The Holy Organs Flashcards

Question

Reporting Features for DCIS

Answer 1

Size of DCIS / In situ component Nuclear grade Architecture Presence of necrosis (and calcifications) Margins

Answer 2

Assessing invasive carcinoma cells Number of cells staining, intensity of staining and whether or not it is complete membranous Usually assessed on core biopsies (better fixation) but repeat if negative on resection specimen as can be heterogenous 0 = No staining or weak membranous staining in \<10% 1+ = Faint / barely perceptible membranous staining in \>10% 2+ = Weak to moderate complete membranous staining in \>10% #+ Complete, strong membranous staining in \>10%

Answer 3

Complicated - ideally use CISH or FISH dual fusion probe to compare ratio of number of HER2 gene loci to number of CEP17 (CEP17 = centromere chromosome 17, needed to quantify # of chromosomes present in each cell given aneuploidy is common) _Positive:_ **Single probe** average HER2 copy number ≥ 6.0 signals/cell **Dual probe** HER2/CEP17 ratio ≥ 2.0 with any average HER2 copy number **or** HER2/CEP17 \< 2.0 with an average HER2 copy number ≥ 6.0 signals / cell

Answer 4

**_TUMOUR (pT)_** Specimen type and laterality Tumour focality Tumour size (invasive and in situ) (Size cutoffs 5, 10, 20 and 50mm) Histologic Type Histologic Grade (Nottingham score) Involvement of skin (epidermis, dermis, dermal lymphovascular spaces) Involvement of skeletal muscle DCIS (size, grade, architecture, necrosis) LVI and PNI Post neoadjuvant treatment effect (tumour and lymph nodes) Margins: invasive and in situ _Biomarkers:_ ER / PR / HER2 **_NODES (pN)_** Sentinel versus non-sentinel _Sentinel nodes_: Number involved, ITC, micro or macrometastases _Non sentinel:_ Number involved, size of largest deposit and ENE **_METASTASES (pM)_** Non regional lymph nodes, lung, liver, bone, brain

Answer 5

_Loss of tumour_ may occur due to concentric shrinking of the tumour or as scattered loss / drop out of tumour cells _Tumour is replaced by_ loose fibrous tissue containing a variable infiltration of histiocytes, lymphocytes, giant cells, hemosiderin and vascular proliferation _Similar changes are seen in lymph nodes_ _Changes in normal breast tissue_ may include lobular atrophy, lobular cellular atypia and fibrous stromal involution **_Classification Systems_** _Residual Cancer Burden (RCB 0 - IV)_ - calculator on MD Anderson site - submit entire maximum cross sectional area of tumour bed, and calculate % of tumour bed that contains residual cancer and % that is residual in situ. - includes number of positive LN's, size of largest deposit _Miller & Payne (1 - 5)_

Answer 6

p63 / p40 SMMHC calponin / SMA

Answer 7

BRCA1 / BRCA2 Cowden / PTEN Hamartoma Syndrome Li-Fraumeni Syndrome Peutz-Jegher Syndrome Ataxia-Telangiectasia Syndrome Hereditary diffuse gastric cancer syndrome (lobular)

Answer 8

**_Criteria:_** Stromal cellularity Stromal overgrowth (\> 4x field) Stromal pleomorphism Infiltrative border Mitoses / 10 HPF Presence of heterologous elements = malignant (except ALT)

Answer 9

1. PPE, 3 points of ID, check MDM (imaging / biopsy results) 2. Orient specimen, weigh and measure in 3D 3. Ink ant / sup blue, ant / inf green and deep black 4. Section from medial to lateral (removing HW in process), lay out slices, label and photograph 5. Describe tumour, including size, circumscription, appearance of cut surface and measure to all margins. 6. Block tumour: if DCIS (and small ish) all through otherwise Xray and block widely around biopsy clip / calcs. If invasive tumour usually 2 full faces of specimen and any other close margins (aiming 2 blocks / cm incl margins).

Answer 10

Metaplastic Carcinoma: HMWCK / P63 / P40 positive Stromal component of Phyllodes: CD34 +, usually ER positive Fibromatosis: SMA positive, Nuclear beta catenin Nodular Fasciitis: SMA positive, USP6 rearranged Myofibroblastoma: SMA, Desmin, ER and CD34 positive

Answer 11

_HPV-Associated_: Younger women / immunocompromised, p16 block positive Slower progression to SCC Usually basaloid with peripheral palisading _HPV-Independent:_ Older women, associated with LSC, p16 negative Rapid progression to SCC "dVIN" acanthosis, hyperparakeratosis, basal atypia with glassy pink cytoplasm. p53 parabasal, null, or cytoplasmic When invasive -\> Well differentiated, keratinising SCC

Answer 12

CRS - chemotherapy response score Assessed in omentum (and other sites) post NAT for HGSC Score 1: No or minimal tumor response (mainly viable tumor with no or minimal regression-associated fibro-inflammatory changes, limited to a few foci); Score 2: Partial tumor response (multifocal or diffuse regression associated fibro-inflammatory changes, with viable tumor ranging from diffuse sheets, streaks or nodules, to extensive regression with multifocal but easily identifiable residual tumor; Score 3: Complete or near-complete response (mainly regression, with few irregularly scattered individual tumor cells or cell groups, all measuring \<2 mm, or no residual tumor identified).

The Holy Organs Flashcards

(36 cards)