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Flashcards in Pathology 2 Deck (36):
1

whats the difference between a fibroadenoma and a malignant phyllodes tumour

the stromal cmpocant in phyllodes is neoplastic

2

when does an angiosarcoma occur

usually post radiotherapy for breast cancer

3

where do lymphomas occur

breast and or lymph nodes

4

what are some of the commonest tumours that metastasis to the breasts

carcinoma - bronchial, ovarial serous, clear cell of the kidney
malignant melanoma
soft tissue tumours such as leimyosarcoma of the myometrium

5

what does breast carcinoma mean

malignant tumour of the breast epithelial cells

6

where does breast carcinoma arise and what is it

glandular epithelium of the terminal duct lobular unit (TDLU)
it is an adenocarcinoma but called a breast carcinoma

7

ductal precursor lesions and the stages to cancer

epithelial hyperplasia of the usual type - benign process
columnar cell change - calcifies
atypical ductal hyperplasia - some pre malignant potential
ductal in situ carcinoma

8

lobular precursor

atypical lobular hyperplasia leading to lobular in situ carcinoma

9

in situ carcinoma is confined within what
cytology
does it always become invasive
classification

basement membrane or acini and ducts

cytologically malignant but non invasive

doesn't always progress and become invasive but it can

lobular or ductal

10

two types of lobular in situ

atypical lobular hyperplasia <50% of lobule involved
lobular carcinoma in situ >50% of lobule involved

11

intra lobular proliferation of characteristic cells

small intermediate sized nuclei
solid proliferation
intra cytoplasmic lumens/vacules
ER positive
E catherine negative - CDH1 gene deleted/mutated

12

what does the CDH1 gene do

cell adhesion gene which is in the cell membrane and holds everything together

13

features of lobular in city neoplasia

frequently multifocal and bilateral
incidence decreases after menopause
not palpable but visibly gross
may calcify
incidental finding usually

14

management of lobular in situ neo[plasia

LN on core biopsy - proceed to excision or vacuum biopsy
LN on vacuum or excision biopsy - follow up

15

intraductal columnar change

slightly dilated
regular columnar cells
in picket fence arrangement
often calcifies

16

intraductal atypical ductal hyperplasia

partial ductal involvement has some features of DCIS

17

DCIS

filled with neoplastic cells and has calcification

18

features of DCIS

arises in TDLU
characteristically unicentric (single duct system)

19

DCIS cytology
where
may involve what

malignant epithelial cells
confined within the BM of the duct
may involve tubules (cancerisation) and nipple skin (pagets)

20

what is pagets

high grade DCIS extending along ducts to reach the epidermis of the nipple
still in situ - non invasive

21

classification types of DCIS

cytological grade
histological grade
presence of necrosis (comedy) - nearly always in high grade DCIS

22

what is micro invasive carcinoma

rare
DCIS high grade with invasion of <1mm
treat as high grade DCIS

23

management of DCIS

diagnosis
surgery
radio
chemo

24

invasive carcinoma is what

malignant epithelial cells which have breached the BM
infiltration of normal tissue r
risk of mets and death

25

risk factors for breast carcinoma (invasive)

age
young age of menarche
few children ]
not breastfeeding
late menopause
hormones - OCP, HRT
previous breast disease
geography
diet, alcohol, smoking
genetics

26

what do NSAIDS do to the risk for breast carcinoma

lower risk

27

BRCA1
BRCA2
TP53
PTEN
STK11/LKB1
ATM

breast/ovarian
breast/ovarian
Li frarumeni syndrome
cow dens
peutz-jeghers
ataxia telengectasia

28

invasion of breast carcinoma local
lymph
blood

loca - stroma of breast, skin, muscles of chest wall
lymph - regional training LNs
blood - bone, liver, brain, lungs, abd viscera, female genital tract

29

histopathology of breast carcinoma from commonest to not so

ductal
lobular
mucinous
medullary
tubular
cribriform
papillary
mixed

30

well differentiated
poorly differentiated

very similar to the parent tissue - low grade - good prognosis

very different - high grade - poor prognosis

31

grading of breast carcinoma

tubular differentiation
nuclear pleomorphism
mitotic activity

32

tumour staging

direct invasion of adjacent tissues - t0-t4
lymphatic spread - N0-N3
blood borne M0-M1

33

predictive and prognostic factors for invasive carcinoma

ER (oestrogen receptor)
HER 2

34

what does ER do

ER expression predicts response to anti oestrogen therapy such as oophorectomy, tamoxifen, aromatase inhibitors, GnRH antagonists

35

HER 2

human epidermal growth factor receptor 2
HER2 over expression and amplification seen in approx 15% - predicts respond to trastuzameb

36

prognostic indices

nottington
adjuvant online
PREDICT