Flashcards in Breast Pathology (Cancerous) Deck (34)
What are the risk factors for developing breast cancer?
Female, older age, early menarchy/late menopause, obesity, atypical hyperplasia, first degree relative with breast cancer (genetic). Generally associated with estrogen exposure.
What is Ductal Carcinoma In Situ?
Malignant proliferation of cells in the ducts, it will be bounded by the basement membrane and will not invade it.
What is "Paget's disease of the nipple?"
DCIS that has walked its way up the duct and presents into the nipple.
What is IDC?
Invasive ductal carcinoma, meaning that as opposed to DCIS where it is bounded by the basement membrane (hence "in situ") IDC breached the basement membrane.
What is Lobular Carcinoma In Situ LCIS and Invasive Lobular Carcinoma ILC?
Basically the malignant proliferation of the lobules, and if the proliferation is bounded by the basement membrane it is in situ (assuming full thickness of the entire cell from basement membrane to basement membrane) and if basement membrane is breached it is invasive LC.
Malignant proliferation of cells in ducts, no mass detected, no invasion of basement membrane, but calcification seen in mammogram, what is the diagnosis? Why the calcification?
Ductal Carcinoma In Situ DCIS. Blood supply becomes inefficient to supply all the proliferating cells so cells in the center die and calcification occur on top of that (dystrophic calcification). This is detected in the mammogram.
What kind of DCIS has high grade cells with necrosis and dystrophic calcification in the center of the ducts?
It's called the "Camedo type" variant of DCIS.
A woman presents with nipple ulcerations and erethema, what is the diagnosis and what should be feared?
Diagnosis is Paget's disease of the nipple, this is always associated with an underlying carcinoma, because generally it is DCIS that progressed its way up the duct all the way up to the nipple.
This disease classically forms duct-like structures, presents as mass detected in physical exam or mammography, and in late stages may present as dimpling of skin or retraction of the nipple. What's the diagnosis?
Invasive Ductal carcinoma, which is the most common type of invasive carcinoma.
What would a biopsy of invasive ductal carcinoma reveal?
Duct like structures and desmoplastic stroma (connective tumor that grows with and supports the tumor).
What are the 4 subtypes of Invasive Ductal carcinoma?
Tubular, mucinous, medullary and inflammatory carcinoma.
How would a tuburous invasive ductal carcinoma differ from normal breast tissue biopsy? Prognosis?
The tubules will look similar however they will not have the myoepithelial cells (thus will have only one layer) as well as the desmoplastic stroma. Very good prognosis.
What is the key feature of the mucinous invasive carcinoma of the breast? Prognosis? Age distribution?
Malignant cells floating in a sea of mucous. Good prognosis and seen in elderly women.
What is the key histologic feature of Inflammatory carcinoma? Prognosis?
Acute mastitis like presentation (very swollen and erethamatous breast) but wont resolve with ABX, biopsy will show the tumor within the dermal lymphatics. Blocks the lymphatics, messes with draining and causes the characteristic inflammation. Very poor prognosis.
What is characteristic of Medullary carcinoma?
High grade malignant tumor cells with inflammatory cells in the background, (lymphocytes and plasma cells).
What subtype of breast cancer is associated with BRCA 1 mutation?
Medullary carcinoma of the breasts.
Can you find masses in LCIS?
No this is diagnosed incidentally. No mass or calcifications.
What is the job of E-cadherin?
It's somewhat of a glue that helps cells stick together.
If biospy reveals dyscohesive lobular cells lacking E-cadherin that is often multifocal and bilateral, what should we suspect?
What is our current understanding of LCIS? (In terms of Tx).
Not exactly a malignant proliferation but is a risk factor for it, tx-ed with tamoxifen (anti-estrogen) and close follow-up.
How does ILC grow and how does this compare with compare with LCIS?
LCIS grows in a ductal pattern but ICS grows in a single file pattern, due to lack of E-cadherin.
What is the most important staging tool for cancer and which is the most useful in terms of breast cancer?
Metastasis is most important in terms of determining prognosis, however axillary lymph node involvement is most useful because most do not present with metastasis.
What is the idea of the "Sentinal lymph node biopsy?"
Radioactive dye is injected into the breast so that only the first tier of axillary lymph nodes light up and is removed, examined. If positive for cancer, the rest are also removed, but if negative the rest are left alone.
What are the 3 most important factors in determining response to treatment?
ER, PR, and HER2 Neu mutations.
What is the idea behind ER's and PR's?
Do the tumor have estrongen and progesterone receptors (and thus be responsive to anti progesterone and estrogen tx like Tamoxifen).
What is the problem with the HER2 Neu gene mutation?
It is an gene amplification mutation where the cell expresses more HER2 Neu receptors, and this is a cell surface growth factor receptor. More HER2 Neu means more cell growth means increased chances of malignancy.
How would we tx a patient who is HER2 Neu mutation positive for breast cancer?
Antibodies against the HER2 Neu receptors. I.E. Trastuzamab
What is "Tripple Negative" carcinoma and who have this?
Negative for ER PR and HER2 Neu, very bad prognosis and african american women have this.
What are three predictor of hereditary breast cancer, which accounts for 10% of all breast cancers?
First line family members with breast cancer, pre menopausal breast cancer, and multiple tumors.
What are the two dominant gene mutations for hereditary breast cancers?
BRCA 1 and 2, single gene mutations.
What is BRCA 1 associated with?
Breast carcinoma and ovarian carcinoma.
What is BRCA 2 associated with?
Breast carcinoma in males.
What are the features of male breast cancer?
Presents in the subaerolar region, in older males, very rare, usually IDC. Might produce nipple discharge.