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Reproductive - Breast > Malignant Pathology > Flashcards

Malignant Pathology Flashcards

1
Q

What type of tumour is a malignant Phyllodes tumour?

A

Sarcoma

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2
Q

What is the commonest sarcoma of the breast? What is usually the cause for this?

A

Angiosarcoma, usually resulting from radiotherapy

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3
Q

Apart from sarcoma and carcinoma, which other type of malignant tumour can affect the breasts and/or lymph nodes?

A

Lymphoma

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4
Q

Which types of tumour are most likely to metastasise to the breast?

A

Bronchial, ovarian serous and kidney clear cell carcinomas, malignant melanomas and leiomyosarcomas (e.g. uterine)

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5
Q

What is the definition of a breast carcinoma?

A

A malignant tumour of breast epithelial cells

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6
Q

Where do all breast carcinomas arise?

A

In the glandular epithelium of the TDLU

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7
Q

What specific type of carcinoma is seen in the breast?

A

Adenocarcinoma

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8
Q

What are the 4 ductal precursor lesions?

A

Epithelial hyperplasia of usual type, columnar cell change, atypical ductal hyperplasia, DCIS

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9
Q

What is the name used to describe lobular precursor lesions? What are its two subtypes?

A

Lobular in-situ neoplasia: atypical lobular hyperplasia and lobular carcinoma in situ

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10
Q

In situ carcinoma in the breast is confined within where?

A

The basement membrane of acini and ducts

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11
Q

Do in-situ carcinomas of the breast always become invasive?

A

No, not all

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12
Q

How is lobar in-situ neoplasia usually found?

A

Usually an incidental finding in breast tissue removed for fibrocystic change

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13
Q

What is the difference between atypical lobular hyperplasia and lobular carcinoma in situ?

A

ALH = < 50% of the lobule is involved, LCIS = > 50% of the lobule is involved

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14
Q

What happens to the incidence of lobar in situ neoplasia after the menopause? Why is this?

A

Incidence decreases due to less oestrogen acting on the ER receptors

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15
Q

Is lobar in-situ neoplasia palpable? Is it visible grossly?

A

No and no

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16
Q

Lobar in-situ neoplasia is often picked up on mammography - what will it show?

A

Calcifications

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17
Q

What is seen in 15-20% of open diagnostic biopsies for lobar in-situ neoplasia compared to core biopsy?

A

A higher grade lesion

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18
Q

Having lobar in-situ neoplasia gives a how many times increased risk of subsequent invasive carcinoma?

A

8

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19
Q

What is the management if lobar in-situ neoplasia is discovered on core biospy?

A

Proceed to excision or vacuum biopsy to exclude a higher grade lesion

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20
Q

What is the management if lobar in-situ neoplasia is discovered on vacuum or excision biopsy?

A

Follow up - mammography more frequently than standard screening

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21
Q

Intra-ductal proliferation can develop from which benign condition?

A

Fibrocystic change

22
Q

By how much do each of the following increase the risk of breast cancer? A) Epithelial hyperplasia of usual type B) Atypical ductal hyperplasia C) DCIS

A

A) 2x B) 4x C) 10x

23
Q

Atypical ductal hyperplasia goes on to become what?

A

DCIS

24
Q

DCIS goes on to become what?

A

Invasive ductal carcinoma

25
Q

DCIS is characteristically unicentric - what does this mean?

A

It only affects a single duct system

26
Q

How does DCIS usually present?

A

Often asymptomatic and picked up on screening as calcification

27
Q

What is DCIS involving the nipple known as?

A

Paget’s disease of the nipple

28
Q

What is Paget’s disease of the nipple?

A

High grade DCIS which extends along the ducts to reach the epidermis of the nipple

29
Q

Is Paget’s disease of the nipple carcinoma in situ or invasive carcinoma?

A

Carcinoma in situ

30
Q

How does Paget’s disease of the nipple usually present?

A

Dry, red skin around the nipple and nipple discharge

31
Q

How likely is it that DCIS will become invasive carcinoma?

A

75%

32
Q

How is DCIS managed?

A

Diagnosis, excision with clear margins and adjuvant radiotherapy

33
Q

What is microinvasive carcinoma?

A

Rare, high grade DCIS with invasion of < 1mm

34
Q

When is invasive breast carcinoma said to have occurred?

A

When malignant epithelial cells breach the basement membrane

35
Q

80% of breast carcinomas are positive for which hormone receptor?

A

ER receptor

36
Q

What is the relationship between ER+ breast cancers and survival? Why?

A

ER+ breast cancers have a better survival rate because they have better response to anti-oestrogen therapy

37
Q

67% of breast carcinomas are positive for which hormone receptor?

A

PgR

38
Q

What is the relationship between PgR+ breast cancers and survival?

A

PgR+ breast cancers have a better survival rate

39
Q

14% of breast carcinomas are positive for which receptor?

A

HER2

40
Q

What is the relationship between HER2+ breast cancers and survival?

A

HER2+ breast cancers have a worse survival rate

41
Q

HER2 overexpression and amplification predicts the response to which treatment?

A

Herceptin (traztusamab)

42
Q

In terms of hormone receptors, name the groups which convey the best - worst prognosis?

A

1) ER+, PgR+, HER2 -
2) ER+, PgR-, HER2-
3) HER2+
4) Triple negative

43
Q

Why is triple negative breast cancer so bad?

A

It won’t respond to any hormonal treatments and will require chemotherapy

44
Q

What is the most common type of invasive breast carcinoma?

A

Ductal (NST)

45
Q

What type makes up 10-15% of invasive breast carcinomas, with various subtypes existing?

A

Lobular carcinoma

46
Q

Which type of invasive breast carcinoma represents around 2% of cases and is often detected on mammography as a spiculate mass?

A

Tubular carcinoma

47
Q

Breast carcinomas can spread by direct infiltration to where?

A

Skin, skeletal muscle and chest wall

48
Q

Breast carcinomas can spread via lymphatics to where?

A

Axillary and mammary nodes

49
Q

Breast carcinomas can spread haematogenously, most commonly to where?

A

Bone, lungs and liver

50
Q

Malignant calcifications found on imaging will often be described as what?

A

Pleomorphic and casting

Reproductive - Breast (10 decks)

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