B8-036 Breast Pathology Flashcards by Felicia Jones

genes that increase risk of breast cancer [3]

BRCA1
BRCA2
PALB2

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[BRCA1 vs BRCA2]
younger age of onset

BRCA1

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[BRCA1 vs BRCA2]
increased risk of ovarian, endometrial, and colorectal cancers

BRCA1

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[BRCA1 vs BRCA2]
associated with risk of triple negative breast cancers

BRCA1

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[BRCA1 vs BRCA2]
increased risk of cervical cancer, and breast cancer in men

BRCA2

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[BRCA1 vs BRCA2]
associated with hormone receptor positive breast cancers

BRCA2

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[BRCA1 vs BRCA2]
well demarcated tumors, solid nests, lymphocytoplasmic infiltrate, high mitotic activity

BRCA1

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arises from ductal atypia and fills ductal lumen; no penetration of basement membrane

often seen early as microcalcifications on mammnography

ductal carcinoma in situ

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extension of underlying DCIS/invasive breast cancer up the lactiferous ducts and into the contiguous skin of the nipple

paget’s

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eczematous patches over nipple and areolar skin

paget’s

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decrease E-cadherin expression
no mass or calcification

incidental biopsy finding

lobular carcinoma in situ

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[ductal/lobular] carcinoma in situ increase the chance of cancer in either breast

lobular

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[ductal/lobular] carcinoma in situ increase the chance of cancer the same breast and quadrant

ductal

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most common type of invasive breast cancer

invasive ductal carcinoma

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firm, fibrous, “rock-hard” mass with sharp margins and small, glandular duct-like cells in a desmoplastic stroma

invasive ductal carcinoma

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decreased E cadherin expression –> single file row of cells
no duct formation
lacks desmoplastic response

invasive lobular carcinoma

(Lines of cells=Lobular)

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invasive carcinoma, often bilateral with multiple lesions in the same location

invasive lobular carcinoma

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dermal lymphatic space invasion –> breast pain with warm, swollen, erythematous skin around exaggerated hair follicles

inflammatory carcinoma

(peau d’orange)

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invasive carcinoma with very poor prognosis

inflammatory

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often mistaken for mastitis or Paget’s disease

lacks a palpable mass

inflammatory carcinoma

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breast carcinomas showing a special histologic pattern in greater or equal to […]% of the tumor are designated as pure special tumor type

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low grade invasive carcinoma composed of well-formed tubules with open lumen

tubular carcinoma

(great prognosis)

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characterized by clusters of epithelial cells suspended in mucin pools

mucinous carcinoma

(great prognosis, unless mixed with ductal)

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most important prognostic factor for invasive carcinoma

presence of distant metastases

(and lymphovascular invasion, suggests mets)

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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

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