B8-036 Breast Pathology Flashcards
genes that increase risk of breast cancer [3]
BRCA1
BRCA2
PALB2
[BRCA1 vs BRCA2]
younger age of onset
BRCA1
[BRCA1 vs BRCA2]
increased risk of ovarian, endometrial, and colorectal cancers
BRCA1
[BRCA1 vs BRCA2]
associated with risk of triple negative breast cancers
BRCA1
[BRCA1 vs BRCA2]
increased risk of cervical cancer, and breast cancer in men
BRCA2
[BRCA1 vs BRCA2]
associated with hormone receptor positive breast cancers
BRCA2
[BRCA1 vs BRCA2]
well demarcated tumors, solid nests, lymphocytoplasmic infiltrate, high mitotic activity
BRCA1
arises from ductal atypia and fills ductal lumen; no penetration of basement membrane
often seen early as microcalcifications on mammnography
ductal carcinoma in situ
extension of underlying DCIS/invasive breast cancer up the lactiferous ducts and into the contiguous skin of the nipple
paget’s
eczematous patches over nipple and areolar skin
paget’s
decrease E-cadherin expression
no mass or calcification
incidental biopsy finding
lobular carcinoma in situ
[ductal/lobular] carcinoma in situ increase the chance of cancer in either breast
lobular
[ductal/lobular] carcinoma in situ increase the chance of cancer the same breast and quadrant
ductal
most common type of invasive breast cancer
invasive ductal carcinoma
firm, fibrous, “rock-hard” mass with sharp margins and small, glandular duct-like cells in a desmoplastic stroma
invasive ductal carcinoma
decreased E cadherin expression –> single file row of cells
no duct formation
lacks desmoplastic response
invasive lobular carcinoma
(Lines of cells=Lobular)
invasive carcinoma, often bilateral with multiple lesions in the same location
invasive lobular carcinoma
dermal lymphatic space invasion –> breast pain with warm, swollen, erythematous skin around exaggerated hair follicles
inflammatory carcinoma
(peau d’orange)
invasive carcinoma with very poor prognosis
inflammatory
often mistaken for mastitis or Paget’s disease
lacks a palpable mass
inflammatory carcinoma
breast carcinomas showing a special histologic pattern in greater or equal to […]% of the tumor are designated as pure special tumor type
90
low grade invasive carcinoma composed of well-formed tubules with open lumen
tubular carcinoma
(great prognosis)
characterized by clusters of epithelial cells suspended in mucin pools
mucinous carcinoma
(great prognosis, unless mixed with ductal)
most important prognostic factor for invasive carcinoma
presence of distant metastases
(and lymphovascular invasion, suggests mets)
breast cancer most commonly presents as a palpable hard mass in the […] quadrant
upper outer
risk of axillary lymph node metastasis increases with […] of primary tumor
size
biomarkers tested in breast cancer [3]
ER
PR
HER2
Luminal A cancers respond to […] therapy
antihormonal
ER positive, Her2 negative, low proliferation
Luminal A
ER positive, Her2 negative, high proliferation
Luminal B
Luminal B is associated with […] mutations
BRCA2
Her2 cancers respond to […] therapy
Herceptin (trastuzumab)
ER negative, Her2 negative
basal-like
basal-like cancers are more common in […] patients
young
basal-like cancers may be associated with […] mutation
BRCA1
most common benign tumor of the breast in women
fibroadenoma
rubbery, painless palpable mass with round, sharply demarcated borders
fibroadenoma
fibroadenomas and phyllodes tumors are driven by mutations in […]
MED12
large mass of connective tissue and cysts with “leaflike” lobulations
phyllodes tumor
(can become malignant)
most common lesion in breast of men
gynecomastia
increased incidence of breast cancer in men is seen in patients with […] syndrome
klinefelters
Malignant proliferation of cells in ducts with no invasion of the basement membrane
DCIS
Often detected as calcification on mammography; does not usually produce a mass.
