Mammary Gland Tumors Flashcards by Aimee Soileau

***What dog breed has been shown to have decreased risk of mammary gland tumor development, although conflicting?

Boxer

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***Germline polymorphisms in both BRCA1 and BRCA2 were associated with significantly increased risk of mammary tumor development in what dog breed?

English springer spaniel

also shih-tzu

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***What hormone has direct genotoxic effects on mammary tissue by increasing mutations?

estrogen

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A prospective randomized trial on the effect of OHE in dogs with mammary carcinoma found a threshold positive staining of both ER and PRs to be an Allred score of > _____.

3.79

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HER2/erb2 overexpression in canine malignant tumors ranges from ___-___%.

17-48%

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_______ overexpression in canine mammary tumors was associated with negative histologic features and short survival times in one study (although conflicting results).

HER2/erb2

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The threshold for positive HER2 staining in canine mammary tumors is > ___% of cells with complete membrane staining.

> 30%

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***Describe the IHC subtypes in humans.

Luminal A: High HR, HER2-, low Ki67 (best prognosis)
Luminal B: Low HR, HER2+/-
HER-2 overexpressing HR-, HER2+
Triple negative: HR-, HER2-
4a. Basal like triple negative: triple negative tumors with expression of basal markers (worst prognosis)
4b. Normal-like: triple negative tumors negative to all markers and shows adipose tissue signature
4c. Claudin-low: triple negative or HR with low expression of claudin but high expression of vimentin (worst prognosis)

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In one study in dogs, IHC subtype of mammary tumors was prognostic. ______ tumors had a shorter DFI and OST.

Basal-like tumors

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***A study of CT indirect lymphography found imaging characteristics of sentinel LNs positive for histologic mammary tumor metastasis in dogs: ______________.

decreased or heterogeneous LN contrast enhancement

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***What is the sensitivity and specificity of mammary gland mass cytology? _____-___% correlate with ex vivo histology.

Se: 88%
Sp: 96%
~70-90%

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Describe the modified staging system currently used for epithelial mammary tumors in dogs.

Stage 1: T <3cm
Stage 2: T: 3-5cm
Stage 3: T >5cm
Stage 4: nodal met
Stage 5: distant met

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***______ mammary neoplasm is composed of one cell type either the luminal epithelial cells or myoepithelial cells.

Simple

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***_____ mammary neoplasm is composed of 2 cell types, both luminal and myoepithelial cells.

complex

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_______ disease is when a carcinoma is present within the mammary gland and carcinoma cells are present within the epidermis of the nipple.

Paget-like disease

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***Describe the grading scheme for mammary carcinoma in dogs and cats (Excluding the new grading scheme in cats).

Tubule formation:
- 1 point: >75% tubules
- 2 points: 10-75% tubules
- 3 points: <10% tubules

Nuclear pleomorphism:
- 1 point: very mild
- 2 point: moderate
- 3 points: marked

Mitoses/10hpf dog
- 1 point: 1-9
- 2 points: 10-19
- 3 points: >19

Mitoses/10hpf cat
- 1 point: 1-8
- 2 points: 9-17
- 3 points: >17

Score:
- grade 1: 3-5
- grade 2: 6-7
- grade 3: 8-9

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***Describe the new grading scheme for mammary gland tumors in cats.

Lymphovascular invasion:
- 1 point: present
- 0 point: absent

Mitoses/10HPF
- 1 point: >62
- 0 point: </= 62

Nuclear form:
- 1 point: >5% abnormal
- 0 point: </=5% abnormal

Score:
- Grade 1: 0
- Grade 2: 1
- Grade 3: 2 or 3

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***What is the MST for the following mammary gland subtypes in dogs: adenosquamous, comedocarcinoma, solid carcinoma, anaplastic carcinoma.

MST:
- adenosquamous: 18mo
- comedocarcinoma: 14mo
- solid carcinoma: 8mo
- anaplastic carcinoma: 3mo

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**______ and ____ subtypes are associated with prolonged survival in dogs.

simple tubular carcinoma
complex tubular carcinoma

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Which subtypes are associated with a 10-fold higher risk of tumor related death in dogs?

simple tubulopapillary carcinoma
intraductal papillary carcinoma
malignant myoepithelioma

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***What are the most consistently reported clinical prognostic factors for dogs with malignant mammary tumors?

tumor size
LN involvement
WHO stage

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What tumor sizes have been associated with worse outcome in dogs?

one study: >40cc (>3.4cm)
other studies: >3cm
other studies: >5cm

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***In a retrospective case series of 79 dogs evaluating chain mastectomy or simple mastectomy, no difference in outcome was found. However, the relative hazard of death within ________ after surgery was slightly higher for dogs receiving regional mastectomy.

the first 2 years

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***In a case series of 99 intact female dogs undergoing either regional or chain mastectomy for a single tumor with unknown histology, new tumors in the remaining ipsilateral gland developed in ___% of dogs after regional mastectomy. Authors advocated for ____________.

