Notes in Robbins Pathology Chapter 23: The Breast

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Published	02/16/2025	Two major structures of the breast
Published	02/19/2025	Two types of epithelial cells of the breast
Published	02/19/2025	Two types of Stroma
Published	02/16/2025	Persistence of epidermal thickenings along the milk line, extends from axilla to perineum. Rarely arise in heterotropic, hormone-responsive foci.Come …
Published	02/16/2025	Normal ductal system which extends into the subcutaneous tissue of the chest wall or the axillary fossa (axillary tail of Spence), outside the area cl…
Published	02/16/2025	Failure of the nipple to evert during development.Common and unilateralCorrect spontaneously during pregnancy, or by simple traction
Published	02/16/2025	Symptoms reported by women with disorders of the breast are pain, palpable mass, lumpiness, and nipple discharge
Published	02/16/2025	Means to detect small, nonpalpable, asymptomatic breast CA and is currently the most common means to detect breast CA
Published	02/16/2025	Principal mammorgraphic signs of breast CA
Published	02/16/2025	Lesions that replace adipose tissue with radiodense tissue.
Published	02/16/2025	Results from secretions, necrotic debris, or hyalinized stroma.
Published	02/16/2025	RareCaused by infections, autoimmune disease, foreign body type reactions to extravasatedkeratin or secretions
Published	02/16/2025	Typically occurs at the first month of breastfeeding, cause by local bacterial infection.Presents as erythematous and painful breast and often accompa…
Published	02/16/2025	Also known as recurrent subareolar abcess, periductal mastitis, and Zuska diseasePresents as painful erythematous subareolar mass that clinically appe…
Published	02/16/2025	Presents as palpable PERIARIOLAR mass associated with thick, white nipple secretions and occasionally with skin retraction.Occurs at age 50-60 usualli…
Published	02/16/2025	Presents as painless palpable mass, skin thickening or retraction, mammorgraphic densities, calcificationCan closely mimic cancerGrossly, gray-white n…
Published	02/16/2025	Presents with single or multiple hard palpable masses or mammorgraphic densities.Atrophic ducts and lobules have thickened BM and surrounded by a prom…
Published	02/16/2025	Can be a manifestation of systemic granulomatous dseGranulomas are closely associated with lobules suggesting that the dse may be caused by a hypersen…
Published	02/16/2025	Divided into 3 groups according to subsequent risk of developing caner:1) Nonproliferative breast changes2) Proliferative Breast Changes3) Atypical Hy…
Published	02/16/2025	Lumpy bumpy breast, dense breast with cyst, benign histologic findings.Not associated with an increased risk of breast CA
Published	02/16/2025	3 principal morphologic changes (Fibrocystic Changes)
Published	02/16/2025	Chronic inflammation resulted from rupture of cysts, releasing secratory materials into the adjacent stroma.
Published	02/16/2025	Increase in number of acini per lobuleA normal feature of pregnancyAcini lined with columnar elipthelium which may appear benign or show atypia. (Flat…
Published	02/16/2025	Formed by the dilatation of lobules and in turn may coalesce to become larger.May be lined by atrophic epithelium or by metaplastic apocrine cellsAbun…
Published	02/16/2025	Presents as palpable masses in pregnant or lactating women.Consists of normal appearing breast tissue with lactational changes
Published	02/16/2025	Proliferation of epithelial cells without atypia associated with a small risk in the risk of subsequent CA in either breast.
Published	02/16/2025	Increased numbers of both luminal and myoepithelial cell types fill and distend ducts and lobules.Irregular lumens can often be discerned at the perip…
Published	02/16/2025	Increased number of acini that are compressed and distorted in the central portion of the lesionStromal fibrosis completely compress the lumen to crea…
Published	02/16/2025	Composed of papillomas and epithelial hyperplasiaRadial sclerosing lesion (Radial Scar)Central radius of entrapped glands in hyalinized stroma is surr…
Published	02/16/2025	Grow within a dilated duct and are composed of multiple branching fibrovascular coresEpithelial hyperplasia and apocrine metaplasia are frquently pres…
Published	02/16/2025	Benign lesion which presents as button-like subareolar enlargement and may be unilateral or bilateralIncrease in dense collagenous connective tissue a…
Published	02/16/2025	Has resemblance to ductal carcinoma in situ (DCIS)Consists of a relatively monomorphic proliferation of regularly spaced cells, sometimes with cribrif…
Published	02/16/2025	Consists of cell identical to those of Lobular Carcinoma In Situ, but the cells do not fill or distend more than 50% of the acini within a lobuleAtypi…
Published	02/16/2025	Chromosomal aberrations of ADH, and ALH
Published	02/16/2025	Usually do not cause symptoms but frequently detected as mammorgraphic calcifications or densitiesClassified according to the subsequent risk of cance…
Published	02/16/2025	Most common non-skin malignancy in women and is second to lung cancer as a cause of cancer deaths.
