Breast Flashcards

Question

Based on estrogen receptor and androgen receptor, cancer can be divided into: Luminal * estrogen receptor (?), androgen receptor (?) Basallike * estrogen receptor (?), androgen receptor (?) Molecular apocrine * estrogen receptor (?), androgen receptor (?)

Answer 1

Based on estrogen receptor and androgen receptor, cancer can be divided into: Luminal * estrogen receptor (+), androgen receptor (+) Basallike * estrogen receptor (-), androgen receptor (-) Molecular apocrine * estrogen receptor (-), androgen receptor (+)

Answer 2

Claudin-low breast cancers * poorly differentiated * frequently metaplastic, show epithelial mesenchymal transition * have a stem cell–like expression profile that appears less differentiated than basal cancers * may show basal markers and low estrogen receptor expression * prognosis is slightly better than basallike tumors * slightly lower pathologic complete response (25% to 40%) than basal cancers

Answer 3

Gene Expression Profiling–Based Breast Cancer Classification 1. Luminal A 2. Luminal B 3. Molecular apocrine-type 4. Claudin-low 5. Basallike 6. HER2-positive

Answer 4

Special Subtypes of Invasive Breast Cancer: a/w good prognosis * luminal A, mucinous, tubular, cribriform, and medullary * Better prognosis than NST a/w bad prognosis * inflammatory carcinoma, which currently is defined primarily on clinical grounds * having an erythematous or peau d’orange skin appearance and carcinoma anywhere in the breast Invasive micropapillary carcinoma * aggressive tumor, a/w high lymphatic and lymph node metastasis rate (75%) regardless of tumor size, even for T1a lesions central fibrotic focus a/w poor prognosis Worse prognosis than invasive ductal NST * luminal B * HER2 amplified * most basal-type Basal-type a/w good prognosis * Pure medullary carcinoma * secretory carcinoma * adenoid cystic carcinoma

Answer 5

Special Subtypes of Invasive Breast Cancer: Inflammatory Breast Carcinoma Associated with a bad prognosis defined primarily on clinical grounds—having an erythematous or peau d’orange skin appearance and carcinoma anywhere in the breast.

Answer 6

Sclerosing adenosis

Answer 7

Paget disease * nipple and subareolar region * DCIS arising in lactiferous ducts and extending into the epidermis

Answer 8

Florid papillomatosis of the nipple * potentially mass-forming lesion * aka nipple adenoma * characterized by ductular proliferation arising from lactiferous ducts and florid intraductal epithelial hyperplasia, varying degrees of atypia * may be a/w cancer

Answer 9

Subareolar sclerosing duct hyperplasia * characterized by a geographic area of duct sclerosis and stromal elastosis with florid epithelial proliferation * looks like nipple adenoma but nipple isn't involved * this lesion is in the family of radial sclerosing lesions but tends to show less cyst formation * may be a/w carcinoma * myoepithelial cells surround the intraductal epithelial proliferation * highlighted with a smooth muscle actin, smooth muscle myosin heavy chain, or p63 immunostain

Answer 10

Syringomatous adenoma of the nipple * benign, locally infiltrating neoplasm histologically similar to the tumor of the skin * does not appear to arise from skin, and it is not typically associated with intraductal epithelial proliferation * should be distinguished from florid papillomatosis of the nipple (nipple adenoma). * small tubular and ductular structures with elongated architecture in a teardrop shape * infiltrative pattern that should not be confused with an invasive carcinoma * ducts are lined by one or more layers of small uniform cells

Answer 11

Gynecomastia * intraductal epithelial hyperplasia and periductal increased cellularity and edema * 3 stages * early florid, intermediate, and late inactive or fibrotic * may be seen in the female breast * most common lesion of the male breast * bimodal distribution but may be seen at any age * affects 30% to 60% of boys and 30% of adults * most are ER positive * occasionally, breast lobules may be seen * a/w hyperthyroidism; cirrhosis; chronic renal failure; use of hormones; and use of numerous common drugs (digitalis, cimetidine, and spironolactone) * NO increased incidence of breast carcinoma * Pseudogynecomastia may be seen in obese males because of lipomastia (i.e., fat in the breast, lacking glandular proliferation).

