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Surgery.(General 2).Breast > 1. Carcinoma of the female breast.(Incidence, Etiology and pathology) > Flashcards

1. Carcinoma of the female breast.(Incidence, Etiology and pathology) Flashcards

1
Q

INCIDENCE of Carcinoma of female breast

A
  • It is the commonest malignancy in female.

* In USA, 1 in every 9 women is expected to develop cancer breast in lifetime

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2
Q

Etiological factors of Carcinoma of female breast

A
  1. Genetic element
  2. High (Major) Risk Factors
  3. Intermediate Risk Factors
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3
Q

Genetic element of etiological factors of Carcinoma of female breast

A

Genetic element: mutation of the following tumour suppressor genes:

  • BRCA 1 located on chromosome No.17
  • BRCA 2 located on chromosome No.13
  • TP53 (p53) located on chromosome No.17
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4
Q

Le Fromaini syndrome

A

(Mutation of p53 tumour suppressor gene) :

  • colorectal cancer
  • endometrial cancer
  • cancer breast
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5
Q

High (Major) Risk Factors of breast cancer

A
  1. Female with cancer of one breast.
  2. Female with near relatives having history of cancer breast.
  3. Nulliparous female
  4. Fibroadenosis with papillomatosis.
  5. Atypical ductal hyperplasia.
  6. Duct papilloma
  7. Lobular carcinoma in situ
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6
Q

lntermediate Risk Factors of breast cancer

A
  1. It has a peak incidence at 45 - 55 y, 65 - 75 y.
  2. Females with early menarche .12 y or late menopause > 50 y.
  3. Infertility & delayed pregnancy.
  4. Prolonged use of contraceptive pills > 10 years.
  5. Obesity & White races.
  6. High socio-economic class.
  7. Artifrcial breast prosthesis.
  8. Smoking, coffee, red meat & high fat diet.
  9. Irradiations.
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7
Q

Pathology of breast cancer

A

Site

Types

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8
Q

Site in Pathology of breast cancer

A

Mostly affecting the upper outer quadrant (60%).

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9
Q

Types in Pathology of breast cancer

A

According to the cell of origin :

I- Ductal carcinoma. (80-85%)
Il- Lobular carcinoma. (10-15%)
III- Paget’s disease of the nipple. (1%)
IV- Rare types of carcinoma.(Mastitis carcinomatosa)

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10
Q

Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A
  1. Non-lnvasive Ductal Carcinoma (Ductal Carcinoma in situ)

2. lnvasive Ductal Carcinoma

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11
Q

Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A
  1. Low and intermediate grade DCIS:

2. High grade DCIS:

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12
Q

Pathogenesis of Low and intermediate grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A
  1. Papillary & micropapillary DCIS
  2. Solid DCIS
  3. Cribriform DCIS
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13
Q

Pathogenesis of High grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

Comedo DCIS

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14
Q

Papillary & micropapillary DCIS in Pathogenesis of Low and intermediate grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A
  1. Microscopic picture:

2. Clinical picture

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15
Q

Microscopic picture of Papillary & micropapillary DCIS in Pathogenesis of Low and intermediate grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

The cancer cells are arranged in a finger-like pattern within the duct

If the cells are very small, they are called micropapillary.

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16
Q

Clinical picture of Papillary & micropapillary DCIS in Pathogenesis of Low and intermediate grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

Leads to bleeding per nipple.

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17
Q

Microscopic picture of Solid DCIS in Pathogenesis of Low and intermediate grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

The tumor cells completely fill the involved ducts.

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18
Q

Microscopic picture of Cribriform DCIS in Pathogenesis of Low and intermediate grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A
  1. There are gaps between cancer cells in the affected breast ducts
  2. like the pattern of holes in Swiss cheese.
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19
Q

Comedo DCIS in Pathogenesis of High grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A
  1. Microscopic picture

2. Pathogenesis of Comedo necrosis

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20
Q

Microscopic picture of Comedo DCIS in Pathogenesis of High grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

The center of the breast duct is plugged with dead cancer cells scattered among the living ones.

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21
Q

Pathogenesis of Comedo necrosis in Comedo DCIS in Pathogenesis of High grade DCIS in Pathogenesis of Non-lnvasive Ductal Carcinoma (DCIS) in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

Necrosis in malignancy usually means that the cancer is growing fast & some cells don’t get enough nourishment, these starved cells die off, leaving areas of necrosis.

