Breast path II

Question 1

Fat necrosis of the breast is secondary to what

Answer 1

trauma

Question 2

describe how fat necrosis occurs

Answer 2

liquefactive necrosis of fate releases cytoplasmic fat which causes acture foreign body granulomatous response in surrounding tissues with repair fibrosis

Question 3

what causing dimpling of the breast skin

Answer 3

coopers ligament being retracted by a mass or fibrosis etc

Question 4

Ddx for fat necoris

Answer 4

carcinoma with desmoplasia (tumoral fibrosis)

Bx is usually required

Question 5

where can breast implants be inserted

Answer 5

inframammary, periareolar, transaxillary

location is subglandular or submuscular

Question 6

complications of breast implants

Answer 6

capsule of fibrous layer forms and may be painful causing contraction
capsule can rupture and foreign body inflammation from leakage
lymphoma- anaplastic large cell lymphoma– rare

Question 7

What can hyperplastic epithelial lobular unit progress to

Answer 7

either fibrocystic changes or atypical ductal hyperplasia

Question 8

what is DCIS

Answer 8

ductal carcinoma in situ

Question 9

what is IBC

Answer 9

invasive breast carcinoma

Question 10

how do fibrocystic changes of the breast present

Answer 10

mass, pain, microcalcifications

Question 11

what differentiates fibrocystic changes from proliferative fibrocystic change w/o atypia

Answer 11

epithelial cells are now >4 cells in thickness

Question 12

What benign condition mimics carcinoma of the breast

Answer 12

radial scar- complex sclerosing lesion

Question 13

what benign fibrocystic change can look like a breast polyp

Answer 13

intraductal papilloma

Question 14

if suspect radial scar what do you need to do

Answer 14

surgical excision to confirm Dx and that it is not Breast CA

Question 15

what is atypical ducta hyperplasia

Answer 15

low grade neoplastic cells idenntified by nuclear cytology

overlap with DCIS

Question 16

When is atypical ductal hyperplasia called DCIS

Answer 16

when duct is completely filled with neoplastic cells and entire lesion is >2mm

Question 17

What is atypical lobular hyperplasia

Answer 17

proliferation of low grade neoplastic cells in lobule

e-cadherin negative

Question 18

what is e-cadherin positive

Answer 18

ductal cells

Question 19

atypical hyperplasia of the breast increases risk by how much

Answer 19

3-5X

Question 20

what breast CA type do you need to remove with clear margins

Answer 20

ductal

Question 21

Age of presentation of DCIS and lobular CIS

Answer 21

DCIS 54-58

LCIS 44-47

Question 22

clinical signs of LCIS

Answer 22

none

Question 23

mammographic signs LCIS and DCIS

Answer 23

LCIS none

DCIS microcalcifications

Question 24

if see necrotic tissue in CA of breast what is it

Answer 24

comido carcinoma, take out right away

Question 25

what is the difference of ductal and lobular carcinoma

Answer 25

both arise from TDLU but there is different expression of gene patterns

Question 26

invasion of ductal and lobular carcinomas is Dx how

Answer 26

based on absence of myoepithelial cells

Question 27

definition low grade DCIS

Answer 27

mild nuclear atypia and micropapillary or cribiform architecture

Question 28

definition high grade DCIS

Answer 28

malignant nuclear atypia and solid archtecture | comedonecrosis and microinvasion

Question 29

what is comedonecrosis

Answer 29

central tumoral necrosis gives unique "toothpaste" finding grossly and necrotic cells prone to dystrophic calcification

Question 30

what is definition on microinvasion

Answer 30

focus of invasion <2mm in dimension

Question 31

LCIS on microscopy

Answer 31

dyshesive architecture with signet cell morphology | + mucin

Question 32

What is Paget disease of breast

Answer 32

eczematous red change to nipple and areola from underlying DCIS and invasion infiltration of epidermis by malignant glandular cells mucin+ CEA and EMA +

Question 33

prognosis of paget disease of the breast

Answer 33

depends on grade and stage

Question 34

what is cribiform histology

Answer 34

sieve- like

Question 35

what is "pagetoid finding"

Answer 35

microscopic finding of upward infiltration of epidermis by glandular neoplastic cells seen in melanoma and SCC

Question 36

what are some biomarkers for paget disease

Answer 36

cytokeratin 7

Question 37

risk factors for invasive carcinoma of the breast

Answer 37

``` lifetime exposure to E radiation exposure breast density proliferative fibrocystic changes life style: alcohol, obesity, sedentary familial and increasing age ```

Question 38

what increases lifetime exposure to E

Answer 38

menarche <35 years | HRT for menopause

Question 39

the luminal invasive CA of breast will be positive for what cytology and what mutations

Answer 39

E receptor positive Her2neu negative BRCA2 mutation, 1q gain 16ploss, PIK3CA mutations

Question 40

the Her2 enrished breast CA have what mutations

Answer 40

P53 mutations | HER2amplification

Question 41

the Basal like invasive CA of breast have what mutations and positive cytology for what

Answer 41

BRCA1 mutations with p53 mutations ER negative HER2 negative

Question 42

What inhibits at G1 and G2 to allow for DNA repairs

Answer 42

GADD45

Question 43

What mutation is involved in Li Fraumeni syndrome and change of developing breast CA

Answer 43

p53 | 85-90%

Question 44

What cancers are also assoc with Li Fraumeni syndrome

Answer 44

soft tissue sarcoma, brain tumors, osteosarcoma, adrenocortical tumores, leukemia

Question 45

when do you consider genetic testing for li fraumeni syndrome

Answer 45

multiple early onset cancers, breast CA usually <30 y.o

Question 46

Genetic counseling is indicated for BRCA when

Answer 46

known family genetic disease (ashkenazy jews, french canadians) early onset <50y.o high risk breast cancer + family history

Question 47

prevention for hereditary breast and ovarian cancer

Answer 47

prophylactic mastectomy salpingo-oophorectomy tamoxifen

Question 48

if risk for hereditary breast and ovarian cancer what is screening schedule

Answer 48

annual mammogram and MRI starting at age 25

Question 49

what chrom encodes for p53 mutated in Li Fraumeni syndrome

Answer 49

17p12