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This Concept Map, created with IHMC CmapTools, has information related to: Breast, Breast Male Breast GYNECOMASTIA -imbalance of est, androgens -puberty or very old -Klinefelter's -testic neoplasms, esp LEYDIG -CIRRHOSIS->hyperestrinism -drugs: EtOH, pot, heroin, anabolic steroids MORPH-micropap hyperplasia of ducts -rare lobule formation, Breast IN SITU -all from terminal duct lobular unit -rarely froms dense mass Ductal CA in situ: -half of mamm-detected CAs -can't invade but can spread thru ducts around breast -often may progress to invasive CA -mostly mixtures of: COMEDOCARCINOMA -solid sheets of high-grade cells in duct -central necrosis->calcify - CHEESE-LIKE -periductal fibrosis, chronic inflam NONCOMEDO DCIS -solid, cribriform, pap, micropapillary -CRIB-intraepith spaces regularly-spaced -PAP-no myoepith layer -micropap-bulbous protrusions DCIS W/ MICROINVASION -mostly w comedoCA -small invasive foci, Breast Stromal Tumors Other Pseudoangiomatous stromal hyperplasia (PASH) Fibrous Tumors- -circumscribed palpable masses, mamm densities -in premenopausal or post w/ HRT Lipomas and hamartomas -palpable All are benign Fibromatosis - clonal proliferation of fibroblasts, myofibs - irregular mass w/ both skin and muscle - closely mimics invasive CA - Wide excision necessary - recurrences are common - locally aggressive, NO METS - most sporadic - some: part of FAP (APC gene) hereditary desmoid syndrome Gardner syndrome, Breast INVASIVE MUCINOUS (COLLOID) CA -1-6% -OLDER WOMEN -extremely soft -can mimic benign MORPH-large lakes of mucin -islands of tumor cells -can have neuroendocrine diff'n Px-BETTER than NST -LN mets in 20%, Breast FIBROCYSTIC CHANGES -more scary than risky In most women No clinical significance 20-40yo Doesn't begin post-menopausal Excess estrogens or low progestin -COC decreases risk MORPH - 3 patterns 1.Cysts-usually multifocal, bilateral -blue-domed w/ turbid fluid -w/ apocrine metaplasia 2.Fibrosis-from ruptured cyst junk ->chronic inflammation ->scar 3.Adenosis-increased acinar units per lobule-pregnant and non -gland lumens also enlarged -calcifications possible in lumen, Breast Inflammations ACUTE MASTITIS -during lactation -usually S aureus or strep -UNILATERAL -can->abscess ->necrosis, scar, Breast Epithelial Tumors LARGE DUCT PAPILLOMA -solitary, unilateral-BENIGN -w/in lactiferous ducts/sinuses -prolif of duct epith cells 80% spontaneous serous, bloody -discharge mostly this Dx MORPH-apocrine metaplasia -can infarct (torsion of cord), Breast INVASIVE INVASIVE LOBULAR CA-5-10% -more bilateral than other tYpes (20%) -multicentric in same breast -diffusely invasive-diff to detect -mets to CSF, serosa, ovary, uterus, marrow -mostly ass'd w/ LCIS -LACKS E-CADHERIN (cell-cell adhesion) MORPH-rubbery, poorly circumscribed -SINGLE FILE CELLS-parallel arrays -signet-ring cells common -BETTER Px than invasive ductal, Breast CA - IN GENERAL Risk Factors -FHx - AD gene -BRCA1, BRCA2 genes -tumor supps -Li-Fraumeni Syndrome -Cowden dz-10q -avg Dx age = 64yo -increased risk w/ age -prolif breast dz -CA of other breast or endometrium -US and Europe>others -long reproductive life -early menarche, late meno -nulliparous ᡖ w/ 1st kid -obesity -excess endogenous est -exogenous estrogens? -Hodgkins, XRT -fat in diet, EtOH, Breast Inflammations PERIDUCTAL MASTITIS-commonly recurs (Recurrent Subareolar Abscess) (Sq Metaplasia of Lactiferous Ducts) -keratinizing epith into duct -can->rupture of duct, abscess, scar -chronic, granulomatous inflam -ass'd w/ SMOKING, NOT age, kids, milk, Breast CA - IN GENERAL Other CA -skin CA like anywhere else -lymphomas (mostly B) -Burkitt - young women -METS rare (melanoma, lung), Breast CA - IN GENERAL STAGING -HER-2/neu -> POORER Px 0-DCIS, LCIS I. invasive, 2cm or less (DCIS w/ microinvasion) no mets II. less than 5cm involved but mobile nodes -or ɱcm w/ no nodes III. ɱcm w/ nodes -or any w/ fixed nodes, etc. w/ no distant mets IV-distant mets, Breast Inflammations SILICONE BREAST IMPLANTS -chronic inflam infiltrate ->fibrous capsule -implant can rupture -often leaks out of capsule -can get calcified after awhile, Breast INVASIVE INVASIVE PAPILLARY CA ə% -usually papillary means DCIS Px-better than NST, Breast Inflammations LYMPHOCYTIC MASTOPATHY (SCLEROSING LYMPHOCYTIC LOBULITIS) -single or multiple hard palpable masses -might be too hard to Bx -some bilateral -detected as mammographic densities MORPH -collagenized stroma around atrophic ducts, lobs -epithelial bsmt memb thickened -prominent lymphocytic infiltrate -ass'd w/ type 1 DM or AI thyroid dz -?autoimmune disease of the breast -distinguish from carcinoma, Breast CA - IN GENERAL Epidemiology 1 in 9 women get it 1/3 of them die., Breast CA - IN GENERAL Features of all -extend in all directions -can adhere to deep fascia -to skin->retraction, dimpling -nipple retraction if in middle -PEAU D'ORANGE from lymph blockage -mostly drain to AXILLARY then along internal mammary a. -1/3 spread to nodes -mets to LUNGS, BONES, LIVER, adrenal, brain, meninges, Breast INVASIVE MEDULLARY CA-1-5% -13% of BRCA1 cancers -high HLA-DR -2-3 cm dia -no desmoplasia - SCANT STROMA -soft, fleshy, yielding on palpation -solid, syncytium-like (75% of mass) -large, vesicular cells -pushing, non-infiltrative border -marked LYMPHOCYTIC infiltrate Px-better than NST, even w/ 'poor-prognostic' indicators, Breast CA - IN GENERAL CLINICAL -w/ distant mets, unlikely to cure -LN mets most important for Px -but 25% w/ (-) recur, die w/in 10y -can regress w/ hormone manip if contain estrogen receptors, Breast Proliferative Breast Dz -increased risk of CA - both sides -mod w/ ADH, ALH -slight w/ EH, SA, paps -none w/ adenosis, apocrine metaplasia SMALL DUCT PAPILLOMAS -Usually silent -fibrovasc cores into duct lumens -can have hyperplasia Malignant if: monoclonal, no myoepith, delicate cores, cribriform, no apocrine