Malignant breast tumors

Question 1

Malignant breast tumors - epidemiology

Answer 1

1. commonly non-menopausal

2. african american

Question 2

Malignant breast tumors - usually arises from

Answer 2

terminal duct lobular unit

Question 3

Malignant breast tumors - genetics

Answer 3

overexpression of estrogen/progesterone receptors or c-erbB12 (HER-2, an EGF receptor) is common

Question 4

Malignant breast tumors - is more aggressive if

Answer 4

triple negative (ER-, PR-, Her2/Neu-)

Question 5

Malignant breast tumors - type affect

Answer 5

therapy and prognosis

Question 6

Axillary lymph node involvement indicates

Answer 6

metastasis –> the most important prognostic factor in early stage disease

Question 7

the most important prognostic factor in early stage disease

Answer 7

Axillary lymph node involvement

Question 8

Malignant breast tumors - most often located … (grossly)

Answer 8

upper-outer quadrant of breast

Question 9

Malignant breast tumors - risk factors

Answer 9

1. High estrogen exposure
2. increased total number of menstrual cycles
3. older age at 1st live birth
4. obesity M
5. BRCA1/2 mutation
6. African American (TRIPLE -)
7. Peutz-Jeghers syndrome

Question 10

malignant breast tumors - obesity is a risk factor - mechanism

Answer 10

high estrogen exposure as adipose tissue converts androstenedione to estrone

Question 11

Malignant breast tumors - are divided to

Answer 11

noninvasive and invasive

Question 12

Malignant breast tumors - noninvasive - types

Answer 12

1. Ductal carcinoma in situ (DCIS)
2. Comedocarcinoma (subtype of DCIS)
3. Paget disease (subtype of DCIS)
4. Lobular carcinoma in situ (LCIS)

Question 13

Ductal carcinoma in situ of breast - histology

Answer 13

• neoplastic cells fillls ductal lumen

- engorged blood vessels

Question 14

Ductal carcinoma in situ of breast - arises from

Answer 14

ductal atypia

Question 15

Ductal carcinoma in situ of breast - presentation

Answer 15

• often seen early as MICROCALCIFICATIONS in mammography

- usually does not produce mass

Question 16

breast comedocarcinoma

Answer 16

Ductal, central necrosis and dystrophic calcification (Subtype of DCIS)

Question 17

breast - Paget disease results from

Answer 17

Results from underlining DCIS or invasive breast cancer

Question 18

breast - Paget disease presentation

Answer 18

Eczematous patches on nipple

Question 19

breast - Paget disease - paget cells?

Answer 19

intraepithelial adenocarcinma cells

Question 20

Malignant breast tumors - invasive - types (and MC)

Answer 20

1. invasive ductal carcinoma (MC - 75% of all breast ca)
2. Invasive lobular carcinoma
3. Medullary carcinoma
4. Inflammatory breast cancer

Question 21

breast - invasive ductal carcinoma - frequency

Answer 21

MC (75%) of all breast invasive cancers

Question 22

breast - invasive ductal carcinoma - presentation

Answer 22

• firm, fibrous, rock hard mass with sharp margins (2cm or greater)
• advance: dippling of the skin or retraction of nipple

Question 23

breast - invasive ductal carcinoma - histology

Answer 23

small, glandular, duct-like cells (duct like structures) –> stellate infiltration

Question 24

Invasive lobular carcinoma - histology

Answer 24

orderly row of cells (INDIAN FILE)

Question 25

invasive lobular carcinoma - SPECIAL characteristic

Answer 25

downregulation of E-cadherin expression --> orderly row of cells (INDIAN FILE)

Question 26

Invasive lobular carcinoma - presentation

Answer 26

often bilateral with multiple lesions in the same location

Question 27

breast - Medullary carcinoma - histology

Answer 27

fleshy, cellular, lymphocytic infiltrate

Question 28

breast - Medullary carcinoma - gross appearance

Answer 28

well circumscribed mass mimicking fibroadenoma in mammography

Question 29

breast - Inflammatory breast cancer

Answer 29

Dermal lymphatic invasion by breast carcinoma --> they block lymphatic drainage

Question 30

breast - Inflammatory breast cancer presentation

Answer 30

Peau d'orange: breast skin resembles orange peel

Question 31

breast - Inflammatory breast cancer - often mistaken with

Answer 31

mastitis or Paget disease

Question 32

breast - Inflammatory breast cancer vs medullary according to prognosis

Answer 32

medullary --> good | Inflammatory breast cancer --> poor (50% surv at 5 yrs)

Question 33

Lobular carcinoma in situ?

Answer 33

- malignant proliferation of lobular cells without invasion - no mass or calcification - low e-cadherin - often multifocal or bilateral

Question 34

situations with calcification in mammography

Answer 34

1. Ductal in situ and invasive 2. sclerosing adenosis 3. fat necrosis