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House AMP > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

DISEASES OF THE BREAST

INFLAMMATORY BREAST DISEASE
• _____,_________ ,_________

FIBROCYSTIC CHANGE
• _________ change
• ______ _________

BENIGN TUMORS OF BREAST
• ______________

BREAST CANCER
• _______ carcinoma
• _________ carcinoma
• carcinoma _________

A

Acute, Chronic, Fat necrosis

• fibrocystic change
• epithelial hyperplasia

fibroadenoma

• ductal carcinoma
• lobular carcinoma
• carcinoma in situ

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2
Q

Anatomy of the breast
▪ A modified ________ gland; adapted for ________ production
▪ Composed of ________ and ________ organized into (small or large?) subdivisions - ________.

A

sweat ; milk

ducts and glands

small; lobules.

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3
Q

Anatomy of the breast

Glands drain into (small or large?) ducts that merge into (small or large?) ___________ ducts at the _________ .

The stroma is mostly _________ plus network of (thin or thick?) _________ ligaments.

A

small

large lactiferous

nipple.

fat ; thin

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4
Q

Anatomy of the breast

Stroma and glands are Both sensitive to cyclical female hormones (________ and _________ )

accounts for increase in size at _________ and changes during the __________________

A

oestrogen ; progesterone

puberty ;menstrual cycle

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5
Q

Anatomy/Physiology of the breast

The breast lymphatic network mostly drains to the _________ nodes

Lymphatics from the medial aspect drain into the _________ _________ nodes

A

axillary nodes

internal mammary nodes

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6
Q

Anatomy/physiology of the breast

During pregnancy, _____-secreting cells develop (______ induced ) and secretion begins immediately after birth

If breast feeding fails to occur, _________ ___________ atrophies

A

milk ; prolactin

glandular epithelium

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7
Q

INFLAMMATORY DISEASE
Acute mastitis
▪acute infection of the _______
▪ (Common or Uncommon?)
▪Most occur in _______ women
▪Typically caused by _______ or _______ organisms

A

breast; Uncommon

lactating ; staphylococcus

streptococcus

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8
Q

INFLAMMATORY DISEASE
Acute mastitis

▪ Access usually through ________ breast ducts plugged with ________ ________
▪Staph infection usually produces ________
▪ strep infection tends to be more (focal or diffuse?) and produces generalized ________, ________, and ________.

A

dilated ; mammary secretions.

An abscess

diffuse ; generalized

swelling, tenderness, and pain.

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9
Q

Inflammation
Chronic breast inflammation

▪Usually associated with _______ change
▪May present with _____ on _______
▪ Infectious causes include _____ in our environment

A

fibrocystic change

pain ; palpation

TB

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10
Q

Inflammation

Fat necrosis
▪ (Usual or Unusual?) type of necrosis that occurs only in fat (mimics _______)
▪Cause often unknown
▪ Many cases can be traced to _______

A

Unusual

cance

trauma

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11
Q

Fibrocystic Change
▪Aka _______________
▪ Consists of _______ , _______ inflammation, and ____________
of breast ducts.
▪ ___% of women have some degree of fibrocystic change, only about _______ of these patients have any symptoms.

A

Fibrocystic Disease

fibrosis; chronic

cystic dilation
.
50% ; one quarter

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12
Q

Fibrocystic Change

Classification
▪______________
▪ ___________
▪ ______
▪ ___________

A

Non-proliferative

Proliferative

Usual

Atypical

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13
Q

Fibrocystic Change

Classification

____________ (increased risk of cancer)

____________– 5x increased risk of cancer

A

Proliferative

Atypical

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14
Q

Common Benign Tumors
▪____________
▪ ___________ Tumour - Benign

A

Fibroadenoma

Phyllodes

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15
Q

There is a spectrum from benign to ________ to ______ Phyllodes

A

Borderline

Malignant

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16
Q

DIFFERENCES BETWEEN FIBROADENOMA AND FIBROCYSTIC CHANGE

FA VS FC

Neoplasm
Circumcision
Capsule
Stroma
Inflammation
Solid or Cystic
Epithelial/stromal elements

A

Benign neoplastic lesion; Benign non-neoplastic

Well circumscribed lesion; diffuse lesion

Encapsulated; Not Encapsulated

Cellular ; fibrotic

Inflammation is not a usual histologic feature; Usually associated with inflammation

Usually solid lesion, cysts not a classical feature; usually cystic

Proliferating epithelial and stromal elements; Proliferation usually limited to epithelial component

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17
Q

Common Malignant Breast Tumors

▪Invasive ______ carcinoma

▪Invasive ______ carcinoma

A

ductal

lobular

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18
Q

Common Malignant Breast Tumors

Invasive ductal carcinoma
▪ Most are “ ____________(NST)”
▪ The remainder are given subtypes:

Invasive lobular carcinoma
▪ __________
▪ ___________

A

no specific type

Classic

Pleomorphic

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19
Q

Breast cancer
Originates from breast tissue, from the (inner or outer?) lining of

▪ breast ducts (______ carcinomas)or
▪ Breast lobules (_______ carcinomas)

A

Inner

Ductal

Lobular

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20
Q

________ cancer is the commonest cancer in women worldwide

The most commonly diagnosed cancer (surpassing ________ cancer) – Globocan 2020

▪___th leading cause of cancer death (6.9%)after ____________________________

▪ Accounts for ____% of all cancers and ____% of cancers in
women

A

Breast cancer; Lung

5

Lung and GI cancers (colorectal, liver, stomach)

15% ; 30%

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21
Q

Breast cancer

It affects (men or women?) much less frequently but they tend to have
(poorer or better?) outcomes

A

men

poorer

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22
Q

Epidemiology
• Breast cancer is a _____geneous disease with distinct subtypes that carry (same or different?) prognosis

• Racial and ethnic differences in incidence, molecular phenotype and prognosis do not exist (T/F)

• Number of cases worldwide has ____eased significantly since the 1970s

• Survival rates in the west has ____eased (84% 5yr survival in the UK); Much (lower or higher?) in developing countries

A

hetero; different

exist

increased ; increased

lower

23
Q

Risk factors of breast cancer
• ________ sex
• _____easing age

• Race: incidence higher in ______
• Increased exposure to _________
– (Early or Late?) menarche, (early or late?) menopause, reduced _______, postmenopausal _______
–Exogenous oestrogen:_____ ,______

A

Female ;Increasing

Caucasians ; oestrogen

Early ;late

parity ; obesity

HRT, OCP

24
Q

Risk factors to breast cancer

• (lower or higher?) socioeconomic status
• significant ________ exposure
• Chemicals: pesticides, organic solvents, polycyclic hydrocarbons etc
• Family history. Mutation __________ genes. Also, _____ and ________
• Smoking
• Alcohol intake
• ________ life style
• Diet: high fat, high calorie, intake of red meat and low intake of fruits and vegetables
• Previous history of certain _____________ diseases

A

higher ; radiation

BRCA1 &2 genes.

p53 ; CHEK2

Sedentary; benign breast diseases

25
Q

Clinical presentation of breast
cancer

  1. Small __________
    ▪ On _________ examination/ USS (Screening)
    ▪ _____ examination
  2. Breast mass with or without ____ changes
    ▪ _________
    ▪ ___________
  3. Peri-areolar _________ changes
A

Breast lump; radiologic

Self ; skin changes

Puckering; ulceration

eczematous

26
Q

Clinical presentation of breast
cancer

  1. _______________ discharge
  2. (Enlarged or Shrunken?) breast with signs of _________
  3. _________ lump
  4. ________ metastases
A

Bloody nipples

Enlarged ; inflammation

Axillary

Distant

27
Q

Imaging is critical in the diagnosis of breast disease

T/F

A

T

28
Q

IMAGING
▪ It is required for
▪ ________
▪ ________
▪ ________
▪ Usually done using _______graphy and ________ graphy (as well as _____)

A

Diagnosis
▪ Screening
▪ Staging

Mammo

Ultrasono

MRI

29
Q

Scoring system of breast cancer
1 _______ (or _______ cytology)
2 _______ (or _______ cytology)
3 _______ but probably _______
4 ________ and probably ________
5 ________

A

1 Normal (or inadequate cytology)
2 Benign (or normal cytology)
3 Suspicious but probably benign
4 Suspicious and probably malignant
5 Malignant

30
Q

The World Health Organization has suggested that for a mammography screening program to be effective in the
reduction of mortality, it needs to cover at least ____% of the
population at risk.

A

70

31
Q

Mammography

▪ Annual screening mammography is recommended starting at:
▪ 1) age ____ for general population;
▪ 2) Age __________ in some intermediate and high risk patients.
OR

____ years earlier than the age of the _________ at diagnosis in some other high risk patients.

A

40 ; 25-30

10 ;affected relative

32
Q

Mammography

Mammography plus supplemental ________ is recommended in selected high-risk populations and those with _______ breast

A

screening

dense breast

33
Q

__________ is the only method of screening for breast cancer shown to decrease mortality .

A

Mammography

34
Q

Molecular Classification of breast cancer

▪ _____ IHC markers (________________________) are
used for molecular class distinction

▪ Three (______________) are used routinely for _______ , a fourth
(________) is used in some resource rich countries for ___________

A

Five ; ER, PR, HER2, CK5/6, and EGFR

ER, PR, HER2 ; all BC

Ki67 ;mitotic index.