Published	02/16/2025	Risk Factors for breast CA
Published	02/16/2025	Major known susceptibility genes for familial breast cancer
Published	02/16/2025	Responsible for 80-90% of single gene familial breast Cancer and about 3% of all breast cancers.
Published	02/16/2025	Chromosomal aberration for BRCA1 & BRCA2
Published	02/16/2025	Most common subtype of breast cancer in person with BRCA2 mutationsOften associated with gain in C(1q) and losses in C(16q) and activating mutations i…
Published	02/16/2025	15% of breast cancerGermline BRCA1 mutation, loss of function mutation in TP53 (Basal-like)
Published	02/16/2025	Most common subtypes in px with germline mutations in TP53 (Li-Fraumeni syndrome) (HER2 enriched)Ex. Atypical apocrine adenosis
Published	02/16/2025	Types of Breast Cancer
Published	02/16/2025	A neoplastic proliferation of epithelial cells that is confined to ducts and lobules by the BM
Published	02/16/2025	A neoplastic proliferation that has penetrated through the BM and grows within the stroma
Published	02/16/2025	Malignant clonal proliferation of epithelial cells limited to ducts and lobules by the basement membraneIt involves lobules, where the expanded acini …
Published	02/16/2025	May occasionally produce vague nodularity, but more often is detected on mammorgraphy as clustered linear or branching areas of calcificationFeatures:…
Published	02/16/2025	Lacks either high-grade nuclei or central necrosisPatterns1) Round/Cookie cutter like spaces (Cribriform DCIS)2) Solid DCIS pattern3) Bulbous protrusi…
Published	02/16/2025	Presents as unilateral erythematous eruption with a scale crustPruritus is common, and the lesion may be mistaken for eczemaMalignant cells extend fro…
Published	02/16/2025	Major risk factors for for cancer recurrence?
Published	02/16/2025	A clonal proliferation of cells within ducts and lobules that grow in a DISCOHESIVE fashion, usually due to an acquired loss of the tumor supressive a…
Published	02/16/2025	Cells expand but do not distort involved spaces and, the underlying lobular architecture is preservedAn incidental buopsy finding shows cells of atypi…
Published	02/16/2025	Means of spread by the cells in LCIS to the adjacent lobule
Published	02/16/2025	Gene mutation in LCIS
Published	02/16/2025	Most common form of invasive breast cancer
Published	02/16/2025	Makes up the majority of cancers in older women and in menMost commontype detected by mammographic screening and in women treated eith hormonal therap…
Published	02/16/2025	Poorly differentiated lobularER levels may be low and progesterone receptor expression may be low or absentMost common carcinoma type associated with …
Published	02/16/2025	Second most common molecular subtype of invasive breast cancerAffects young women, non-white women, TP53 mutation carriers ER-positiveCan metastasize …
Published	02/16/2025	Medullary, adenoid cystic, secretory, metaplasticAffects young women, BRCA1 mutation carriers, African American and Hispanic womenHigh proliferation a…
Published	02/16/2025	All invasive carcinoma are graded using what?Involves the ff:1) tubule formation2) nuclear pleomorphism3) mitotic rate
Published	02/16/2025	Grow in tubular pattern(cribriform pattern) with small round nuclei(Usually monomorphic) and have low proliferative rate
Published	02/16/2025	Less tubular formation, more solid clusters(nests) or single infiltrating cellsGreater degree of nuclear polymorphism and mitotic figures are present
Published	02/16/2025	Invade as ragged nests or solid sheets of cells with enlarged irregular nuclei (pleomorphic) High proliferative rate (numerous mitotic figures) and ar…
Published	02/16/2025	Forms a hard irregular masses similar to other breast cancers, but may also have a diffuse infiltrative pattern with minimal desmoplasia.Histologic ha…
Published	02/16/2025	Soft or rubbery and has the consistency and appearance of pale gray-blue gelatin.The boarders are pushing or circumscribedTumor cells are arranged in …
Published	02/16/2025	Exclusively of well formed tubules and is sometimes mistaken for a benign sclerosing lesionAssociated with flat epithelial atypia, atypical lobular hy…
Published	02/16/2025	Produces true papillae, fronds of fibrovascular tissue lined with tumor cells
Published	02/16/2025	Resemble cells that line sweat glandsThese cells have enlarged round nuclei with prominent nucleoli and abundant eosinophillic, occasionally granular …
Published	02/16/2025	Forms hollow balls of cells that float within intercellular fluid, creating structures that mimic the appearance of true papillae
Published	02/16/2025	Softer than other carcinoma due to minimal desmoplasia and often presents a well circumscribed mass1) Solid, syncytium-like sheets of large cells with…
Published	02/16/2025	Mimics lactating breast by forming dilated spaces filled with eosinophilic material
Published	02/16/2025	Shows extensive invasion and proliferation within lymphatic channels, causing swelling that mimics non-neoplastic inflammatory lesions.
