Benign And Premalignant And FEL

Question 1

Term when DCIS involves the lobules

Answer 1

Cancerization of lobules
Lobular cancerization

Question 2

LG vs HG DCIS
Size requirement
Er, pr, her2

Answer 2

LG: if not adh, usually (+) ER and PR and (-) HER2

HG: no size requirement, usually (-) ER and PR and (+) HER2

Question 3

RR of invasive cancer of DCIS in ipsilateral breast
Associated type of calcification in mammography

Answer 3

10x
Linear calcifications

Question 4

Multicentric vs multifocal

Answer 4

Multicentric- diff quadrants >5 cm apart
Multifocal- same quadrant <5 cm apart

Question 5

Atypical lobular hyperplasia (ALH)
Criteria
Pagetoid spread?
RR for IC
Ipsilateral? Contra lateral?

Answer 5

<1/2 of lobular involvement
Yes
4-5x RR
67%
33%

Question 6

LCIS
criteria
Subtypes and tx
RR for IBC
Mammographic findings
Special stains
Ihc

Answer 6

> 50% of acini involved
Classic, pleomorphic and florid
Tx: if classic seen on biopsy, no need to excise or have negative margins
But if pleomorphic or florid, must excise with negative margin due to aggressive behavior
No assoc mammo findings
(+) mucicarmine in intracytoplasmic vacuoles
E-cadherin (-)
P120 cytoplasmic (not membranous)
Beta catenin membrane staining LOST

Question 7

The earliest step in low grade carcinoma pathway
Criteria
Assoc with
RR to IBC

Answer 7

Columnar cell change
1-2 cells thick only (if > 2 : columnar cell hyperplasia)
Adh, low grade dcis, ibc
1.5 RR

Question 8

Earliest morphologically recognizable clonal lesion of the breast
Morpho?
RR to IBC
Tx?
Molecular

Answer 8

Flat epithelial atypia (FEA)
Same cells as adh and dcis but if with complex architecture, it is not FEA but ADH or DCIS
RR of 1.5
If found in a targeted lesion, less than 5% of cases will have associated cancer, but is an indication for excision to exclude worse Lesion in close proximity
Deletions of chromosome 16qa

Question 9

This lesion has stellate dense fibroelastosis with entrapped glandular structures in a radiating outward configuration.
2 cel layers maintained throughout the Lesion.
Dx?
Radiographic appearance?
RR to IBC
mutation

Answer 9

Radial sclerosing lesion (radial scar)
Smaller and stellate vs complex sclerosing lesion which is larger and more disorganized than a scar
Spiculated lesion on radiograph
RR 1.5 to 2 fold in either breast
PIK3CA mutation

Question 10

Well, circumscribed proliferation of closely packed hyperplastic, secretory Lobules separated by delicate connective tissue. The epithelial cells are cuboidal to hobnailed, and bland with vacuolated to granular, cytoplasm and small uniform pinpoint nucleolus.
This can be diagnosed during pregnancy and breast feeding
Dx?
Location?
Behavior

Answer 10

Lactating adenoma
Anywhere along the mammary line
No known progression to carcinoma

Question 11

It is composed of a haphazard proliferation of small round uniform, tubular glands, composed of a single layer of epithelium without associated myoepithelial cells they have bland nuclei, and amphophilic cytoplasm. The liminal spaces are open and often have eosinophilic colloid-like secretion.
(+) CK, S100
(-) ER, PR, HER2, myoepithelial markers
Dx?
Importance?

Answer 11

Microglandular adenosis
Might be mistaken for carcinoma
25% assoc with invasive carcinoma
Hypothesized ti be a non-obligate precursor of basal-type breast cancer

Question 12

It is composed of well circumscribed sharply demarcated and dense proliferation of closely approximated, round, oval tubular structures, with a little background stroma. It is usually found in younger women in the upper outer quadrant.
Dx?

Answer 12

Tubular adenoma

Question 13

Lobulocentric proliferation of benign glandular structures, composed of epithelial cells with abundant granular cytoplasm. The apocrine cells have round, nuclei, and prominent nucleoli.
Dx?
Ihc?

Answer 13

Apocrine adenosis
Think apocrine metaplasia + adenosis
(-) ER
(+) AR and GCDFP15

Question 14

Intraductal deposits of basement membrane, which are amorphous, and eosinophilic, acellular of fibropapillary spherules
Dx?
Commonly seen with which lesions
Stain?

Answer 14

Collagenous spherulosis
Papilloma, UDH, sclerosing lesioms
(+) PAS, Alcian blue

Question 15

MC benign solid breast mass in young women
Which elements proliferate?
Patterns of growth?
Subtype?
Mutation

Answer 15

Fibroadenoma
Epithelial and stromal
Intracanalicular and pericanalicular
Juvenile fibroadenoma - rapidly grows and predominantly have pericanalicular growth pattern
60% have MED12 mutation (stromal
Cells) — myxoid FA lack this mutation

Question 16

Phyllodes tumor
Elements?
Included in criteria?
Increased incidence in what syndrome
Mutations

Answer 16

Biphasic- epithelial and stromal
Stromal atypia, cellularity, overgrowth, mitoses, margin, presence of heterologous elements except liposarcoma
Li-fraumeni syndrome
Benign: MED12 and RARA
Borderline and Malignant: many and RB1

Question 17

This is a breast mass, composed of normal ducts, lobules, fibers tissue, and adipose tissue in varying proportions. It is a pain less breast mass, and requires clinical data or imaging correlation to distinguish from normal breast
Diagnosis?

Answer 17

Hamartoma or adenolipoma