Breast

Question 1

Classify invasive breast carcinomas.

Answer 1

1. No Special Type (NST) carcinoma (aka Typical Ductal Carcinoma)
2. Special Type Carcinoma
   i) Lobular
   ii) Medullary
   iii) Mucinous
   iv) Tubular
   v) Papillary

Question 2

Short note on Typical ductal carcinoma or NST breast carcinoma.

Answer 2

Gross:

1) Hard, irregular, radiodense mass
2) On cutting the tumor, a grating sound is produced because of central area of heavy desmoplasia and foci of calcification
3) Rarely, it may have deceptive gross features: well curcumscribed and no desmoplasia
4) The large tumors can invade Pectoralis muscle, become fixed to chest wall and cause dimpling of the skin
5) If tumor is in central part of the breast— nipple retraction can occur
6) Rarely, the cancer may metastasize to axillary nodes even befpre detection by mammography

Microscopy:

1) Ducts/tubules of tumor cells
2) Ducts are lined by pleomorphic cells
3) Absence of myoepithelial cell layer
4) Mitoses

Grading is done based on extent of duct/tubule formation, pleomorphism and mitotic rate: Nottingham/ Bloom richardson histological score .

Question 3

Which type of invasive breast cancer has worst prognosis?

Answer 3

Inflammatory carcinoma.

Distant metastasis is present at the time of presentation.

Question 4

Prognostic factors of breast carcinoma,

Answer 4

1. Lymph node metastasis
2. Distant metastasis
3. Tumor size
4. Locally advanced disease
5. Lymphovascular invasion
6. Inflammatory carcinoma subtype
7. Gene expression profiling (ER, PR, Her2 expression status)
8. Response to chemotherapy