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Breast pathology 2 Flashcards

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1
Q

What are the metastatic tumours to the breast?

A
  • Carcinoma
    • bronchial
    • ovarian serous carcinoma
    • clear cell carcinoma of the kidney
  • malignant melanoma
  • soft tissue tumours
    • leiomyosarcoma
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2
Q

Define breast carcinoma

A

A malignant tumour of breast epithelial cells

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3
Q

Where does breast carcinoma arise?

A

Glandular epithelium of the terminal duct lobular unit (TDLU)

It is an adenocarcinoma but is usually just referred to as ‘breast carcinoma’

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4
Q

What are the precursor lesions of breast carcinoma?

A
  • ductal
    • epithelial hyperplasia of usual type
    • columnar cell change (+/- atypia)
    • atypical ductal hyperplasia
    • ductal carcinoma in situ
  • lobular
    • lobular in situ neoplasia
      • atypical lobular hyperplasia
      • lobular carcinoma in sity
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5
Q

What is in situ carcinoma?

A

confined within basement membrane of acini & ducts

Cytologically malignant but non-invasice

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6
Q

What is in situ carcinoma a precursor for?

A

Non-obligate precursor of invasive carcinoma

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7
Q

How is in situ carcinoma classified?

A

Lobular

Ductal

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8
Q

What are the two classifications of lobular in situ neoplasia?

A

Atypical lobular hyperplasia (ALH) <50% of lobule involved

Lobular carcinoma in situ (LCIS) >50% of lobule involved

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9
Q

Describe intra-lobular proliferation of characteristic neoplastic cells

A
  • small-intermediate sized nuclei
  • solid proliferation
  • intra-cytoplasmic lumens/vacuoles
  • ER positive
  • E-carherine negative (deletion and mutation of CDH1 gene on Chr 16q22.1)
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10
Q

Lobular in situ neoplasia is frequently ______ and ______.

A

Lobular in situ neoplasia is frequently multifocal and bilateral.

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11
Q

When does the incidence of lobular in situ neoplasia decrease?

A

After menopause

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12
Q

What is the significance of lobular in situ neoplasia?

A

relative risk of invasive carcinoma

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13
Q

What is the management of lobular in situ neoplasia?

A

LN discovered on core biopsy

  • proceed to excision or vacuum biopsy to exclude higher grade lesion

LN discovered on vacuum or excison

  • follow up
    • clinical trials*
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14
Q

What is intraductal proliferation?

A

Epithelial hyperplasia of usual type

  • Columnar cell change (lesion)
  • Columnar cell change with atypia
  • Atypical ductal hyperplasia
  • Ductal carcinoma in situ
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15
Q

What is the RR of progression of intraductal proliferation to invasive carcinoma?

A
  • epithelial hyperplasia of usual type= 2 x RR
  • Atypical ductal hyperplasia = 4 x RR
  • Ductal carcinoma in situ (low grade) = 10 x RR
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16
Q

Ductal carcinoma in situ are characteristically ________ (_____ duct system)

A

Ductal carcinoma in situ are characteristically unicentric (single duct system)

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17
Q

Describe the cytology of DCIS

A

Cytologically malignant epithelial cells confined within basement membrane of duct

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18
Q

What is cancerisation

A

DCIS involving lobules

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19
Q

What is paget’s disease of the nipple?

A

DCIS involving the nipple skin

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20
Q

Is paget’s disease invasive?

A

No still in situ carcinoma

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21
Q

How is DCIS classified?

Study These Flashcards
A
  • cytological grade
  • histological type
  • presence of necrosis
22
Q

what is the significance of DCIS?

Study These Flashcards
A

risk factor for progression of invasive carcinoma

23
Q

How is DCIS managed?

Study These Flashcards
A
  • diagnosis
  • surgery
    • trials of mammographic follow-up in low risk DCIS
  • adjuvant chemotherapy
  • chemoprevention
    • endocrine therapy
24
Q

What is microinvasive carcinoma?

