Breast Cancer

Question 1

Stem; female who underwent mastectomy for breast tumor 5 years ago as well as parotidectomy for pleomorphic adenoma 10 years ago. Now, she presents with supraclavicular lymph node enlargement.

Q1: Investigation?
Q2: Imaging?

Answer 1

FNAC
..
US / Breast Mammogram / MRI

Question 2

Q3: What test to be done on FNA?

Answer 2

IHC / Receptor status (ER/PR)

Question 3

Q4. Which receptors by FNAC?

Answer 3

ER receptors / PR receptor / HER2 receptor

Question 4

Q5. Why is ER important?

Answer 4

Planning of treatment and prognosis

Question 5

Q6: What is HER2?

Answer 5

Oncogene, biomarker, transmembrane Human Epidermal growth factor receptor 2 and it is overexpressed in 15% of breast cancer cases and associated with bad prognosis.
Test: IHC, FISH.

Question 6

Q7.3 Differences between histology and cytology?

Answer 6

H; we can see the cells and surrounding tissue, complex and more invasive, gives more info
C; shows only cells, simple quicker and minimally invasive , gives less info

Question 7

Q8. When cytology is seemed inconclusive?

Answer 7

Incorrect sample or technique /
Inflammatory and blood cells can mask metastasis cells /
Poor labeling

Question 8

You are shown report of FNAC (C4 lesion):
Q9. What is C1, 2, 3, 4, 5?

Answer 8

C4– > Suspicious malignancy
1—insufficient 2—Benign 3—equivocal 5—Malignant

Question 9

Q10.What is adenocarcinoma?

Answer 9

Malignant tumor of epithelial origin with glandular pattern

Question 10

Q12: What hormonal therapy to give in pre- and post-menopausal?

Answer 10

Pre; Tamoxifen – > blocks estrogen receptor
Post; Aromatase inhibitor (Anastrozole) – > prevent peripheral conversion of estrogen

Question 11

Q13.Patient has redness around nipple, what does it mean?

Answer 11

Hyperemeia due to DDx; Paget’s / Eczema / mastitis

Question 12

Q14. What is the pathophysiology of Paget disease?

Answer 12

Extension of DCIS (ductal carcinoma in situ) up the lactiferous ducts and into the contiguous skin of the nipple producing a unilateral crusting exudate over the nipple and areolar skin

Question 13

Q. Paget cells?

Answer 13

Malignant epithelial cells drived from underlying Ductal adenocarcinoma of breast that invade into skin and nipple
These cells are large with round nuclei and large nucleoli and never invade dermal basement membrane

Question 14

Q. Relation between pleomorphic adenoma and breast adenocarcinoma

Answer 14

expression gland salivary and cancer breast (BASE)
Identification of a breast cancer gene that encodes a secreted protein designated BASE (breast cancer and salivary gland expression) even more supports the common biology of the tumors.

Question 15

Q.Mechanism of aromatase inhibitors

Answer 15

Aromatase inhibitors work by inhibiting the action of the enzyme aromatase, which converts androgens into estrogens by a process called aromatization. As breast tissue is stimulated by estrogens, decreasing their production is a way of suppressing recurrence of the breast tumor tissue