L 77, 78 - Breast Path and Breast Cancer Flashcards

1
Q

what is the functional unit of the breast

A

Terminal Duct Lobules -

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2
Q

path of milk through the breast during lactation

how do you differentiate between lobules and ducts on histology

A

Acini –> Terminal Ducts – > subsegmental duct –> Lactiferous ducts –> Nipple

Lobules – small and numerous

Ducts – larger tube through which milk collects after generation in the lobules. Seen as larger diameter circles or tube cut longitudinally

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3
Q

______-lobular stroma is hormone responsive; therefore explaining what symptoms?

A

□ Intralobular – responsive to hormones which explains breast tenderness in response to porgesterone

Interlobular stroma is not hormone responsive

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4
Q

what are two cell layers of ducts and acinin

A

Epithelial (luminal) Layer + Myoepithelial layer (outer layer, squeezing function during milk ejection)

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5
Q

Patient presents to clinic with complaints of breast pain; what is likelihood this is a cancer?

what should you ask to differentiate between breast pain etiologies?

A

Very few cancers present as breast pain (5%); likelihood increases if there is a mass (10%)

Ask if pain is cyclical vs non cyclical with menstruation

If cyclical: non pathologic
If non cyclical: no pathology; may be ruptured cyst

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6
Q

____% of patients presenting with palpable mass have cancer

True/false: younger women are more at risk for malignancy

A

10-35%

False: likelihood of malignancy increases with age

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7
Q

Patient presents with galactorrhea; what is your ddx? what are odds its malignant

what if the discharge is serous/bloody?

A

Not associated with malignancy
Usually from prolactinoma, anovulatory syndromes or side effects of TCA, OCP, Methyldopa

serous/bloody– usually benign papilloma or cyst; but risk of malig does increase with age.

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8
Q

Most common bug associated with acute lactation mastitis;

other physical signs

A

S. Aureus

Signs: cracks and fissures along the nipple; route of entry

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9
Q

Fat Necrosis – usually associated with _____

what is seen on mammography?

A

a/w trauma

usually see calcifications/densities which are mistaken for malignancies

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10
Q

Patient presents with painful recurrent sub areolar masses

what is it?
what’s seen on histo?
#1 risk factor?

A

Periductal Mastitis: recurrent subareolar abscess +squamous metaplasia

Histo: Squamous metaplasia and keratinization of nipple ducts

90% of pts are smokers

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11
Q

patient presents with periareolar mass and skin retraction + thick white/green/brown nipple secretions

dx?

is this patient a smoker or non smoker?

A

Mammary Duct Ectasia:

Non smoker

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12
Q

what is the most common benign breast tumor??

what age group is susceptible?

abnormal growth of what cell type?

A

Fibroadenoma

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13
Q

Phyllodes Tumor

characteristic cytology architecture?

is this malignant?

abnormal growth of what cell type?

A

“leaf-like architecture”

low grade malignancy that doesn’t metastasize, but recur locally

Intralobular stroma – therefore responsive to hormones

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14
Q

Patient presents with mass;
gross path is a “blue domed” lesion with apocrine histology

dx

what is the course?

A

Blue dome = cyst
Apocrine changes = fibrocystic

Entirely benign and very common

Fibrosis may be from ruptured cysts;

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15
Q

4 forms of proliferative breast disease without atypia

what is the relative risk of cancer ?
what is the absolute risk?

A

Epithelial Hyperplasia - mild, moderate, severe
Sclerosis Adenosis
Intraductal Papilloma
Gynocomastia

AR: 5-7%
RR: 1.5-2x (for moderate and severe hyperplasia, adenosis, and intraductal papilloma)

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16
Q

Epithelial Hyperplasia

what is seen on histo?
what grades have increased RR

A

Histo: increased proliferation of epithelial cells (luminal and myoepi)

Only moderate and severe
forms have increased RR

Lumen fills with heterogenous, mixed population of luminal and myoepithelial cells

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17
Q

IntraDuctal Papilloma

differences in presentation beween young vs older women?

A

Older women: subareolar, solitary; “large duct papilloma”

younger women: peripheral, multiple;

18
Q

what drugs or conditions may cause gynocomastia?

A

Gynocomastia

Cirrhosis, Testicular Tumor, Klinefelters, Puberty, Old ag

Spironolactone, Digoxine, Cimetidinbe, Alcohol, Ketoconazole (Some drugs create awesome knockers)

19
Q

2 types of proliferative breast disease with atypia?

what is the relative risk?
what is the absoute risk?
is this for the ipsilateral breast, conralateral or both ?

A

Atypical Ductal Hyperplasia

Atypical Lobular Hyperplasia –

RR: 4-5x
AR: 13-17% of having BC over the next 15 years
Both Breasts

20
Q

Atypical Lobular Hyperplasia —

what is the associated mutation ?

A

E Cadherin mutation

21
Q

what is the term for breast cancer which is contained to the epithelial layer?

which is much more common

A

DCIS – much more common

LCIS – not even in FIRST AID

22
Q

what are the two forms subtypes of DCIS

A

Comedocarcinoma (Comedo DCIS)

Paget’s Disease of the Nipple

23
Q

DCIS – what is the RR and AR? is this for the ipsilateral, contralateral or both breasts?