Study These Flashcards
A

Rare, high grade DCIS with invasion of <1mm

25
How is microinvasive carcinoma treated?
as high grade DCIS
26
What is invasive breast carcinoma?
Malignant epithelial cells have breached the basement membrane Infiltration of normal tissues
27
What is the risk with invasive breast carcinoma?
Metastasis and death
28
What are the risk factors for carcinoma of the breast?
* age * reproductive history * hormones * previous disease * geography * lifestyle * genetics
29
What are the reproductive history risk factors for carcinoma of the breast?
* age at menarche * age at first birth * parity * breastfeeding * age at menopause
30
What hormones affect risk of carcinoma of the breast?
Endogenous Exogenous - OCP - HRT
31
How increased is the risk of breast cancer with OCP use, how long does it take to return to population risk
1.0 -\> 1.24 10 years
32
What aspects of lifestyle contribute to risk of carcinoma of the breast?
* body weight- *higher oestrogen from fatty tissue conversion* * physical activity (protective)- *lowers oestrogen levels* * alcohol consumption- *higher oestrogen levels* * diet- *high fat intake* * NSAID- *reduces risk slightly* * smoking
33
first degree Affected by breast cancer _______ relative risk
doubles
34
What are the cancer syndromes contributing to genetic risk of breast cancer?
* BRCA1- *breast/ovarian predispostion* * BRCA2- *breast/ovarian predisposition* * TP53- *li fraumeni syndrome* * PTEN- *cowden's syndrome* * STK11/LKB1- *peutz-jeghers syndrome* * ATM- *ataxia telengiectasia*
35
What is the lifetime risk of breast cancer with BRCA1 AND 2 mutations?
45-64%
36
What is the net 10 year survival from carcinoma of the breast??
78%
37
What is the commonest female cancer
Invasive breast carcinoma
38
Describe the natural history of invasive breast carcinoma?
* local invasion (T) * stroma of breast * skin * muscles of chest wall * lymphatics (N) * regional draining lymph nodes * Blood-borne (M) * bone, liver, brain, lungs, abdominal viscera, female genital tract
39
Which lymph nodes does the breast drain to?
Internal mammary Intramammary Sentinel nodes Axillary nodes Atypical nodes Infraclavicular nodes Supraclavicular nodes Cervical nodes
40
How can invasive breast cancer be classified morphologically?
Type Grade
41
How can invasive breast cancer be classified through gene expression profiling?
Intrinsic sub-types
42
How can invasive breast cancer be classified through hormone receptor expression?
Oestrogen receptor Progesterone receptor HER2
43
How is breast carcinoma graded?
Objective assessment of; * tubular differentiation (1-3) * nuclear pleomorphism (1-3) * mitotic activity (1-3) Score 3,4 or 5 = grade 1 Score 6 or 7 = grade 2 Score 8 or 9 = grade 3
44
What are the intrinsic breast cancer subtypes?
* basal like: ER-, HER2-, Basal CK+ * HER2: ER-, HER2+ * Normal breast-like: ER-, non-epithelial * Luminal A: ER+, low proliferation * Luminal B: ER+, high proliferation * Luminal C: ER+, high proliferation
45
\_\_% of breast cancers are ER positive \_\_% of breast cancers are PgR positive \_\_% of breast cancers are HER2 positive
**80**% of breast cancers are ER positive **67**% of breast cancers are PgR positive **14**% of breast cancers are HER2 positive
46
What does ER expression predict?
Response to anti-oestrogen therapy - oophorectomy - tamoxifen - aromatase inhibitors (letrozole) - GnRH antagonists (goserlinin [zoladex])
47
What is HER2?
Human epidermal growth factor receptor 2
48
* HER 2 overexpression and amplification seen in ~**\_\_**% * HER 2 overexpression or amplification predict response to **\_\_\_\_\_\_\_\_** (**\_\_\_\_\_\_\_\_**)
* HER 2 overexpression and amplification seen in ~**15**% * HER 2 overexpression or amplification predict response to **trastuzamab** (**herceptin**)
49
What are the predictive and prognostic factors for invasive carcinoma?
ER (PgR) HER2
50
What is the nottingham prognostic index?
* 0.2 x tumour diameter (cm) * Tumour grade (1-3) * Lymph node status (1-3)

Reproductive & Sexual Health (54 decks)

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