Breast

Question 1

Lesions arising from the lobules and terminal ducts

Answer 1

Cyst, sclerosing adenosis, small duct papilloma, hyperplasia, atypical hyperplasia, carcinoma

Question 2

Lesions arising from large ducts

Answer 2

Duct ectasia, squamous metaplasia, large duct papilloma, pagets

Question 3

lesions arising from intralobular stroma

Answer 3

Fibroadenoma, phyllodes

Question 4

lesions arising from interlobular stroma

Answer 4

fat necrosis, lipoma, fibromatosis, sarcoma

Question 5

Smoker, usually female, (usually) recurrent painful subareolar mass with tract opening at edge of areola. What am I?

Answer 5

Squamous metaplasia of lactiferous duct/periductal mastitis. Keratinising squamous metaplasia of the nipple ducts causing blockage, dilatation, rupture.

Question 6

Is duct ectasia associated with smoking?

Answer 6

No, generally with multiparity.

Question 7

Breast cancer mimic found in T1DM, autoimmune thyroid disease. Present with single or multiple hard masses or mammographic densities. Is not a cancer.

Answer 7

Lymphocytic mastopathy/sclerosing lymphocytic lobulitis

Question 8

Proliferative breast disease without atypia
- proliferation of epithelial cells without atypia, ax with small increased risk of subsequent carcinoma in either breast. 4 types:

Answer 8

epithelial hyperplasia
sclerosing adenosis - can have calcs
complex sclerosing lesion - can have components of the other 3
papilloma - 80% produce nipple dc. Can have calcs

Question 9

Causes of gynaecomastia

Answer 9

• increased estrogen:
• —cirrhosis
• —(relative increase) due to reduced testicular androgen production
• —steriods, alcohol, marijuana, HIV meds
• —Klinefelter
• —-Leydig or Sertoli cell tumours

Question 10

The four known susceptability genes for familial breast cancer and their function

Answer 10

BRCA1, BRCA2, TP53, CHEK2. All tumour suppressor genes and have roles in DNA repair.

Question 11

Cancers ax with BRCA1

Answer 11

breast, ovarian, male breast (although BRAC2 more), prostate, pancreas, fallopian tube

Question 12

Cancers ax with BRCA2

Answer 12

breast, ovarian, male breast, prostate, pancreas, stomach, melanoma, gallbladder, bile duct, pharynx.

Question 13

Cancers ax with TP53 (Li Fraumeni)

most common gene mutation in sporadic breast ca

Answer 13

prostate, thyroid, kidney, colon, sarcomas (osteosarcoma, rhabdomyosarcoma), CNS tumours (gliomas, choroid plexus carcinoma, medulloblastoma, neuroectodermal tumours), adrenal cortical carcinoma

Question 14

Cancers ax with CHEK2

Answer 14

prostate, thyroid, kidney, colon

Question 15

More likely to be bilateral out of DCIS and LCIS?

Answer 15

LCIS (20-40% vs 10-20%). LCIS is always an incidental biopsy finding, as it does not produce stromal reaction or calcification that can be seen on mammo. More likely to develop bilateral disease/cancer.

Question 16

Most common type of invasive carcinoma (in terms of ER, HER2 status)

Answer 16

ER+
HER2-
low proliferation more common than high proliferation.
*the high pro more likely in BRCA2.
*HER2+ more likely in familial cancers like Li Fraumeni
*Triple negative more likely in BRCA1. Rapidly growing and often present between mammos.

Question 17

All types of invasive carcinoma are graded using the Nottingham Histologic Score. Three components to the score:

Answer 17

Tubule formation, nuclear pleomorphism and mitotic rate.
Grade I: well differentiated
Grade II: mod differentiated
Grade III: poorly differentiated

Question 18

Invasive Lobular Carcinoma - loss of expression of what gene? And spread of disease to where?

Answer 18

CDH1, E cadherin loss.
Characteristic spread of disease to peritoneum, retroperitoneum, leptomeninges, GIT, ovaries and uterus.
M + F with this mutation are also at greater risk of gastric signet ring cell carcinoma

Question 19

Most important prognostic factor for invasive carcinoma in the absence of distant mets

Answer 19

Axillary lymph node status.

Question 20

Most common primary breast lymphoma

Answer 20

Non-Hodgkin lymphoma, B-cell