01b: Breast Cancer Flashcards
By far the most common tumor of the breast arises from which tissues?
Ductal (predominantly) and lobular epithelium (adenocarcinomas)
Very common cause of “breast lumps” that fall under non-proliferative breast disease. Does this increase risk of malignancy?
Fibrocystic change
No (not unless associated with atypical hyperplasia)
List the tissue changes in fibrocystic disease of breast.
- metaplasia
- stromal fibrosis and calcification
- cyst formation
Proliferative breast disease without atypia usually causes (palpable/non-palpable) masses with (X) relative risk of developing breast cancer.
Non-palpable (detected by mammogram);
X = 1.5-2x
T/F: Proliferative breast disease with atypia fulfill criteria for carcinoma.
False - almost, but fall short
List the two types of proliferative breast disease with atypia.
- ADH (atypical ductal hyperplasia)
2. ALH (atypical lobular hyperplasia)
Proliferative breast disease with atypia associated with (X) relative risk of developing breast cancer.
X = 4-5
Most common benign tumor found in breast. Which tissue components are found in this lesion?
Fibroadenoma;
Epithelial (ductal) and mesenchymal
Fibroadenomas occur primarily in (older/younger) women, are hormonally (responsive/unresponsive), and (increase/decrease) in size with menopause.
Younger (under 30);
Responsive
Decrease/regress
T/F: Fibroadenomas generally confer no increased risk for cancer.
True (unless accompanied by more complex epithelial proliferation)
Carcinomas of breast are divided into which two main types? Star the most common.
Carcinomas arising from:
- ductal epithelium* (75%)
- lobular epithelium
Intraductal carcinoma is (invasive/non-invasive) and associated with (good/bad) prognosis.
Non-invasive (Carcinoma-in-situ)
Good (if adequately excised)
Intraductal carcinoma now accounts for a (lower/higher) % of breast carcinoma cases, since the use of mammogram screening.
Higher (up to 30% as opposed to 5% in the past); this is good - detecting before invasion
(By far) the most common breast carcinoma, arising from (ductal/lobular) epithelium:
Ductal;
Invasive ductal carcinoma NST (no special type)
Describe the texture of the typical masses found in Invasive ductal carcinoma (NST). What gives them this texture?
Firm, gritty;
Prominent background fibrosis and calcification
Invasive ductal carcinoma (NST): by the time the carcinoma is palpable, (X)% of patients will have metastasis to axillary lymph nodes.
X = 50
Well-differentiated breast carcinomas tend to be estrogen R (pos/neg) and progesterone R (pos/neg) and HER2 (pos/neg).
Pos, Pos, neg
Medullary carcinoma is a (ductal/lobular) disease of the breast that’s more commonly seen with (X) mutation. What’s the general prognosis?
Ductal
X = BRCA1 (13% of carcinomas in these patients; only 1% of breast carcinomas overall)
Better prognosis than typical ductal NST
(X) subtype of ductal breast carcinomas tends to occur in older women. It’s characterized by excessive (Y) production, forming (soft/hard) masses.
X = Colloid (mucinous) carcinoma
Y = mucin
Soft (gelatinous)
T/F: Colloid (mucinous) carcinoma has worst prognosis than typical ductal carcinoma NST.
False - better
Paget’s disease of the nipple is seen in (X)% of breast cancers. (Benign/malignant) cells extend from underlying (X) to nipple epidermis.
X = 1-2
Malignant
X = ducts
T/F: Presence of Paget’s worsens prognosis of underlying carcinoma because cells must cross BM to reach nipple epithelium.
False - don’t cross BM; doesnt alter prognosis
Breast cancer from lobular epithelium: cells are (larger/smaller), (more/less) likely to be palpable. Tendency to be (uni/multi)-centric and (X)% are bilateral.
Smaller; less
Multi;
X = 5-10
Lobular carcinoma in situ: (X)% of patients develop invasive carcinoma that’s (lobular/ductal) in (same/contralat) breast over period of 20 y.
X = 30
Etiher/both;
Either same or contralateral breast
Invasive lobular carcinoma: why are as many as (X)% of cases easily missed?
X = 25
Negligible stromal reaction
(X) breast carcinomas have different metastasis pattern compared to others. They metastasize to (lungs/GI/ovaries) as opposed to (lungs/GI/ovaries).
X = Invasive lobular
GI, ovaries/uterus (peritoneum, retroperit, meninges);
Lungs/pleura
Ductal carcinoma of breast: which subtype(s) rarely metastasize?
Medullary, colloid, tubular
T/F: EGFR is a poor prognostic factor in breast cancer.
True
Scarff-Bloom-Richardson Grading System: which 3 characteristics taken into account in breast cancer grading?
- Tubular formation
- Nuclear pleomorphism
- Mitosis
T/F: Many ovarian neoplasms cannot be detected early.
True - so they’re responsible for almost half of the deaths from cancer of the female genital tract
Most, 80%, of ovarian neoplasms are (benign/malignant) and occur in (young/old) patients.
Benign;
Young (20-45 years old)
Malignancy more common in older women
Primary tumors of the ovary arise from one of which ovarian components?
