Intro to Breast Cancer Flashcards Preview

Reproductive System > Intro to Breast Cancer > Flashcards

Flashcards in Intro to Breast Cancer Deck (39):
1

How do the breast change during life?

  • Pre-pregnancy
  • Pregnancy
  • Post-menopausal

  • Pre-pregnancy
    • Neonatal
    • Pubertal
    • Menstrual cycle
  • Pregnancy
    • Lactational change
  • Postmenopausal
    • Atrophy

2

What can be done to diagnose a breast lesion?

  • Self examination
  • Imaging
    • Mammography
    • Ultrasound
    • MRI
  • Biopsy
    • Fine needle aspiration
    • Core needle biopsy
    • Vacuum assisted or mammotome
    • Excisional

3

Screening vs. Diagnostic Mammograms (differences?):

  • Screening occurs in asymptomatic women
    • 40-50 years: every year or every other year
    • >50 years: yearly screening
    • 1st degree relative with breast cancer: screening begins 10 years before the age at diagnosis in the 1st degree relative
  • Diagnostic mammograms are used to evaluate a palpable lesion

4

What are suspicious mammographic findings?

  • Density
    • These carcinomas are ½ the size of palpable ones
  • Microcalcifications
    • Picks up even smaller lesions
    • May herald an in situ carcinoma
  • Magnification or compression views may aid in the evaluation of mammographic abnormalities

5

When is an ultrasound used to evaluate breast tissue?

  • Often used in women younger than 35 years especially if the lesion is clinically benign
  • Can differentiate solid from cystic masses
  • Often used in conjunction with mammography

6

What are the indications for a breast MRI?

  • Pre-operative evaluation of extent of malignant disease/contralateralprocess
  • Evaluate tumor response to neo-adjuvant chemotherapy
  • Axillarylymph node positive for metastatic carcinoma with unknown primary
  • Evaluate integrity silicone breast implant
  • High risk screening

7

What are different types of breast pathology specimens?

  • FNA
  • Core biopsy
  • Excisional biopsy
  • Excision / lumpectomy
  • Mastectomy
  • Lymph nodes:
    • sentinel node
    • axillary dissection

8

What are the advantages/disadvantages of a fine needle aspirate (FNA)?

  • Safe, accurate and well tolerated
  • Requires subspecialty expertise for interpretation
  • Cannot distinguish between in situ and invasive lesions
  • Higher rate of false negative results

9

How is a core needle biopsy obtained?

  • 8, 11 or 14 gauge needles
  • Several cores are usually obtained
  • False negatives are usually due to sampling error
  • Can be obtained using radiologic guidance if the mass is small, deep, mobile, vaguely palpable or multiple

10

  • What is a lumpectomy?  
  • What is used for orientation?

  • Needle localization biopsy
  • Oriented with clips

11

  • What is the "triple test"?
  • How is it interpreted?

  • Combination of physical examination, imaging studies and biopsy
  • If all three tests point to a benign diagnosis,
    • it is likely that the process is benign
    • can be followed without requiring surgical removal (95% sensitive)
  • If there is any discordance among the three tests,
    • further studies are indicated

12

Most common lesion best on age group: 

  • 15-25: 
  • 25-35: 
  • 35-50: 
  • Over 50: 
  • Pregnant or lactating:

  • 15-25
    • Fibroadenoma
  • 25-35
    • Fibroadenoma (cyst or cancer possible but uncommon)
  • 35-50
    • Fibrocystic changes, cancer, cyst
  • Over 50
    • Cancer until proved otherwise
  • Pregnant or Lactating
    • Lactating adenoma, cyst, mastitis, cancer

13

What are the inflammatory conditions of the breast?

  • Acute mastitis
  • Periductal mastitis
  • Mammary duct ectasia
  • Fat necrosis
  • Other (lymphocytic mastopathy, granulomatous mastitis, plasma cell mastitis, galactocele)

14

What are the benign epithelial lesions of the breast?

  • Non-proliferative breast changes (fibrocystic changes)
  • Proliferative breast disease without atypia
  • Proliferative breast disease with atypia

15

What are the different types of non-proliferative breast changes (Fibrocystic Changes)?

  • Cysts
  • Fibrosis
  • Apocrine metaplasia

16

Non-proliferative Breast Changes (Fibrocystic Changes):

Clinical Presentation

  • May present as lumpy breast, mass, calcifications, nipple discharge
  • Pain, tenderness, pain may occur in the premenstrual phase of the cycle
  • Masses may be multiple and/or bilateral and may fluctuate in size

17

Non-proliferative Breast Changes (Fibrocystic Changes)

  • Age predilection
  • Incidence

  • Age predilection
    • Premenopausal (30 –50 years old)
  • Incidence
    • May be part of normal spectrum
    • Most common benign condition of the breast

18

Proliferative Breast Disease Without Atypia: 

Clinical Findings

 

  • Mammographic densities (rarely form masses)
  • Calcifications
  • Incidental

19

Different Types of Proliferative Breast Disease Without Atypia

Includes:

  • Moderate, florid hyperplasia
  • Sclerosingadenosis
  • Complex sclerosing lesions
  • Papillomas

20

What is ductal hyperplasia?