Study These Flashcards

58%
initial unilateral chain mastectomy for intact dogs with a single tumor

***Post-operative complications following radical mastectomy in dogs is ___%.

77%

Development of second mammary tumors in dogs after a lumpectomy is reported to occur in > ___%.

>70%

***In intact dogs with BENIGN tumors, concurrent OHE significantly reduces the risk of further tumor development by almost ___%.

50%

***A prospective randomized clinical trial of 60 intact dogs with MALIGNANT tumors, which subset of dogs benefited from OHE?

- Those with grade 2 ER+ tumors - Those with increased peri-surgical serum E2 concentration

A wide surgical excision of ____ cm for the lateral margin is recommended for dogs who present with a single mammary tumor of known or unknown histology.

2cm

_____ mastectomy is recommended for mammary tumors in dogs that are fixed or have skin ulceration and are <1cm in diameter.

local

For incompletely excised mammary tumors in dogs, additional surgery is recommended. Two retrospective studies reported a MST of ____-____ for those with incomplete excision vs. _____-_____ for those with complete excision.

MST: - incomplete: 2-16mo - complete: 23-29mo

Adjuvant chemotherapy in dogs with malignant mammary tumors is recommended with high risk tumors: _______, _____, and ________

- large tumors (>3cm) - postive LNs - aggressive histology

_____ is an ER antagonist that may not be tolerable or feasible in dogs due to pro-estrogenic signs.

tamoxifen

_______ and _______ cause suppression of estrogen synthesis.

- aromatase inhibitors - LH-releasing hormone agonist

A randomized study documented improvements in DFI in a subset of dogs with malignant mammary tumors randomized to receive _________, a progesterone receptor antagonist.

aglepristone

Name systemic medical therapy options that have reported benefit in dogs with malignant mammary tumors.

- Perioperative desmopressin - NSAIDs - Aglepristone - DOX or cisplatin for extraskeletal OSA - carboplatin - Cyclophosphamide + 5-FU

The main risk factors for mammary tumor development in cats are _____, _____, and _____.

age, breed, hormonal influence (same as dogs)

What cat breed is over-represented for mammary tumors and is typically younger at diagnosis.

Siamese

Sexually intact cats have a ____ - fold higher risk than spayed cats for mammary tumor development.

7-fold

Exogenous progestins in cats have a higher risk in development of ____ mammary tumors

benign

________ is the most common histologic change in cats treated with exogenous progestins for shorter periods of time and can occur relatively quickly - after 1 injection.

fibroepithelial hyperplasia

_____ expression tends to be HIGHER in cats than in dogs and humans with mammary tumors.

HER-2

Describe the staging system for cats with malignant mammary tumors.

- Stage 1: T <2cm - Stage 2: T 2-3cm - Stage 3: T >3cm and/or LN met - Stage 4: Distant metastasis

What are the most common subtypes of mammary malignant tumors in cats?

- simple tubular carcinoma - simple tubulopapillary carcinoma - Solid carcinoma

Using the new and old grading systems for malignant mammary carcinomas in cats, what are the reported respective MSTs?

Grade 1: - MST old: 36mo - MST new: 31mo Grade 2: - MST old: 18mo - MST new: 14mo Grade #: - MST old: 6mo - MST new: 8mo

____ is the most consistently reported clinical prognostic factor in cats with malignant mammary tumors.

tumor size

What is the MSTs based on tumor size (<8cm3 or <2cm vs. 8-27cm3 or 2-3cm vs. >27cm3 or >3cm) in cats with malignant mammary tumors treated with surgery alone?

<8cm3 or <2cm - MST: >3 years 8cm-27cm3 or 2-3cm - MST: 2 years >27cm3 or >3cm - MST: 6mo

A retrospective study of 93 cats with malignant mammary tumors found that all cats with LN metastasis died within ______ of diagnosis. In another retrospective study of 107 cats treated with either unilateral or bilateral mastectomy for mammary adenocarcinomas found that _____ of cats with evidence of LN metastasis did NOT progress to additional metastasis.