- Surface epithelium
- Germ cells
- Stroma of ovary
Ovarian neoplasms: on gross exam, the risk of malignancy increases as a function of…
The amount of discernible SOLID epithelial growth (ex: papillary projections, necrotic/friable regions)
(X)% of all ovarian tumors are of the serous type. Most, (Y)%, of these are (benign/malignant).
X = 30 Y = 75
Benign or borderline malignant
(X) account for approximately (Y)% of all ovarian cancers and are the most common malignant ovarian tumors.
X = Serous cystadenocarcinomas
Y = 40
Ovarian cystadenocarcinomas are lined by (X) cells and are filled with (Y).
X = tall, columnar, ciliated epithelial Y = serous fluid
T/F: Papillary cystadenoma (presence of papillary projections on serous ovarian tumor) is sign of malignancy.
False - benign
Borderline malignant ovarian tumors: nuclear atypia is (present/absent) and papillary projections differ in which ways from benign tumor?
Present;
Increase in number/complexity of papillary projections with more solid tumor mass
Ovarian tumors: key difference between borderline malignant and malignant tumors.
Malignant will show destructive infiltration into stroma
(X) are concentric calcifications that characterize (Y) (breast/ovarian) tumors, although they are not specific.
X = psammoma bodies
Y = serous
Ovarian
The 5-year survival rate for borderline and malignant tumors confined to the ovaries is, respectively, (X)% and (Y)%.
X = 100 Y = 70
5-year survival rate for borderline and malignant tumors involving the peritoneum is about (X)% and (Y)%, respectively.
X = 90 Y = 25
T/F: Unlike serous ovarian tumors, majority of mucinous tumors are malignant.
False - 80% are benign/borderline
T/F: Mucinous ovarian tumors occur most often in middle adult life.
True
Benign mucinous tumors histology: lining of (X) cells with (apical/basal) mucin.
X = tall, non-ciliated, columnar epithelial
Apical
Which ovarian tumors fall under “Type 1” and “Type 2”?
1: Mucinoid, endometrioid
2: Serous
Type (1/2) ovarian tumors tend to be low grade, slower growing.
1
Type (1/2) ovarian tumors tend to follow step-wise progression.
1 (benign to borderline to malignant)
Characteristic mutations seen in Type 1 ovarian tumors.
PTEN and MSI (endometrioid)
k-ras, BRAF (mucinous)
Characteristic mutations seen in Type 2 ovarian tumors.
BRCA1,2 and p53
Cell type of origin in serous ovarian tumors:
Not known! Controversial, no defined precursor
T/F: Tubal ligation is protective against all ovarian tumors.
False - not serous
Aside from endometrioid tumors, (X) rare ovarian tumors have VERY strong association with endometriosis. They fall under the Type (1/2) category for ovarian tumors.
X = clear cell
Neither
Serous ovarian tumor cells resemble (X) cells.
X = fallopian tube
Cauliflower-like projections are seen in (benign/borderline/malignant) (serous/mucinous) ovarian tumors.
Borderline; serous
Borderline serous ovarian tumor: which characteristic of “invasion” won’t alter/worsen the prognosis?
- Under 3 mm (microinvasion)
2. Invasion into vascular space
The presence of (X) and whether they are invasive are
the most important indicators of outcome in serous
borderline tumors
X = implants (peritoneal deposits)
Mucinous ovarian tumor cells resemble (X) cells.
X = cervix or GI tract (stomach/intestine)
Serous ovarian carcinomas are graded based on (X). And mucinous based on (Y).
X = nuclear morphology Y = architecture
(X) ovarian tumors tend to be VERY large (300 lbs) and almost always (uni/bi)-lateral.
X = mucinous
Unilateral
Pseudomyxoma Peritonei is a(n) (X) tumor which is almost always metastatic from (Y).
X = ovarian mass Y = GI tract (appendix)
(X)% of ovarian tumors are germ cell tumors. The vast majority are (benign/malignant).
X = 15-20
Benign, mature cystic teratomas
(X) ovarian tumor
containing hair, teeth,
keratin/sebaceous debris
X = germ cell tumor (mature cystic teratoma)
Your patient comes in with an ovarian mass containing hair. She asks you what are the chances that it is/will become malignant, and you say:
It’s benign (Mature Cystic Teratoma); 1% undergo malignant transformation
Ovarian counterpart of seminoma in the testis:
Dysgerminoma
T/F: Dysgerminoma has poor prognosis.
False - over 80% survival with proper therapy
(X) ovarian tumors are derived from ovarian stroma, which is derived from (Y) in the developing embryo
X = Y = sex cord cell
Which ovarian tumors secrete hormones? What’s the cell of origin for each tumor?
Sex cord cell tumors
- Granulosa-Theca Cell Tumors (estrogen)
- Sertoli-Leydig Cell Tumors (androgens)
(X) ovarian tumor can lead to precocious puberty in young patients
X = Granulosa-Theca Cell (secretes estrogen)
(X) tumor: Bilateral ovarian metastasis by mucin-secreting signet ring cells, usually of (Y) origin.
X = Krukenbern
Y = gastric