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22
Q

Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

1- lnvasive duct carcinoma not otherwise specified “NOS” > 75 %

2- Medullary carcinoma: 5%

3- Mucinous carcinoma 1%

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23
Q

Pathogenesis of NOS in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A
  1. Alternative names for NOS
  2. Gross picture
  3. Cut section
  4. Microscopic picture
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24
Q

Alternative names for NOS in Pathogenesis of NOS in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

NSP no special type

scirrhous carcinoma

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25
Q

meaning of scirrhous carcinoma

A

Means alot of fibrous tissue

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26
Q

Gross picture in Pathogenesis of NOS in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A
  • Small, hard, irregular mass
  • with flat under-surface
  • fixed within the breast.
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27
Q

Cut section in Pathogenesis of NOS in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

1- Gritty.

2- Retract (concave) due to the fibrous tissue inside.

3- Non-capsulated.

4- Pale grayish with yellowish white streaks

5- areas of hemorrhage & necrosis.

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28
Q

Meaning of Gritty

A

Full of fibrous tissue Akennak bte2ta3 fe kommetra

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29
Q

why some cut sections are concave others are convex ?

A

Concave : much fibrous tissue

Convex : little fibrous tissue

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30
Q

Microscopic picture in Pathogenesis of NOS in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

1- Masses of small malignant spheroidal cells

2- arranged in irregular groups

3- separated by dense fibrous tissue

4- with areas of hemorrhage & necrosis.

5- The fibrous tissue element is more than the cellular element.

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31
Q

Pathogenesis of Medullary carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A
  1. Alternative name for Medullary carcinoma
  2. Gross picture
  3. Cut section
  4. Microscopic picture
  5. Aggressiveness and prognosis
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32
Q

Alternative name for Medullary carcinoma in Pathogenesis of Medullary carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

encephaloid carcinoma

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33
Q

Gross picture in Pathogenesis of Medullary carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

Large, irregular mass & soft in consistency.

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34
Q

Cut section in Pathogenesis of Medullary carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A
  1. Bulge (convex)
  2. Non-capsulated
  3. brain like appearance.
  4. areas of hemorrhage and central necrosis.
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35
Q

Microscopic picture in Pathogenesis of Medullary carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

1- Large masses of malignant spheroidal cells

2- arranged in pseudoacinus form.

2- The stroma is scanty and the vascularity is high.

3- cellular element > fibrous tissue element

4- Lymphocytic infiltration may be present.

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36
Q

Tumours with Lymphocytic infiltration:

A

1) seminoma
2) Medullary breast carcinoma
3) monomorphic adenoma of parotid

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37
Q

Aggressiveness and prognosis in Pathogenesis of Medullary carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

It’s less aggressive and metastasize later and hence has better prognosis than NOS

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38
Q

Pathogenesis of Mucinous carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A
  1. Alternative name for Mucinous carcinoma
  2. Gross picture
  3. Cut section
  4. Microscopic picture
  5. Prognosis
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39
Q

Alternative name for Mucinous carcinoma in Pathogenesis of Mucinous carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

colloid carcinoma

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40
Q

Gross picture in Pathogenesis of Mucinous carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

Large cystic tumour

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41
Q

Cut section in Pathogenesis of Mucinous carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

Honey comb appearance due to colloid

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42
Q

Microscopic picture in Pathogenesis of Mucinous carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

Malignant cells producing abundant mucin giving the signet ring appearance.

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43
Q

meaning of signet ring appearance.

A

Nucleus is pushed to side by mucin

44
Q

Prognosis in Pathogenesis of Mucinous carcinoma in Pathogenesis of lnvasive Ductal Carcinoma in Pathogenesis of Ductal carcinoma in Types in Pathology of breast cancer

A

Unlike colloid carcinoma of GIT, it has usually a good prognosis

45
Q

Lobular carcinoma in Types in Pathology of breast cancer

A
  1. Cell of origin
  2. Behavior
  3. Pathogenesis
46
Q

Cell of origin of Lobular carcinoma in Types in Pathology of breast cancer

A

Terminal lobular ducts or the acini.

