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Breast Pathology

Chapter 23

Acute mastitis first month of breastfeeding, Staph Aureus, erythematous breast, painful, fever
Periductal mastitis painful erythematous subareolar mass, keratinizing squamous metaplasia of the nipple ducts and keratin plugs the ductal system (90% smokers)
Mammary duct ectasia poorly defined periareolar mass, thick nipple secretions and dilated ducts with lipid-laden macrophages, may be mistaken for carcinoma
Fat necrosis painless palpable mass, thickening or retraction of skin, history of breast trauma or prior surgery, acute lesions may be hemorrhagic and contain central areas of liquefactive fat necrosis, may be mistaken for carcinoma
Lymphocytic mastopathy (sclerosing lymphocytic lobulitis) single or multiple hard palpable massess, collagenized stroma surrounding atrophic ducts and lobules, common in type 1 diabetics and autoimmune thyroid disease, must be distinguished from cancer
Granulomatous mastitis Wegener, sarcoidosis, infection with mycobacteria or fungi, immunocompromised patients
Nonproliferative Breast Changes (Fibrocystic changes) cysts form by the dilation and unfolding of lobules, blue-dome cysts, lined by metaplastic apocrine cells, calcification on mammography, cysts disappears after aspiration of contents, ruptured cysts create fibrosis, adenosis (increased number of acini)
Proliferative Breast Disease without Atypia Discharge Densities or calcifications on mammography, epithelial hyperplasia of ducts and lobules (two or more cell layers), sclerosing adenosis, complex sclerosing lesion (central nidus in hyalinized stroma with projections), papillomas in dilated duct
Proliferative Breast disease with Atypia cellular proliferation resembling CIS but lacking sufficient features, atypical ductal hyperplasia like DCIS with monomorphic changes but only partially filling ducts, atypical lobular hyperplasia like LCIS, but cells do not fill more than 50% of acini
BRCA-1 breast cancers 2% of all breast cancers, commonly poorly differentiated, medullary features, do not express hormone receptors or overexpress HER2/neu, marked increase in ovarian carcinoma, absence of Barr body
BRCA-2 breast cancers 1% of all breast cancers, relatively poorly differentiated, more often ER positive, associated with male breast cancer
Ductal Carcinoma in Situ 15-30% of breast cancers, found on mammography, untreated develop cancer 1% per year, mastectomy curative for 95%
Comedocarcinoma DCIS, solid sheets of pleomorphic cells with "high-grade" hyperchromatic nuclei and central necrosis, necrotic cell membranes calcify and are detected on mammography
Noncomedo DCIS, cribiform, solid, papillary, micropapillary, calcifications form on intraluminal secretions
Paget disease DCIS, extends up lactiferous ducts, unilateral erythematous eruption with a scale crust, pruritus, 50-60% have palpable mass (underlying carcinoma)
DCIS microinvasion area of invasion through the basement membrane into stroma no more than 0.1 cm
Lobular Carcinoma in Situ incidental biopsy finding, bilateral 20-40%, young women, dyscohesive cells with oval or round nuclei and small nucleoli, lack E-cadherin, mucin-positive signet-ring cells, ER and PR positive, increased risk of invasive carcinoma,
Invasive Carcinoma axillary lymph node metastases in 50% with palpable mass, peau d'orange, blockage of skin draining due to lymphatic involvement produces skin thickening
Invasive Carcinoma, No special type majority (70-80%) of carcinomas, firm to hard with irregular borders, characteristic grating sound when cut, chalky-white elastotic stroma, occassional small foci of calcification, tubule formation, small round nuclei, rare mitotic figures
Luminal A NST cancers 40-55% of NST, ER positive, HER2/neu negative, slow growing and respond well to hormone treatments, but poor response to chemo,
Luminal B NST cancers (15-20% of NST) ER positive, high grade, HER2/neu overexpression, triple positive
Normal breast-like NST cancers (6-10% of NST) ER positive, HER2/neu negative
Basal-like NST cancers (13-25% of NST ER, PR, HER2/neu negative, triple-negative, BRCA1, high grade, high proliferation
HER2 positive NST cancers (7-12% of NST) ER negative, HER2/neu overexpression, amplification of 17q21, poorly differentiated, high proliferation, brain metastasis
Invasive Lobular carcinoma palpable mass, mammographic density with irregular borders, difficult to palpate, dyscohesive infiltrating tumor cells in single file or loose sheets, signet-ring cells common, luminal A like, no E-cadherin
Medullary carcinoma most common in 6th decade, well-circumscribed mass, soft, fleshy tumor, solid syncytium-like sheets of large cells, mitotic figures, lymphoplastic infiltrate, pushing border, infrequent metastasis, basal-like
Mucinous (Colloid) carcinoma 71 median age, slow growing, soft and rubbery, pale gray-blue gelatin, pushing borders, clusters of tumor cells within mucin lakes, ER positive, moderate differentiation, uncommon metastasis
Tubular carcinoma small irregular mammographic densities, 40s, well formed tubules, myoepithelial layer absent, tumor in contact with stroma, apocrine snouts, ER positive, HER2/neu negative
Metaplastic carcinoma poor prognosis, triple negative, basal-like
Fibroadenoma most common benign tumor of the female breast, 20s or 30s, intralobular stroma, multiple and bilateral, freely movable, shaprly circumscribed, rubbery, grayish
Phyllodes tumor intralobular stroma, 60s, palpable masses, larger lesions have nodules of proliferating stroma covered by epithelium, small rate of metastasis,
Created by: schroerk