SFP: breast pathology II

Question 1

What is in-situ carcinoma of the breast?

Answer 1

Cancer confined to the ducts of the breast; basement membrane will be intact

Question 2

What are the in-situ carcinomas of the breast?

Answer 2

DCIS and LCIS

Question 3

What cells does in-situ carcinoma often arise from?

Answer 3

Cells of the terminal lobular unit

Question 4

What is the general morphology of LCIS?

Answer 4

Uniform cells with bland round nuclei

Question 5

What is the morphology of LCIS?

Answer 5

Expanded units often incidentally found. It is not mass forming and isn’t really associated with calcifications

Question 6

What is true of invasive cancer risk with LCIS?

Answer 6

Increased risk bilaterally!!

Question 7

What is true of the distribution of LCIS?

Answer 7

Often multifocal

Question 8

What is the histologic appearance of DCIS?

Answer 8

Varies a bunch! Differing architecture, possible necrosis, calcifications

Question 9

DCIS is associated with…

Answer 9

Calcifications

Question 10

What is the prognosis of DCIS?

Answer 10

Super good!

Question 11

Describe Paget’s disease of the nipple.

Answer 11

Extension of DCIS up lactiferous sinuses and ducts into the epithelial surface of the nipple

Question 12

What does Paget’s disease of the nipple look like?

Answer 12

Ulceration/eczema-like rash

Question 13

Describe invasive lobular carcinoma.

Answer 13

Single celled, single file infiltration through the stroma

Question 14

What causes the linear pattern seen in invasive lobular carcinoma?

Answer 14

Loss of the e-cadherin adhesion molecule causes single cells to squeeze themselves through fibrosis

Question 15

What are sites of metastasis for invasive lobular carcinoma?

Answer 15

CSF, serosa, GI, ovaries, bone marrow

Question 16

What are biomarker features of invasive lobular carcinoma?

Answer 16

ER+, Her2-

Question 17

What is the most common breast cancer?

Answer 17

Invasive ductal carcinoma

Question 18

What are subtypes of invasive ductal carcinoma?

Answer 18

Tubular carcinoma, medullary carcinoma, mucinous carcinoma

Question 19

Describe tubular carcinoma.

Answer 19

Usually well diff with little glands spread throughout the tissue that causes small irregular masses

Question 20

What are biomarker features of tubular carcinoma?

Answer 20

ER+, Her2-

Question 21

Describe mucinous carcinoma.

Answer 21

Lots of extracellular mucin

Question 22

What are biomarker features of mucinous carcinoma?

Answer 22

ER+, Her2-

Question 23

Describe medullary carcinoma.

Answer 23

Poor diff triple negative breast cancer with lots of T cell infiltration around the edges that presents as a well circumscribed mass

Question 24

What are biomarker features of medullary carcinoma?

Answer 24

Triple neg

Question 25

What gene mutation is often seen in medullary carcinoma?

Answer 25

BRCA1

Question 26

Describe metaplastic carcinoma.

Answer 26

A poor diff tumor with anaplastic growth commonly with squamous features. They may have heterologous like cartilage

Question 27

What are biomarker features of metaplastic carcinoma?

Answer 27

Triple neg

Question 28

What is inflammatory carcinoma?

Answer 28

A presentation of invasive carcinoma that presents with peau’ de orange over 1/3rd of the breast

Question 29

What causes peau d’orange?

Answer 29

Dermal lymphatic invasion aka blocking of lymphatics by tumor

Question 30

Describe angiosarcoma.

Answer 30

A cutaneous lesion made of malignant epithelial cells

Question 31

Who often gets angiosarcoma of the breast?

Answer 31

Older women secondary to radiation for breast carcinoma, often 20 years later

Question 32

What are BRCA 1 and 2?

Answer 32

Tumor suppressor genes; loss of heterozygosity may result in cancer

Question 33

BRCA mutation is associated with which cancer types?

Answer 33

Ovarian and breast

Question 34

Where does breast cancer typically metastasize to first?

Answer 34

Axillary lymph nodes

Question 35

Breast tumor pathology staging is based on…

Answer 35

Size

Question 36

Breast tumor clinical staging is based on…

Answer 36

Size, lymph nodes, metastasis

Question 37

TNBC and Her2+ tumors tend to metastasize to…

Answer 37

Brain and viscera

Question 38

ER+ tumors tend to metastasize to…

Answer 38

Bone