T/F: DCIS is a direct precursor of invasive breast cancer

T/F: majority is found bilaterally

A

RR: 8-10x
AR: 25-30% of BC if 15 years
Breasts at risk: Ipsilateral only

True: DCIS is the direct precursor

False: DCIS in found bilaterally in only 10-20% of cases

24
Q

what s comedocarcinoma –

characteristic path?

A

High grade DCIS which is more likely to progress.

area has central necrosis

25
Q

what is paget’s disease of the nipple?
clinical appearance?
characterisitc pathology?

A

DCIS extends into the lactiferous ducts and extends into the nipple epidermis

Clinical: Eczematous/crusting patches on the nipple

Histo: Paget’s Cells – large cells in epidermis with clear halo (abundant pale cytoplasm)

26
Q

Mutlifocal and bilateral lesions found on mammography – bx reveals carcinoma contained to the epithelium. what is the dx?

A

LCIS === MULTIFOCAL AND BILATERAL

27
Q

LCIS –
AR, RR
is this for the ipsilateral, contralateral or both breasts?’

T/F: LCIS is a direct precursor to invasive carcinoma?

associated mutation

T/F — if DCIS does becomes invasive, it will always be invasive ductal carcinoma?

A

RR: 8-10x
AR: 25-30% of BC if 15 years
BOTH BREASTS

NOT A PRECURSOR, but A MAKER OF INCREASED RISK BILATERALLY of INVASIVE CARCINOMA

Mutation: E Cadherin

False – if a DCIS has bi-allelic mutations to E cadherin, it will become invasive lobular carcinoma

28
Q

what is the most common form of Invasive breast cancer?

Is this usually bilateral or unilateral?

A

Invasive Ductal Carcinoma – 80-85% of all breast cancers

Unilateral –

29
Q

how does an invasive ductal carcinoma appear clinicaly?

Radiographically?
Gross path?
histologically?

A

Clinically – “rock hard mass”

Radiograph – spiculated mass

Gross: firm, fibrotic center

histo: fibrotic center; ducts and lobules invading surrounding breast tissue; lots of desmoplasia;

30
Q

Pathognomonic histology for invasive lobular carcinoma

how does lobular invasive present?

what is the prognosis comapred to DCIS?

A

“Indian File” – orderly row of cells due to loss of E cadherin expression

BILATERAL AND MULTIFOCAL

Prognosis: same as DCIS

31
Q

three other forms of invasive breast cancer that have favorable prognosis… what age groups are most likely to get each?

A

Medullary carcinoma – usually in younger patients

Colloid (mucinous carcinoma) – old lady

Tubular carcinoma – most favorable prognosis

32
Q

two invasive carcinoma forms that have poor prognosis ?

A

Invasive Micropapillary Carcinoma

Metaplastic Carcinoma

33
Q

what is Inflammatory breast carcinoma and what are the characteristic findings?

A

Dermal lymphatic invasion by breast carcinoma
neoplasitc cells block lymphatic drainage

Skin erythema + Peau d’ orange (orange peel skin)

34
Q

what are important ancillary tests run on breast cancer findings; what is their signifiance ?

what is the marker for proliferation?

A

Hormone Receptor IHC:
Positive findings = Positive Prognostic and Positive Predictive findings

Her2/Neu (C-erb-2): weakly unfavorably prognostic, but positive predictive (Trastuzumab)

Ki-67: Marker for proliferation rate

35
Q

Luminal A invasive breast cancer:

postive/negative for what anxcillary tests:

A
ER+/PR+/HER2- 
Proliferative low (low Ki-67) 
Low histological grade 
Older men and women
Long survival
36
Q

Luminal B invasive breast cancer:

A

ER+/PR+/HER2-
Medium to high prolifeation (more Ki-67)
Some associated with BRCA2
Behavior: Intermediate

37
Q

HER2+ invasive carcinoma

A

May be PR or ER +
Who: young, non white women with P53 mutations
Respond to herceptin

38
Q

Triple Negative –

A

ER-/PR-/HER2 -
Extremely High proliferation
Who; young AA and Hispanic women; BRCA1
Prognosis – Dramatic response to chemo; quickly relapse
If BRCA positive – bilateral mastectomy

39
Q

Luminal A invasive breast cancer:
whats the ancillary test profile?
prognosis ?

A
ER+/PR+/HER2- 
Proliferative low (low Ki-67) 
Low histological grade 
Older men and women
Long survival
40
Q

Luminal B invasive breast cancer:
whats the ancillary test profile?
prognosis?

A

ER+/PR+/HER2-
Medium to high prolifeation (more Ki-67)
Some associated with BRCA2
Behavior: Intermediate

41
Q

HER2+ invasive carcinoma
whats the ancillary test profile?
Prognosis?

A

May be PR or ER +
Who: young, non white women with P53 mutations
Respond to herceptin

42
Q

Triple Negative –
whats the ancillary test profile
Prognosis?

A

ER-/PR-/HER2 -
Extremely High proliferation
Who; young AA and Hispanic women; BRCA1
Prognosis – Dramatic response to chemo; quickly relapse
If BRCA positive – bilateral mastectomy