47
Q

Behavior of Lobular carcinoma in Types in Pathology of breast cancer

A

It’s bilateral and mulitcentric

48
Q

what is bad about lobular carcinoma

A

It’s bilateral and mulitcentric so conservative breast surgery is contraindicated

49
Q

Pathogenesis of Lobular carcinoma in Types in Pathology of breast cancer

A
  1. Non-invasive lobular carcinoma (LCIS)

2. Invasive lobular carcinoma

50
Q

Pathogenesis of Non-invasive lobular carcinoma (LCIS) in Pathogenesis of Lobular carcinoma in Types in Pathology of breast cancer

A
  1. Gross picture
  2. Microscopic picture
  3. Prognosis
51
Q

Gross picture in Pathogenesis of Non-invasive lobular carcinoma (LCIS) in Pathogenesis of Lobular carcinoma in Types in Pathology of breast cancer

A

Common to be an incidental finding associated with a breast biopsy performed for another indication.

52
Q

Microscopic picture in Pathogenesis of Non-invasive lobular carcinoma (LCIS) in Pathogenesis of Lobular carcinoma in Types in Pathology of breast cancer

A
  1. A monomorphic population of small, rounded, Loosely cohesive cells
  2. Fill and expand the acini of a lobule.
53
Q

Prognosis in Pathogenesis of Non-invasive lobular carcinoma (LCIS) in Pathogenesis of Lobular carcinoma in Types in Pathology of breast cancer

A
  • Approximately, 10-20% of women with LCIS develop invasive breast cancer within 15 years from their LCIS diagnosis.
  • Thus, LCIS is considered a biomarker of increased breast cancer risk
54
Q

The reason why LCIS is considered a biomarker of increased breast cancer risk

A

Approximately, 10-20% of women with LCIS develop invasive breast cancer within 15 years from their LCIS diagnosis.

55
Q

Invasive lobular carcinoma in Pathogenesis of Lobular carcinoma in Types in Pathology of breast cancer

A

Consists of cells morphologically identical to LCIS but with invasion of the basement membrane.

Occasionally they surround normal-appearing acini or ducts

56
Q

Paget’s disease (CIS) in Types in Pathology of breast cancer

A
  1. Definition
  2. Spread
  3. Microscopic picture
  4. Clinical picture
  5. Differential Diagnosis
57
Q

Definition of Paget’s disease (CIS) in Types in Pathology of breast cancer

A

lt is a slowly growing intraductal carcinoma that begins in the epithelium of a main collecting lactiferous duct

58
Q

Spread of Paget’s disease (CIS) in Types in Pathology of breast cancer

A
  1. Outward

2. Inward

59
Q

Outward Spread of Paget’s disease (CIS) in Types in Pathology of breast cancer

A
  • affecting the skin of the nipple & areola

* leading to superficial erosions, ulcerations & crustations.

60
Q

Inward Spread of Paget’s disease (CIS) in Types in Pathology of breast cancer

A

Later on it spreads inwards & a mass appears 2 years from the onset of the disease

61
Q

Microscopic picture of Paget’s disease (CIS) in Types in Pathology of breast cancer

A
  1. Epidermal hyperplasia & hyperkeratosis.
  2. Malignant Paget’s cells in all layers of the epidermis
  3. The dermis contains a dense infiltrate of lymphocytes, histiocytes, plasma cells, and occasionally eosinophils.
62
Q

Morphology of Malignant Paget’s cells in Microscopic picture of Paget’s disease (CIS) in Types in Pathology of breast cancer

A

Large, oval or rounded cells with intracytoplasmic vacuoles & large hyperchromatic nuclei with prominent nucleoli “high nuclear-to-cytoplasmic”

63
Q

Clinical picture of Paget’s disease (CIS) in Types in Pathology of breast cancer

A

Usually occurs at menopause [6th decade]

Pricking sensation of the nipple with erosions & ulcerations

64
Q

Differential Diagnosis of Paget’s disease (CIS) in Types in Pathology of breast cancer

65
Q

differentiate between Paget’s disease and Eczema by

A
  1. side
  2. age
  3. itchiness
  4. Presence of vesicles-oozing
  5. Edge
  6. Biopsy
  7. Response to treatment
66
Q

side of Paget’s disease

A

Unilateral

67
Q

side of Eczema

A

Commonly Bilateral

68
Q

age in Paget’s disease

A

Usually occurs at menopause [6th decade]

69
Q

age in Eczema

A

Commonly occurs at lactation

70
Q

itchiness of Paget’s disease

A

May be itchy

71
Q

itchiness of Eczema

A

always itchy

72
Q

Presence of vesicles-oozing in Paget’s disease

A

No vesicles no oozing (dry)

73
Q

Presence of vesicles-oozing in Eczema

A

vesicles are present - oozing

74
Q

Edge of Paget’s disease

A

Well defined.

