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Pathoma Exam: Questions And Well Detailed Solutions
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Pathoma Exam: Questions And Well Detailed SolutionsWhat is the functional unit of the breast? Right Ans - Terminal Duct lobular
unit -- the lobules make milk that drains via ducts to the nipple.
Breast tissue is essentially modified sweat glands embryonically derived from
the skin. Explain how you can have extra nipples or breast tissue: Right Ans
- Breast tissue can develop anywhere along the *milk line*, which runs from
the axilla to the vulva
The lobules and ducts are lined by two layers of epithelium -- what are they
and what are their functions? Right Ans - 1. Luminal cell layer -- inner cell
layer responsible for milk production in the lobules;
2. Myoepithelial cell layer -- outer cell layer with contractile function that
propels milk towards the nipple.
Breast tissue is hormone sensitive. Describe the breast (1) prior to puberty
and how it changes (2) following puberty, during (3) menstruation and (4)
pregnancy, and (5)after menopause: Right Ans - 1. Before Puberty -- M and
F breast tissue primarily consists of large ducts under the nipple;
2. Development after menarche is driven by estrogen and progesterone --
lobules and ducts form, esp. in UOQ;
3. Breast tenderness during menstrual cycle, esp. prior to menstruation;
4. Breast lobules undergo hyperplasia during pregnancy (due to E and P
produced by corpus luteum, fetus, and placenta);
5. After menopause, breast tissue undergoes atrophy;
Galactorrhea is not a symptom of breast cancer - True or False? Right Ans -
True -- it refers to milk production outside of lactation and causes include
nipple stimulation, prolactinoma of anterior pituitary, and drugs;
Bacterial infection of the breast usually *staphylococcus aureus* associated
with breast-feeding: Right Ans - *Acute Mastitis* presents as an
erythematous breast with purulent nipple discharge that may progress to
,abscess formation. During breast-feeding, fissures develop in the nipple,
providing a route of entry for microbes. Treatment involves continued
drainage (e.g. feeding) and antibiotics (e.g. dicloxacillin);
Subareolar mass with nipple retraction typically seen in smokers: Right
Ans - *Periductal Mastitis* -- the epithelium of the breast is highly dependent
on Vitamin A. As smokers are typically vitamin A deficient, the epithelium of
the duct undergoes *squamous metaplasia* resulting in kertain debris
plugging of the ducts, resulting in inflammation,
Peri-areolar mass with green-brown nipple discharge that classically arises in
multi-parous postmenopausal women: Right Ans - *Mammary Duct
Ectasia* ---- inflammation with dilation (i.e. ectasia) of the subareolar ducts.
Chronic inflammation with plasma cells are seen on biopsy.
Trauma related breast mass that appears as an abnormal calcification on
mammography: Right Ans - Fat Necrosis of breast fat with calcification due
to saponification. Biopsy shows necrotic fat with associated calcifications and
giant cells.
Most common change in *pre-menopausal* breast that is thought to be
hormone mediated. Presents as vague irregularity of the breast tissue (i.e.
lumpy breast): Right Ans - Fibrocystic Change -- development of fibrosis
and cysts in the breast, usually in the UOQ. Cysts have blue-dome appearance
on gross exam.
While most fibrocystic change of the breast is benign, some changes are
associated with an increased risk for invasive carcinoma in both breasts.
Outline the relative risks for (1) Fibrosis, cysts, and apocrine metaplasia; (2)
Ductal hyperplasia and sclerosing adenosis; (3) Atypical hyperplasia Right
Ans - 1. Fibrosis, cysts, and apocrine metaplasia -- no increased risk;
2. Ductal hyperplasia and sclerosing adenosis -- 2X increased risk;
3. Atypical hyperplasia -- 5X increased risk;
Classically presents as bloody nipple discharge in a pre-menopausal women.
Must be distinguished from papillary carcinoma. Right Ans - *Intraductal
Papilloma* -- papillary growth, usually into a large duct that is characterized
by fibrovascular protections lined by epithelial (luminal) and myoepithelial
cells.
,How can you distinguish papillary carcinoma from intraductal papilloma?
Right Ans - Papillary carcinoma is characterized by fibrovascular projections
line by epithelial cells without underlying myoepithelial cells. Risk of papillary
carcinoma increases with age, thus it is seen more in post menopausal
women.
Most common benign neoplasm of the breast usually seen in premenopausal
women that presents as a well-circumscribed, mobile marble-like mass:
Right Ans - *Fibroadenoma* -- tumor of fibrous tissue and glands that is
benign with no increased risk of carcinoma. It is *estrogen sensitive* --
growing during pregnancy and can cause pane during the menstrual cycle.
Fibroadenoma-like tumor with overgrowth of the fibrous component with
characteristic "leaf-like" projections seen on biopsy: Right Ans - *Phyllodes
Tumor* -- most commonly seen in post-menopausal women. Can be malignant
in some cases.
Most common carcinoma in women by incidence (excluding skin cancer):
Right Ans - Breast cancer -- 2nd most common cause of cancer mortality in
women.
What are the risk factors for breast cancer? Right Ans - Risk factors are
mostly related to estrogen exposure:
1. Female gender;
2. Age (post-menopausal women, except hereditary breast cancer);
3. Early menarche/late menopause;
4. Obesity (estrone);
5. Atypical hyperplasia;
6. 1st degree relative (mother, sister, or daughter) with breast cancer;
Malignant proliferation of cells in ducts with no invasion of the basement
membrane that is often detected as calcification on mammography: Right
Ans - *Ductal Carcinoma In Situ (DCIS)* -- though mammographic
calcifications can be associated with benign conditions such as fibrocystic
changes (sclerosing adenosis) and fat necrosis. *Biopsy of calcifications is
often necessary to distinguish between benign and malignant conditions*
, Subtype of Ductal Carcinoma In Situ that is characterized by high grade cells
with necrosis and dystrophic calcification in the center of ducts: Right Ans -
Comedo Type of DCIS
Subtype of DCIS that extends up the ducts to involve the skin of nipple,
presenting as nipple ulceration and edema: Right Ans - Paget Disease of the
Breast
Nipple ulceration and erythema almost always associated with an underlying
carcinoma: Right Ans - Paget's Disease of the breast;
Invasive carcinoma that typically forms duct-like structures: Right Ans -
*Invasive Ductal Carcinoma* -- considered the most common type of invasive
carcinoma in the breast, accounting for >80% of cases.
How does invasive ductal carcinoma present? Right Ans - Presents as a
mass detected by physical exam or mammography. Clinically detected masses
are usually 2 cm or greater and Mammographically detected masses are
usually 1 cm or greater.
Advanced tumors may result in dimpling of the skin or retraction of the
nipple.
What does biopsy of invasive ductal carcinoma reveal? Right Ans - Duct
like structures in adesmoplastic stroma
Subtype of invasive ductal carcinoma that is characterized by well-
differentiated tubules that lack myoepithelial cells: Right Ans - *Tubular
Carcinoma* -- relatively good prognosis;
Subtype of Invasive ductal carcinoma that is characterized by carcinoma with
abundant extracellular mucin -- i.e. tumor cells floating in a mucus pool;
Right Ans - *Mucinous Carcinoma* -- tends to occur in older women (70 YO)
with relatively good prognosis;
Subtype of Invasive Ductal Carcinoma characterized by large, high-grade cells
growing in sheets with associated lymphocytes and plasma cells: Right Ans
- *Medullary Carcinoma* grows as well circumscribed mass that can mimic
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