Published	02/16/2025	Where lymphatic vessels in most breast carcinoma drains first, can be identified using radiotracer or colored dyes
Published	02/16/2025	DCIS orLCISNo matastases (lymph nodes)No distant metastases
Published	02/16/2025	Invasive CA less than or equal to 2cmMicrometastasesNo distant metastases
Published	02/16/2025	Invasive CA greater than 2cm but less than 5 cm1-3 positive lymph nodes No distant metastases
Published	02/16/2025	Invasive CA greater than 5 cmWith skin or chest wall involvement or inflammatory CAGreater than or equal to 4 positive lymph nodes
Published	02/16/2025	Any size invasive CAPositive or negative lymphnodesWith distant metastases
Published	02/16/2025	Inter lobular and intralobular
Published	02/16/2025	Most common benign tumor of the female breastWomen in mid 20's and 30'sMultiple and bilateralTypically increases in size due to lactational changes du…
Published	02/16/2025	Arises from intralobular stroma, most present at 6th decade of lifeGain of functin in C(1q) or overexpression of HOXB13 or Homeobox transcription fact…
Published	02/16/2025	Consists of myofibroblasts and is the only breast tumor that is equally common to males
Published	02/16/2025	Often palpable fat-containing lesions
Published	02/16/2025	Clonal proliferation of fibroblasts and myofibroblasts.Irregular, infiltrating mass that can involve both skin and muscle
Published	02/16/2025	Malignant tumors of interlobular stroma
Published	02/16/2025	May arise primarily in the breast or may be a secondary involvement of a systemic diseaseMost are of B-cell type, rare ones are T-cell lymphomas which…
Published	02/16/2025	Multifocal, bilateral blue-brown cysts ("blue dome cysts") of the breast, measuring 1-5 cm diameter, filled with serous turbid fluid. Occurs normally …
Published	02/16/2025	Defined as having more than two layers of lining epithelium (normally, one layer for luminal, and another for myoepithelial cells); can have atypia (e…
Published	02/16/2025	Type of fibrocystic change characterized by proliferation of luminal spaces (adenosis) lined by epithelial cells and myoepithelial cells with massive …
Published	02/16/2025	These are stellate lesions characterized by a central nidus of entrapped glands in a hyalinized stroma; important as it appears like carcinoma
Published	02/16/2025	The most common benign neoplasm of the female breast; grossly, discrete, usually solitary, freely movable nodule, 1 to 10 cm in diameter, easily "shel…
Published	02/16/2025	Biphasic tumor composed of highly cellular stromal elements forming leaf-like projections and epithelial elements; usually benign and localized; omino…
Published	02/16/2025	Clinically presents with bloody or serous discharge; tumors usually are solitary and less than 1 cm in diameter, consisting of delicate, branching gro…
Published	02/16/2025	Most common location of breast carcinoma
Published	02/16/2025	The two non-invasive breast carcinomas; both of which arise from terminal duct lobular unit (TDLU)
Published	02/16/2025	A distinct type of DCIS characterized by highly pleomorphic nuclei of cells (high-grade nuclei) with extensive central necrosis; with calcifications e…
Published	02/16/2025	Clinically presents as an eczematoid lesion on the breast; associated with an invasive carcinoma in most cases; cause is anunderlying DCIS that extend…
Published	02/16/2025	CIS composed of monomorphic cells with bland round nuclei (low-grade nuclei) that occur in loosely cohesive clusters within the lobules.
Published	02/16/2025	Most common of the infiltrating carcinomas; associated more with DCIS; characterized with intense desmoplasia that produces a hard palpable mass; micr…
Published	02/16/2025	Infiltrating carcinoma with cells looking like those seen in LCIS; only in single-file conformation ("Indian filing"); reflecting loss of E-cadherin f…
Published	02/16/2025	Clinically presents as an enlarged, swollen, erythematous breast with a palpable mass; histologically high-grade; involves dermal lymphatic spaces, wh…
Published	02/16/2025	Infiltrating carcinoma composed of sheets large anaplastic cells with well-circumscribed pushing borders with a pronounced lymphoplasmacytic infliltra…
Published	02/16/2025	Characterized by increase in connective tissue and epithelial hyperplasia of the ducts; lobule formation is rare.
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