1st study: - all cats died within 9 months 2nd study: - 33% did NOT progress

A multi-institutional retrospective case series of 107 cats having either unilateral or bilateral mastectomies reported a longer PFS for cats with bilateral surgery of ____ compared to cats with unilateral of _______. Disease-specific survival time was improved for cats treated with _____________.

PFS: - Bilateral: 18mo - Unilateral: 10mo - both surgery and chemotherapy

***In a multi-institutional retrospective study comparing cats treated with surgery and adjuvant DOX to surgery alone, cats having unilateral surgery followed by DOX had longer MST of ____ compared to cats having a unilateral surgery alone at _____. Local recurrence was reported in ___%.

MST: - Uni + DOX: 5.5 years - Uni alone: 14mo LR: 50%

Objective responses following combination of DOX and cytoxan for macroscopic primary and/or metastatic disease in cats with malignant mammary tumors are ___-___%.

40-50%

A retrospective study evaluating the outcome of 23 cats with mammary tumors that were treated with surgery, chemotherapy with doxorubicin, and meloxicam was published. What was the DFI and MST in this study?

- DFI: 9mo - MST: 15mo

A retrospective study evaluated the impact of toceranib, piroxicam, and thalidomide with or without hypofractionated radiation therapy in dogs with inflammatory mammary carcinoma. The overall TTP was ____ and MST was ____. Medical therapy alone resulted in an ORR of ___%, clinical benefit of ___%, TTP of ____, and MST of ____. Medical therapy and hypofractionated RT resulted in an ORR and clinical benefit of ____% and a significantly improved TTP of ______ and MST of _______.

- oTTP: 1mo - oMST: 4mo Medical therapy: - ORR: 21% - CB: 64% - TTP: 1mo - MST: 4mo Medical therapy + hRT: - ORR and CB: 100% - TTP: 5mo - MST: 6mo

A recent retrospective study compared the efficacy of a COX-2 inhibitor combined with Palladia and metronomic cyclophosphamide to COX-2 inhibitor alone in 16 dogs with inflammatory mammary carcinoma and reported a significantly improved ST in multi-drug therapy of ______ compared to NSAID alone at _____. MST was also improved with surgery (______ vs. _____). The clinical benefit of multidrug therapy was ____% compared to _____ for NSAID alone.

MST: - Multi-drug: 3mo - NSAID alone: 1mo - sx: 3mo - no sx: 1mo Clinical benefit: - Multi-drug: 100% - NSAID alone: 33%

***The refined flexible scoring system (bio-scoring) for canine mammary gland carcinoma evaluates ____, ____, ____, and ______ and was found to be superior to the multivariate scoring (MVS). What was the metastasis survival for dogs with a RFS score of 0, 1, 2, 3, 4 and 5?

- size, grade, LN status, and histologic subtype Metastasis-free survival: - RFS 0, 1, 2: not reached - RFS 3: 12mo - RFS 4: 14mo - RFS 5: 5mo

A recent retrospective study evaluated factors influencing complications following mastectomy in 140 dogs with mammary gland tumors. The complication rate was ___%. ______, _____, and ______ were associated with increased odds of complications. Dogs undergoing chain mastectomy that did not receive ______ had the highest odds of complications.

- comp rate: 17% - High BW, bilateral mastectomy, post-op abx - abx post-op

A recent retrospective study evaluating outcome of 73 cats with metastatic stage IV mammary cancer reported an overall TTP of ____ and TSS of _____. _______ and _______ lowered TSS. TSS did NOT differ between treatment groups (MTD chemo, metronomic chemo vs. Palladia).

- oTTP: <1mo - oTSS: 2mo - clinical signs and pleural effusion

A recent retrospective study in 137 cats with mammary carcinoma who underwent radical mastectomy compared adjuvant doxorubicin vs. metronomic cyclophosphamide and meloxicam vs. surgery alone. DFI and MST were NOT significantly different between groups, suggesting adjuvant chemotherapy did NOT improve survival in this study. The DFI for cats treated with surgery alone was ____, ____ with adjuvant DOX, and ____ with adjuvant metronomic chemo. The MST for cats with surgery alone was _____, _____ with adjuvant DOX, and _____ with adjuvant metronomic chemo.

DFI: - Sx alone: 9mo - Sx + DOX: 8mo - Sx+ MC: 12mo MST: - sx alone: 11mo - sx + DOX: 14mo - sx + MC: 14mo

Mammary Gland Tumors Flashcards

(58 cards)