Breast Pathology 2

Question 1

what part of the tumour is malignant in a malignant phyllodes tumour?

Answer 1

stroma

Question 2

post operative radiotherapy triggers what malignant breast cancer?

Answer 2

angiosarcoma

Question 3

what kind of cancers elsewhere can metastasise to the breast - be specific

Answer 3

bronchial carcinoma
ovarian SEROUS carcinoma
clear cell carcinoma of the kidney
malignant melanoma

Question 4

what soft tissue tumoru can metastasise to the breast?

Answer 4

leimyosarcoma

Question 5

define a breast carcinoma

Answer 5

malignant tumour of breast epithelial cells

Question 6

where does a breast carcinoma arise?

Answer 6

glandular epithelium of the TDLU

Question 7

what kind of cancer is a breast carcinoma?

Answer 7

adenocarcinoma

Question 8

name the 2 types of precursor lesions to breast cancer

Answer 8

ductal

lobular

Question 9

what does carcinoma mean?

Answer 9

it’s epithelial

it looks malignant

Question 10

an in situ carcinoma of the breast is confined to…

Answer 10

basement membrane of acini and ducts

Question 11

name the 2 types of lobular precursor lesion and what makes them different

Answer 11

atypical lobular hyperplasia (<50% of lobule involved)

lobular carcinoma in situ (>50% of lobule involved)

Question 12

LCIS neoplasia is usually oestrogen receptor positive/negative

Answer 12

positive

Question 13

how does LCIS present?

Answer 13

multifocal
bilateral
fertile women
not palpable

Question 14

risk of cancer is _% if you have LCIS and a family history

Answer 14

20

Question 15

Ix LCIS

Answer 15

1. core biopsy

2. excision/vacuum biopsy to exclude higher grade lesions

Question 16

intraductal proliferation involves a change in what cells of the breast?

Answer 16

columnar cells of the ducts

Question 17

what % of breast malignancies are DCIS?

Answer 17

15-20%

Question 18

where does ductal carcinoma in situ arise?

Answer 18

TDLU

Question 19

DCIS tends to involve a single/multi duct system

Answer 19

single

Question 20

a malignancy is classed as DCIS if its located where?

Answer 20

within BM of the duct

Question 21

high grade DCIS that extends to the nipple is called..

Answer 21

paget’s disease of the nipple

Question 22

Tx DCIS

Answer 22

surgery

adjuvant radiotherapy

Question 23

what is microinvasive carcinoma?

Answer 23

basically DCIS with invasion of <1mm

Question 24

Tx microinvasive carcinoma

Answer 24

surgery

treat like high grade DCIS

Question 25

if you have high grade DCIS what cancer are you likely to progress to?

Answer 25

grade 3 ductal carcinoma - BAD!

Question 26

what cancer is LCIS likely to progress to?

Answer 26

lobular carcinoma

Question 27

what is low grade DCIS likely to progress to?

Answer 27

grade 1 ductal carcinoma

Question 28

reproductive risk factors for breast carcinoma

Answer 28

``` age at menarche age at first birth parity breastfeeding age at menopause ```

Question 29

risk factors for breast carcinoma?

Answer 29

``` OCP/HRT use age reproductive factors previous breast disease caucasian weight/low exercise alcohol diet smoking genetics ```

Question 30

what FH would double your risk?

Answer 30

affected first degree relative

Question 31

1 in __ carry a BRCA mutation

Answer 31

450

Question 32

where will invasive breast carcinoma spread to?

Answer 32

``` bone liver brain lungs abdo viscera female genital tract ```

Question 33

Ix for nodes in invasive carcinoma?

Answer 33

sentinel node biopsy (less likely to cause oedema)

Question 34

most common type of invasive breast carcinoma?

Answer 34

ductal (non specific types)

Question 35

what does a tumour grade measure?

Answer 35

tumour differentiation

Question 36

name 3 ways of measuring breast carcinoma differentiation

Answer 36

presence of tubules appearance of nucleus mitotic activity

Question 37

what does an ER positive tumour tell you?

Answer 37

it will respond to anti-oestrogen therapy

Question 38

give examples of anti-oestrogen therapy

Answer 38

oophorectomy tamoxifen aromatase inhibitors GnRH antagonists

Question 39

most common positive hormone receptor in breast carcinoma?

Answer 39

oestrogen receptors

Question 40

what does HER2 stand for

Answer 40

human epidermal growth factor receptor 2

Question 41

name a drug that binds to HER2

Answer 41

trastuzamab (herceptin)

Question 42

Tx HER2+ breast carcinoma

Answer 42

herceptin + chemo