DCIS
(Mammographic calcifications can also be associated with benign conditions
such as fibrocystic changes (especially sclerosing adenosis) and fat necrosis)
DCIS that extends up the ducts to involve the skin of the nipple
Paget disease
Paget disease of the breast is almost always associated with an underlying
[…]
carcinoma
Invasive carcinoma that classically forms duct-like structures
invasive ductal carcinoma
Most common type of invasive carcinoma in the breast, accounting for > 80% of cases
invasive ductal carcinoma
Biopsy usually shows duct-like structures in a desmoplastic stroma
invasive ductal carcinoma
special subtypes of invasive ductal carcinoma [4]
tubular
mucinous
medullary
inflammatory
subtype of invasive ductal carcinoma characterized by well-differentiated tubules that lack myoepithelial cells
tubular
subtype of invasive ductal carcinoma characterized by carcinoma with abundant extracellular mucin
mucinous
‘tumor cells floating in a mucus pool’
subtype of invasive ductal carcinoma characterized by large, high-grade cells growing in sheets with associated lymphocytes and plasma cells
medullary
subtype of invasive ductal carcinoma with increased incidence in BRCA1 carriers
medullary
subtype of invasive ductal carcinoma that grows as a well-circumscribed mass that can mimic fibroadenoma on mammography
medullary
subtype of invasive ductal carcinoma
characterized by carcinoma in dermal lymphatics
inflammatory
subtype of invasive ductal carcinoma that presents classically as an inflamed, swollen breast (tumor cells block drainage of lymphatics) with no discrete mass; can be mistaken for acute mastitis
inflammatory
(poor prognosis)
Malignant proliferation of cells in lobules with no invasion of the basement membrane
LCIS
[DCIS/LCIS] does not produce a mass or calcifications and is usually discovered incidentally
on biopsy
LCIS
Characterized by dyscohesive cells lacking E-cadherin adhesion protein
LCIS
[DCIS/LCIS] Often multifocal and bilateral
LCIS
characteristically grows in a single-file pattern
cells may exhibit signet-ring morphology
No duct formation due to lack of E-cadherin
invasive lobular carcinoma
where are ER and PR receptors located in the cell?
nucleus
where is the Her2 receptor located in the cell?
growth factor receptor present on cell’s surface
Presence of ER and PR is associated with response to antiestrogenic agents like [medication]
tamoxifen
HER2/neu amplification is associated with response to [medication]
trastuzumab (Herceptin)
breast cancer in males usually presents as a […] mass in older males
subareolar
breast cancers in males represent […]% of all breast cancers
1
Most common histological subtype of breast cancer in males is […]
invasive ductal carcinoma.
male breast cancer is associated with […] mutations and […] syndrome
male breast cancer is associated with [BRCA2] mutations and [Klinefelter] syndrome
single most important prognostic factor in carcinoma of the breast
axillary lymph node status
[BRCA 1 vs BRCA 2]
more commonly ER negative
BRCA 1
[BRCA 1 vs BRCA 2]
has distinct medullary carcinoma morphology
BRCA 1
[BRCA 1 vs BRCA 2]
more commonly ER+
BRCA 2
[BRCA 1 vs BRCA 2]
more commonly associated with male breast cancer
BRCA2
[BRCA 1 vs BRCA 2]
higher risk of ovarian cancers
BRCA1
firm, gritty, chalky mass composed of gland-like structures infiltrating into adjacent stroma
surrounded by strong desmoplastic reaction
invasive ductal carcinoma
oozing red patch on nipple
involvement of epidermis by malignant cells
large cells with abundant clear cytoplasm and pleomorphic nuclei
paget
nodular breast with microcalcifications, fibrosis, cysts, apocrine metaplasia, and adenosis
fibrocystic changes
ducts contain solid sheets of large malignant cells with central necrosis
myoepithelial layer present around each duct
DCIS
mammogram is used to detect […] in screening for breast cancer
abnormal calcifications
tend to metastasize to the leptomeninges causing “carcinoma meningitis”
lobular carcinomas
small, poorly cohesive cells and signet ring cells
lobular carcinoma
