposure
- Female Gender
- Age: usually in postmenopausal women, with the notable exception of hereditary breast cancer
- Early menarche
- Late Menopause
- Obesity
- Atypial hyperplasia
- 1st degree relative with breast cancer
|
|
|
Term
| Ductal Carcinoma in Situ (DCIS) |
|
Definition
- Malignant proliferation of cells in ducts with no invasion of the basement membrane
- Often detected as calcifications on mammography
- DCIS does not produce a mass
- Mammographic calcifications can also be associated with benign conditions such as fibrocystic changes (especially sclerosing adenosis) and fat necrosis
- Biopsy of calcifications is necessary to distniguish between benign and malignant conditions
- Histologic subtypes are based on architecture
- Comedo type is characterized by high grade cells with necrosis and dystrophic calcification in the center of ducts
|
|
|
Term
| Pagets Disease of the Breast |
|
Definition
- Presents as nipple ulceration and erythema
- Pagets disease of the breast is associated with an underlying carcinoma
- Extension of DCIS into lactiferous ducts and skin of nipple producing a rash with or without nipple retraction
- Paget's cells are present but they are not malignant.
|
|
|
Term
| Invasive Ductal Carcinoma |
|
Definition
- Invasive carcinoma that classically forms duct-like structures
- MC type of invasive carcinoma in the breast accounting for > 80% of cases
- Presents as a mass detected by physical exam or by mammography
- Clinically detected masses are > 2 cm
- Mammography detected msses are > 1cm
- Advanced tumors may result in dimpling of the skin or retraction of the nipple called Peau d' orange
- Biopsy usually shows duct like strucutres in stroma special subtypes include:
- Tubular carcinoma: characterized by well-differentiated tubules that lack myoepithelial cells. Relatively good prognosis
- Mucinous carcinoma: characterized by carcinoma with abundant extracellular mucin (tumor cells floating in a mucous pool)
- Tends to occur in older women (avg age is 70)
- Relatively good prognosis
- Medullary carcinoma: characterized by large, high-grade cells growing in sheets with associated lymphocytes and plasma cells
- Grows as a well circumscribed mass that can mimic fibroadenoma on mammography
- Relatively good prognosis
- Increased incidence in BRCA 1 carriers
- Inflammatory carcinoma-characterized by carcinoma in dermal lymphocytes
- Presents classically as an inflamed, swollen breast
- Tumor cells block drainage of lymphatics
- No discete mass
- Can be mistaken for acute mastitis
- Poor prognosis
|
|
|
Term
| Lobular Carcinoma in Situ (LCIS) |
|
Definition
- Malignant proliferation of cells in lobules with no invasion of the basement membrane
- LCIS does not produce a mass or calcifications and is usually discovered incidentally on biopsy
- Characterized by dyscohesive cells lacking E-cadherin adhesion protein
- Often multifocal and bilateral
- Treatment is tamoxifen (to reduce the risk of subsequent carcinoma) and close follow up
- Increased risk of both lobular and ductal carcinoma
|
|
|
Term
| Invasive Lobular Carcinoma |
|
Definition
- Invasive carcinoma that characteristically grows in a single file pattern
- Cells may exhibit signet-ring morphology
- No duct formation due to lack of E-cadherin
|
|
|
Term
| Prognostic and predictive factors of Breast Cancer |
|
Definition
- Prognosis in breast cancer is based on TNM staging
- Metastasis is the most important factor
- Most patients present before metastasis
- Spread to axillary lymph nodes is the most useful prognostic factor
- Sentinel lymph node biopsy is used to assess axillary lymph nodes
- Presence or ER and PR is associated with response to antiestrogen agents (tamoxifen). Both receptors are located in the nucleus. These are postive predicitve factors
- HER2/neu amplification is associated wiht response to Herceptin a designer antibody directed against the HER2 receptor. HER2/neu is a growth factor receptor present on the cell surface. NEgative predicitve factor
- Triple negative are negative for HER2/neu, PR, ER and have a poor prognosis. BRCA 1, and African Americans have an increased propensity to develp triple-negative carcinoma
|
|
|
Term
|
Definition
- Represents 10% of breast cancer cases
- Clinical features that suggest hereditary breast cancer include multiple first degree relatives with breast cancer, tumor at an early age (premenopausal), and multiple tumors in a single patients
- BRCA1 and BRCA2 mutations are the most important single gene mutations associated with hereditary breast cancer
- BRCA1: mutation is associated with triple negative invasive ductal carcinoma, and ovarian cancer
- BRCA2: mutation is associated with breast carcinoma in men
- Women with genetic propensity to develop breast cancer may choose to have a bilateral mastectomy and bilateral overectomy.
- A small risk for cancer remains bc breast tissue sometimes extends into the axilla or subcutaneous tissue of chest wall
|
|
|
Term
|
Definition
- Rare
- Usually presents as a subareolar mass in older males
- Highest density of breast tissue in males is underneath the nipple
- May produce nipple discharge
- Most common histological subtype is invasive ductal carcinoma
- Lobular carcioma is rare, the male breast develops very few lobules
- Associated with BRCA 2 and Klinefelter syndrome
|
|
|