75
Q

Edge of Eczema

A

Ill defined

76
Q

Biopsy in Paget’s disease

A

Biopsy is diagnostic

77
Q

Biopsy in Eczema

A

Biopsy is diagnostic

78
Q

Response to treatment in Paget’s disease

A

no response to eczema treatment

79
Q

Response to treatment in Eczema

A

responds to eczema treatment

80
Q

Mastitis carcinomatosa in Types in Pathology of breast cancer

A
  1. Alternative name for Mastitis carcinomatosa
  2. Clinical picture
  3. Behavior
  4. Prognosis
  5. Differential Diagnosis
81
Q

Alternative name for Mastitis carcinomatosa in Types in Pathology of breast cancer

A

Acute inflammatory (Lactating) carcinoma

82
Q

Clinical picture of Mastitis carcinomatosa in Types in Pathology of breast cancer

A
  • Occurs mostly during pregnancy and lactation (due to high hormonal level)
  • but may occur at any age unassociated with these events.
  • The overlying skin is red, warm & edematous.
83
Q

Behavior of Mastitis carcinomatosa in Types in Pathology of breast cancer

A
  • Aggressive rapidly metastasizing tumour
  • Considered stage lV cancer breast.
  • The tumour infiltrates the breast diffusely & the overlying skin is red, warm & edematous.
84
Q

Prognosis of Mastitis carcinomatosa in Types in Pathology of breast cancer

A

A Very bad prognosis. The patient dies within few months.

85
Q

Differential Diagnosis of Mastitis carcinomatosa in Types in Pathology of breast cancer

A

Acute bacterial mastitis.

86
Q

Differentiate between Mastitis carcinomatosa and acute bacterial mastitis by

A
  1. onset
  2. Fever
  3. Degree of breast involvement
  4. Axillary nodes
  5. CBC
  6. Response to antibiotics
87
Q

onset of Mastitis carcinomatosa

A

Gradual onset

88
Q

onset of acute bacterial mastitis

A

Acute onset

89
Q

Fever in Mastitis carcinomatosa

A

no or low grade fever

90
Q

Fever in acute bacterial mastitis

A

high fever

91
Q

Degree of breast involvement in Mastitis carcinomatosa

A

involves more than one third of the breast

92
Q

Degree of breast involvement in acute bacterial mastitis

A

one breast sector is affected

93
Q

Axillary nodes in Mastitis carcinomatosa

A

non tender axillary nodes (hard fixed)

94
Q

Axillary nodes in acute bacterial mastitis

A

tender axillary nodes

95
Q

CBC in Mastitis carcinomatosa

96
Q

CBC in acute bacterial mastitis

A

Leucocytosis

97
Q

Response to antibiotics in Mastitis carcinomatosa

A

no response to antibiotics in one week is an indication for biopsy

98
Q

Response to antibiotics in acute bacterial mastitis

A

The lesion is either cured by antibiotics or forms an abscess

99
Q

Histological grading of breast cancer

A
  1. Mechanism

2. Grades

100
Q

Mechanism of Histological grading of breast cancer

A

This grading is done according to a numerical grading system based on scoring of 3 individual factors:

  • Mitotic rate
  • Nuclear pleomorphism
  • Tubular formation
101
Q

Grades of Histological grading of breast cancer

A

All pathological types are classified according to the degree of differentiation to:

Grade l : Well differentiated
.
Grade ll : Moderately differentiated.

Grade lll : Poorly differentiated.

102
Q

Recent pathological classification of breast cancer

A

A) Non-invasive carcinoma

B) Invasive carcinoma

103
Q

Non-invasive carcinoma according to Recent pathological classification of breast cancer

A
  1. Ductal carcinoma in situ.
  2. Lobular carcinoma in situ.
  3. Paget’s disease of the nipple (with no mass).
  4. Non invasive papillary carcinoma.
104
Q

Invasive carcinoma according to Recent pathological classification of breast cancer

A
  1. Invasive ductal carcinoma not otherwise specified “NOS”.
  2. Invasive lobular carcinoma.
  3. Medullary carcinoma.
  4. Mucinous (colloid carcinoma).
  5. Inflammatory carcinoma.
  6. Paget’s disease with a mass.
  7. Tubular carcinoma.
  8. Papillary carcinoma.
  9. Adenoid cystic (cribriform) carcinoma.
  10. Metaplastic breast cancer (MBC).
  11. Carcinoma with neuroendocrine differentiation.
105
Q

DCISLeads to bleeding per nipple.

A

Papillary & micropapillary DCIS

Surgery.(General 2).Breast (8 decks)

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