  • Lumen filled by heterogeneous population of cells
  • Different morphologies –myoepithelial and epithelial
  • Irregular slit-like fenestrations, prominent at periphery

22

Describe sclerosing adenosis:

  • Enlarged lobule, circumscribed edge
  • Preserved background lobular architecture
  • Compressed and distorted acini
  • Dense stroma, calcifications

23

What is the clinical presentation of complex sclerosing adenosis?

  • Most common between 40 and 60 years of age
  • Rarely palpable
  • Usually detected by mammography
  • Mammogram shows a stellate or spiculated lesion with a central core
  • Biopsy is needed for confirmation of diagnosis
  • Complete excision is warranted

24

How does a complex sclerosing adenosis (radial scar) appear microscopically?

  • Stellate lesion
  • Central hyalinized stroma with entrapped glands
  • Dilated ducts at periphery

25

What is the clinical presentation of papilloma?

  • May occur at any age
  • Majority are located in the central breast
  • Nipple discharge is the primary symptom in up to 80% of cases (less common in peripheral lesions)
    • Bloody discharge occurs in 71% of central papillomas
  • Subareolar mass may be present

26

How does a papilloma appear microscopically?

  • Branching fibrovascular cores within duct
  • Epithelial hyperplasia often present

27

List the types of Proliferative Breast Disease With Atypia (2):

  1. Atypical ductal hyperplasia
  2. Atypical lobular hyperplasia

28

What is the microscopic appearence of atypical hyperplasia?

  • Resembles in situ carcinoma
    • Lacks quantitative or qualitative features for this diagnosis

29

Relative risk for invansive carcinoma for the following group: 

  1. Adenosis
  2. Fibroadenoma
  3. Fibrosis
  4. Hyperplasia without atypia
  5. Cysts
  6. Apocrine metaplasia

no increased risk

30

Relative risk for invansive carcinoma for the following group: 

  1. Complex fibroadenoma
  2. Florid hyperplasia without atypia
  3. Sclerosing adenosis
  4. Solitary papilloma

Slightly increased risk (1.5 - 2.0)

31

Relative risk for invansive carcinoma for the following group: 

  1. Atypical ductal hyperplasia
  2. Atypical lobular hyperplasia

Moderately increased risk (4.0 - 5.0)

32

Relative risk for invansive carcinoma for the following group: 

  1. DCIS (ipsilateral breast)
  2. LCIS (both breasts)

Significantly increased risk (8.0-10.0)

33

List the stromal breast tumors:

  • Fibroadenoma
  • Phyllodes tumor
  • Sarcomas

34

What is the most common breast tumor in young adults?

Fibroadenoma

35

Fibroadenoma

  • Peak incidence: 
  • Clinical Presentation: 
  • Regression?

  • Peak incidence: 3rd decade
    • Less than 5% postmenopausal
  • Solitary, well-circumscribed, movable, painless nodule
    • Multiple - 15%
  • Regression during menopause

36

Phyllodes Tumor:

  • Gross appearance: 
  • Peak Incidence: 
  • Palpable? 
  • Aggressive?

  • Large, fibroepithelial tumor
    • Benign or malignant
  • Most in 5th, 6th decade
    • < 1% of breast tumors
    • Latin women 3 -4x increased incidence
  • Discrete palpable breast mass
  • Rapid growth

37

Phyllodes Tumor:

Benign features

  • Circumscribed
  • Not encapsulated
  • Gray-tan cut surface
  • Interlacing clefts
  • Cysts
  • Necrosis
  • Hemorrhage

38

What are microscopic findings of a benign phyllodes tumor?

  • Leaf-like or epithelium lined clefts, cysts
  • Increase in stromal cellularity
  • Stromal overgrowth

39

What are the malignant features of a phyllodes tumor?

  • Marked stromal cellularity
  • Increased mitoses
  • Low grade: 2-5 per 10 hpf
  • High grade: >5 per 10 hpf
  • Cellular pleomorphism
  • Infiltrating border
  • Necrosis

40

Prognosis of Phyllodes Tumor: 

  • Benign: 
  • Low grade: 
  • High grade: 

  • Benign phyllodes tumor
    • May recur
  • Low grade phyllodes tumor
    • May recur, rarely metastasize
  • High grade phyllodes tumors
    • Aggressive
    • Distant mets in 1/3 cases
    • Axillary node metastases