35
Q

Molecular Classification of breast cancer

▪ They are predictive markers because they _________________
▪ Resulting in targeted use of very specific treatments and less frequent use of chemotherapy
▪ Marked reduction in _________ (and sometimes ______)

A

they guide treatment use

toxicity ;cost

36
Q

Perou classification of breast cancer

_______ type
_______ type
_______ type
_______ type

A

Luminal
Normal
Her-2
Basal-like

37
Q

Luminal A:

____,_____,_____,______ (<14%)
▪ Usually grade_______[
▪ About ____% of breast cancers

A

ER+,PR+,HER2-,Ki67(<14%)

1 or 2

70

38
Q

Luminal A:

Metastasis:
▪ most commonly to ______
▪ Least likely to ______, ______ or ______
▪ ______ response to hormonal therapy
▪ Least likely to benefit from ______

A

bone

brain, liver or lung

Good ; chemo

39
Q

Luminal B: (her2-)

____,_____,_____,_____ (>14%)
▪ Usually grade _______
▪ About ____% of breast cancers

A

ER+,PR?,HER2-,Ki67(>14%)

2 or 3

10%

40
Q

Luminal B: (her2-)

Metastasis:
▪ most commonly to _______ , followed by _______ & _______
▪ Benefits from _______ & _______ therapy

A

bone, followed by liver & lung

chemo & hormonal therapy

41
Q

Luminal B: (her2+)

____,______,_______,______ (>14%)
▪ Usually grade ____
▪ About __% of breast cancers

A

ER+,PR?,HER2+,Ki67(>14%)

3

10%

42
Q

Luminal B(HER2+)

Metastasis:
▪ most commonly to _______ , _______, _______ & _______

More likely to have
▪ _______________ disease
▪ Multiple ____________
▪ _______ recurrence
▪ Benefits from _______, _______ targeted therapy & _______
therapy

A

bone, brain, liver & lung

multicentric disease; positive nodes

Local ; chemo

HER2 ; hormonal therapy

43
Q

HER2:

_____ ,_____,_____,________ (>14%)

▪ Usually grade ____
▪ About __% of breast cancers

Metastasis:
▪ most commonly to _______ , _______, _______ & _______

A

ER-,PR-,HER2+,Ki67(>14%)

grade 3

10%

bone, brain, liver & lung

44
Q

HER2:

More likely to have
▪ _________ disease
▪ Multiple _________
▪ Local _________
▪ Benefits from _________, _________ targeted therapy
▪ Affects (younger or older?) patients

A

multicentric disease

positive nodes

recurrence

chemo; HER2

younger patients

45
Q

Basal:

More likely to have ______ recurrence
▪ (More or Less?) likely to have positive nodes
▪ Benefits from ______
▪ Affects (younger or older ?) patients

A

local recurrence

Less ; chemo

younger

46
Q

Basal:
______,______ ,______,______

____% ER+, ____%HER2+
▪ Usually grade ____
▪ About ______% of breast cancers

Metastasis:
▪ most commonly to ______, ______, ______ & ______

A

ER-,PR-,HER2-,CK5/6+

10% ER+, 10%HER2+

3

15% bone, brain, liver & lung

47
Q

Basal Phenotype
▪ Mostly ____, few ___
▪ CK5/6 ___ve
▪ ____ amplification
▪ C-KIT __ve
▪ (Low or High?) grade
▪ Associated with ———- mutation

A

TN ; ER+

+ve; amplification

+ ; High

BRCA1 mutation

48
Q

(Lethal or Non-lethal?) genetic damage is the basis of the excessive cellular proliferation that is the root-cause of tumourigenesis

A

Non-lethal

49
Q

BRCA 1 & 2
▪__________ genes
▪ Identified in the ________
▪ Located on chromosomes ____ and ___ respectively
▪ Founder mutations in ________

A

Tumour suppressor genes

1990s

17 & 13

Ashkenazi Jews

50
Q

BRCA 1 & 2

The cumulative risks of developing breast cancer by the age of
70 years approach
▪________% in BRCA1-mutation carriers
▪ _______% in BRCA2-mutation carriers

A

50–70%

40-50%

51
Q

BRCA 1 & 2
▪ Normal BRCA genes ________
▪ _______ inheritance of ____zygous mutations present in _______ mutation carriers
▪ Loss of heterozygosity = _____zygous mutation. __________ function ceases
▪ This results in spontaneous _______ of the genome

A

inhibit proliferation

Germline ; heterozygous

BRCA 1 & 2 mutation

homozygous mutation

Growth inhibiting function

instability of the genome

52
Q

BRCA 1 & 2
▪ Instability of genome activates __________ mechanisms.
▪ This results in _______ of affected cells
▪ However tissue specific survival/growth factors in breast and
ovary predispose to _______________ of these cells

▪ Facilitating the acquisition of more mutations over time that
increase _________ and cause tumours of the ________,________ and
other tissues

A

check point

elimination; prolonged viability

proliferation

breast, ovary and other tissues

53
Q

Finally

A

Done

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