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Flashcards in Breast path II Deck (49):
1

Fat necrosis of the breast is secondary to what

trauma

2

describe how fat necrosis occurs

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

3

what causing dimpling of the breast skin

coopers ligament being retracted by a mass or fibrosis etc

4

Ddx for fat necoris

carcinoma with desmoplasia (tumoral fibrosis)
Bx is usually required

5

where can breast implants be inserted

inframammary, periareolar, transaxillary
location is subglandular or submuscular

6

complications of breast implants

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

7

What can hyperplastic epithelial lobular unit progress to

either fibrocystic changes or atypical ductal hyperplasia

8

what is DCIS

ductal carcinoma in situ

9

what is IBC

invasive breast carcinoma

10

how do fibrocystic changes of the breast present

mass, pain, microcalcifications

11

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

epithelial cells are now >4 cells in thickness

12

What benign condition mimics carcinoma of the breast

radial scar- complex sclerosing lesion

13

what benign fibrocystic change can look like a breast polyp

intraductal papilloma

14

if suspect radial scar what do you need to do

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

15

what is atypical ducta hyperplasia

low grade neoplastic cells idenntified by nuclear cytology
overlap with DCIS

16

When is atypical ductal hyperplasia called DCIS

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

17

What is atypical lobular hyperplasia

proliferation of low grade neoplastic cells in lobule
e-cadherin negative

18

what is e-cadherin positive

ductal cells

19

atypical hyperplasia of the breast increases risk by how much

3-5X

20

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

ductal

21

Age of presentation of DCIS and lobular CIS

DCIS 54-58
LCIS 44-47

22

clinical signs of LCIS

none

23

mammographic signs LCIS and DCIS

LCIS none
DCIS microcalcifications

24

if see necrotic tissue in CA of breast what is it

comido carcinoma, take out right away

25

what is the difference of ductal and lobular carcinoma

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

26

invasion of ductal and lobular carcinomas is Dx how

based on absence of myoepithelial cells

27

definition low grade DCIS

mild nuclear atypia and micropapillary or cribiform architecture

28

definition high grade DCIS

malignant nuclear atypia and solid archtecture
comedonecrosis and microinvasion

29

what is comedonecrosis

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

30

what is definition on microinvasion

focus of invasion <2mm in dimension

31

LCIS on microscopy

dyshesive architecture with signet cell morphology
+ mucin

32

What is Paget disease of breast

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

33

prognosis of paget disease of the breast

depends on grade and stage

34

what is cribiform histology

sieve- like

35

what is "pagetoid finding"

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

36

what are some biomarkers for paget disease

cytokeratin 7

37

risk factors for invasive carcinoma of the breast

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

38

what increases lifetime exposure to E

menarche <35 years
HRT for menopause

39

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

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

40

the Her2 enrished breast CA have what mutations

P53 mutations
HER2amplification

41

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

BRCA1 mutations with p53 mutations
ER negative
HER2 negative

42

What inhibits at G1 and G2 to allow for DNA repairs

GADD45

43

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

p53
85-90%

44

What cancers are also assoc with Li Fraumeni syndrome

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

45

when do you consider genetic testing for li fraumeni syndrome

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

46

Genetic counseling is indicated for BRCA when

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

47

prevention for hereditary breast and ovarian cancer

prophylactic mastectomy
salpingo-oophorectomy
tamoxifen

48

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

annual mammogram and MRI starting at age 25

49

what chrom encodes for p53 mutated in Li Fraumeni syndrome

17p12