Answer 12

Location of Lesions in the Breast Skin * Angiosarcoma (anywhere radiation/obstruction) The terminal duct lobular unit * cystic disease * usual ductal hyperplasia * adenosis and sclerosing adenosis * atypical ductal or lobular hyperplasia * lobular and ductal carcinoma in situ * invasive lobular/ductal carcinoma * peripheral papilloma Nipple * Paget disease representing ductal carcinoma in situ arising in lactiferous ducts and extending into the epidermis * florid papillomatosis of the nipple (nipple adenoma) * Solitary intraductal papillomas * syringomatous adenoma of the nipple Subareolar * Solitary intraductal papillomas * abscess formation * lactiferous ducts with squamous metaplasia * Terminal duct obstruction leads to duct rupture proximally * Duct ectasia * subareolar sclerosing duct hyperplasia.

Answer 13

Breast Cancer Staging by American Joint Committee on Cancer Microinvasive breast cancer * Stage pN0(ITC) i * finding tumor cells that show no malignant activity (i.e., stromal reaction or mitotic activity spanning Stage pN1mi * Lymph node micrometastasis that spans 0.2 to 2 mm * If multiple lymph nodes show micrometastases but none shows a regular metastasis (i.e., \>2 mm) * if one of the metastases is greater than 2 mm, the pN(1-3) status corresponds to the total number of nodes that are positive regardless of their micrometastatic status The definition of inflammatory breast carcinoma (T4d) by AJCC criteria is largely a clinical definition. * Most of the skin is involved, showing diffuse erythema and edema (peau d’orange). * The presence of carcinoma in the skin or dermal lymphatics, although closely associated with inflammatory breast cancer, is insufficient for the diagnosis. * If no clinical evidence of inflammatory breast cancer is present, the staging of tumor involving the skin is based on its overall size or whether there is skin ulceration or satellite skin nodules (T4b). * Conversely, any amount of tumor anywhere in the breast, whether or not involving the skin, in the presence of clinical evidence of inflammatory breast cancer is inflammatory breast carcinoma. T4a * carcinoma extension to chest wall (includes ribs, intercostal muscle, and serratus anterior muscle) but does not include invasion of pectoralis muscle only.

Answer 14

Breast Cancer—Her2/neu * Amplification of the HER2/Neu (ERBB2) gene, with associated HER2 protein overexpression and constitutive activation of its tyrosine kinase activity, is more frequent in ER/PR-negative breast cancers and is an independent indicator of poor prognosis. * More importantly, ERBB2 is a target of, and ERBB2 amplification is a marker of, sensitivity to treatment with trastuzumab (Herceptin). In addition, the small tyrosine kinase inhibitor (TKI) lapatinib, and the new anti-HER2 antibody, pertuzumab, which targets a different HER2 epitope, have been shown to be effective in HER2 amplified breast cancer. The latter has been shown to improve progression-free survival rate by almost 50% in patients with advanced breast cancer, when added to docetaxel and trastuzumab. * Although semiquantitative immunohistochemical tests for protein expression, such as Herceptest, are convenient, variability of antigen preservation and retrieval, as well as interobserver variability in interpretation, make immunohistochemistry a less reliable predictor of response than FISH. The American Society of Clinical Oncology and College of American Pathologists have issued guidelines for evaluating the HER2 status of breast tumors. * Resistance to trastuzumab is poorly understood, and many mechanisms may be involved, including loss of the ERBB2 external domain, overexpression of MUC4, increased transcription of ERBB2, and bypassing EGFR signaling by activation of downstream pathways, especially the PI3-kinase/mTOR pathway, including activating PIK3CA mutations and loss of PTEN. * One means of overcoming resistance is treatment with mTOR pathway inhibitors, such as everolimus. Although modest responses have been shown in pretreated patients, clinical trials to evaluate the drug in combination with chemotherapy and trastuzumab are underway. * Trastuzumab has also been shown to be active in HER2 amplified/overexpressing adenocarcinoma of the stomach and distal esophagus. The criteria for immunohistochemical and FISH evaluation from the ToGA trial that showed this benefit differed from the CAP/ASCO criteria, although a recent publication from Memorial Sloan Kettering shows that the CAP/ASCO criteria may be adequate.