- a surface protein responsible for the cohesion of NORMAL breast epithelial cells

Breast Pathology 2 Flashcards by Shiv Krishnan

Name miscellaneous malignant tumors

Malignant phyllodes tumor
Angiosarcoma
Lymphoma
Metastatic tumors

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What is the tumorous version of the fibroadenoma?

Malignant phyllodes tumor - has sacromatous stromal component

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Which organ does the phyllodes tumor generally metastasize to?

Lung

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Which malignant tumor usually occurs post radiotherapy?

Angiosarcoma

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Which metastatic tumors usually spread to the breast?

Carcinoma : Bronchial / ovarian serous/ clear cell ca of kidney

Malignant Melanoma

Soft Tissue tumors ( leiomyosarcoma)

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Where does breast cancer arise from?

The glandular epithelium of the TDLU

—an adenocarcinoma

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What are the ductal precursor lesions?

epithelial hyperplasia type
columnar cell change (+/- atypia)
atypical ductal hyperplasia
ductal carcinoma in situ???

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Name lobular precursor lesions.

Lobular in situ neoplasia

atypical lobular hyperplasia
lobular CA in situ

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What is seen histologically with in situ carcinoma ?

Confined within BM of acini and ducts

- cytologically appear MALIGNANT but non invasive

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Can in situ carcinoma still progress to invasive ca?

Yes.

if High Grade In situ carcinoma

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What are 2 types of Lobular In situ hyperplasia ?

ALH ( atypical lobular hyperplasia) …<50% of lobulee involved

LCIS (lobular ca in situ)…>50% of lobule

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What is characteristic of the cells proliferating in lobular in situ neoplasia?

ER positive
E-cadherin Negative (d/t mutation and deletion of CDH1 gene) `
small intermediate sized nuclei
—small, rounded, loosely cohesive cells fill and expand the acini

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What is e-cadherin?

a surface protein responsible for the cohesion of NORMAL breast epithelial cells

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What are the key fts of the LCIS?

FREQ. Multifocal and bilateral

- incidence decreases after menopause and is 0.4-4% present in benign biopsies

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Gross and imaging ft of LCIS?

GROSS= not palpable or visible

- may calcify (seen on mammography)

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What is the significance of Lobular in situ neoplasia?

marker of subsequent risk

- TRUE precursor lesion

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How to manage Lobular in situ neoplasia?

And why is it done this way?

vacuum/ excision biopsy
> do follow-ups
> clinical trials

—-as lobular in situ neoplasia is multifocal; there is no point to perform a multiple lumpectomy

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What is the risk of developing ductal carcinoma from A LOW gr. DCIS?

10x the risk

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What are the fts of DCIS?

15-20% OF BREAST malignancies are DCIS
arises in TDLU
unicentric

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What are the histological fts of DCIS?

malignant looking cells confined within the BM of the duct
may involve the lobules (cancerisation) and nipple skin (Paget’s)

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What is Paget’s disease? Is it invasive?

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high gr. DCIS extending along the ducts REACH the epidermis of the nipple
—still in situ carcinoma (not invasive)

How is DCIS classified?

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cytological type
histological grade
presence of necrosis (COMEDO)

What is the risk of ductal ca in situ progressing into an INVASIVE CA?

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true precursor to invasive carcinoma

- 75% progress to INVASION following incisional biopsy

How to manage DCIS?

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dx> Surgery
( mammographic follow-up in LOW risk DCIS pts)
Adjuvant radiotherapy
Chemoprevention (endocrine therapy)

What is a key ft of Micro-invasive Carcinoma?

- basically DCIS that extends <1mm past the BM | = treat as HIGH grade DCIS

When is a tumour deemed to be invasive?

- when the malignant epithelial cells have BREACHED the Bm - infiltration of normal tissues - risk of death and metastasis

What is said to be the primary risk factor of developing CA of the breast?

-the more estrogen in your life; the greater the chance of you to develop INVASIVE breast cancer

What should be explored with the pt for risk factors?

- age at menarche - age at first birth - parity - breastfeeding - age at menopause - exogenous/endogenous hormones ( OCP/HRT) - previous breast disease - genetics - lifestyle

IS there greater risk of breast cancer with estrogen-only HRT or estrogen-progesterone HRT?

- greater risk with estrogen and progesterone HRT

What factors of lifestyle predisposes one to carcinoma of the breast?

- body weight - alcohol consumptiom - food types (smoked food) - smoking - inactivity - NSAID (lowers risk)

2 MAJOR gene mutations a.w breast cancer?

- BRCA 1 and BRCA 2 (but only 1 in 450 people carry the mutation) - 45-64% LIFE-time risk

How does invasive carcinoma usually arise?

- genes along with external factors may further predispose on to the cancer - ---lifestyle and hormones

What are the stats like with breast cancer incidence and mortality?

- Incidence is risng | - Mortality is falling

Name the MOST common female cancer!

- invasive breast carcinoma----- 1 in 8! may develop | 2nd most common cause of cancer death

How may the breast cancer be staged?

TNM 1. Local invasion of the tumor (stroma/ skin/ muscles of chest wall) 2. Lymphatics (regional draining LN) 3. Blood-borne (M) ---> bone/ liver/ brain/ lungs/ abd. viscera/ female genital tract

Where are the possible nodes for the cancer to spread to?

- internal mammary and intra-mammary nodes - supra-/ infra-clavicular nodes - apical and AXILLARY nodes - cervical nodes

What are the 3 things invasive breast cancer is classified by?

1. Morphology (type and grade) 2. Gene Expression Profiling (intrinsic sub-types) 3. Hormone Receptor Expression (ER/ PR/ HER2)

What are the diff. types of invasive breast CA?

- ductal/ lobular/ mucinous/ medullary/ tubular/ cribriform/ papillary/ mixed

What is meant by tumour grade?

- MEASURE of tumour differentiation a) well differentiated= low grade= GOOD PROGNOSIS b) poorly differentiated= high grade= POOR prog.

What is the tumor grading based on?

- tubular differentiation (1-3) - nuclear pleomorphism (1-3) - mitotic activity (1-3)

Survival rate reduces with _____

higher tumor grade

What hormone receptors may be found on malignant cells of the breast?

- ER - PgR - HER2

Significance of knowing which receptor is predominantly found on the tumor cells?

- ER expression indicates response to anti-estrogen therapy

What is invovlved in anti-estrogen therapy?

- oophorectomy - Tamoxifen - Aromatase Inhibitors (Letrozole) - GnRH antagonists (Zoladex)

WHich tumor is likely have better prognosis, er +/-?

- ER + | same with PR

What is HER2?

- Human epidermal growth factor receptor 2 | - ----amplification seen in 15%

Which drug is responsive to HER2 + tumor?

Trastuzumab

Which poses as having poor prognosis, HER2 +/- ?

HER2 -

Which breast tumor has the worst prognosis?

being triple negative

What TNM hold worst prognosis?

- - bigger tumors - -more than 1 LN metastasis - -presence of lymphovascular invasion

What prognostic indices are used for breast cancer?

- Nottingham Prognostic Index (histopathology only) - Adjuvant online (ER+ Clinical factors+ histopathology) - NHS predict (ER+ clinical factors+ HER2+ histopathology+ mode of detection)

Breast Pathology 2 Flashcards

(51 cards)