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Pathoma Breast Pathology > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What is the most common carcinoma in women by incidence (excluding skin)?

A

breast

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2
Q

breast cancer is the Xth most common cause of cancer mortality in women

A

2nd

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3
Q

Name six risk factors for breast cancer

A
  1. Female gender
  2. Age
  3. Early menarche/late menopause
  4. Obesity
  5. Atypical hyperplasia
  6. First-degree relative (mother, sister, daughter) with breast cancer
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4
Q

what do you call a malignant proliferation of cells in ducts with no invasion of the basement membrane?

A

ductal carcinoma in situ

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5
Q

how is DCIS usually detected?

A

calcification on mammography; DCIS does not produce a mass

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6
Q

mammographic calcifications can also be associated with benign conditions such as

A

fibrocystic changes (especially sclerosing adenoma) and fat necrosis

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7
Q

how do you know whether mammographic calcifications are benign or malignant?

A

biopsy

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8
Q

histologic subtypes of DCIS are based on

A

architecture

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9
Q

what is the subtype of DCIS that is characterized by high-grade cells with necrosis and dystrophic calcification in the center of ducts

A

comedo

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10
Q

what do you call DCIS that extends up the ducts to involve the skin of the nipple

A

pager’s disease of the breast

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11
Q

Paget disease of the breast presents as

A

nipple ulceration and erythema

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12
Q

paget disease of the breast is almost always associated with an underlying

A

carcinoma

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13
Q

what do you call an invasive breast carcinoma that classically forms duct-like structures?

A

invasive ductal carcinoma

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14
Q

what is the most common type of invasive carcinoma in the breast, accounting for >80% of cases

A

invasive ductal carcinoma

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15
Q

how does invasive ductal carcinoma usually present

A

mass on physical exam or mammography

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16
Q

clinically (PE) detected breast masses are usually at least what size

A

2 cm

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17
Q

mammographically detected breast masses are usually at least what size

A

1 cm

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18
Q

advanced breast tumors may result in

A

dimpling of the skin or retraction of the nipple

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19
Q

biopsy of invasive ductal carcinoma usually shows duct-like structures in a

A

desmoplasic stroma

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20
Q

subtype of invasive ductal carcinoma that is characterized by well-differentiated tubules that lack myopeithelial cells?

A

tubular carcinoma

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21
Q

subtype of invasive ductal carcinoma that is characterized by carcinoma with abundant extracellular mucin (tumor cells floating in a mucus pool)?

A

mucinous carcinoma

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22
Q

what is the typical population of the mucinous subtype of invasive ductal carcinoma?

A

older women (average age is 70)

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23
Q

subtype of invasive ductal carcinoma that is characterized by large, high-grade cells growing in sheets with associated with lymphocytes and plasma cells

A

medullary carcinoma

24
Q

grows as a well-circumscribed mass that can mimic fibroadenoma on mammography; increased incidence in BRCA1 carriers

A

medullary carcinoma (invasive ductal)

25
Q

subtype of invasive ductal carcinoma that is characterized by carcinoma in dermal lymphatics

A

inflammatory carcinoma

26
Q

presents as an inflamed, swollen breast (tumor cells block drainage of lymphatics) with no discrete mass; can be mistaken for acute mastitis

A

inflammatory carcinoma (invasive ductal)

27
Q

which subtype of invasive ductal carcinoma has the worst prognosis?

A

inflammatory

28
Q

malignant proliferation of cells in lobules with no invasion of the basement membrane

A

LCIS

29
Q

how is LCIS discovered?

A

incidentally on biopsy (!) - it doesn’t produce a mass or calcifications

30
Q

histology of LCIS

A

dyscohesive cells lacking E-cadherin adhesion protein

31
Q

LCIS is characterized by dyscohesive cells lacking WHAT?

A

E-cadherin adhesion protein

32
Q

Besides being undetectable except by incidental biopsy, what other features of LCIS make it scary?

A

usually multifocal and bilateral

33
Q

how do you treat LCIS?

A

tamoxifen (to reduce the risk of subsequent carcinoma) and close followup

34
Q

LCIS risk of progression to invasive carcinoma?

A

low

35
Q

invasive carcinoma that characteristically grows in a single-file pattern; cells may exhibit signet-ring morphology

A

invasive lobular carcinoma

36
Q

why is there no duct formation in invasive lobular carcinoma?

A

lack of E-caherin

37
Q

what is the most important factor in breast cancer prognosis?

A

metastasis, but most patients present before metastasis occurs

38
Q

what is the most useful prognostic factor in breast cancer?

A

spread to axillary lymph nodes; sentinel lymph node biospy is used to assess axillary lymph nodes

39
Q

what do you call factors that predict response to treatment

A

predictive factors

40
Q

what are the most important predictive factors

A 
estrogen receptor (ER),
progesterone receptor (PR).
Her2/neu amplification (overexpression) status
41
Q

Presence of ER and PR is associated with response to

A

antiestrogenic agents (eg tamoxifen)

42
Q

ER and PR are located where?

A

in the nucleus

43
Q

HER2/neu amplification with response to

A

trastuxumab (Herceptin)

44
Q

what is trastuxumab?

A

a designer antibody directed against the HER2 receptor

45
Q

What is HER2/neu?

A

a growth factor receipt present on the cell surface

46
Q

what do you call a tumor that is negative for ER, PR, and HER2/neu

A

triple negative tuomr

47
Q

what is the prognosis of triple negative tumors?

A

poor

48
Q

what population has increased risk of developing rip negative carcinomas?

A

African American women

49
Q

Hereditary breast cancer represents what percentage of breast cancer cases?

A

10%

50
Q

what are three clinical factors that suggest hereditary breast cancer?

A
  1. multiple first-degree relatives with breast cancer
  2. tumor at an early age (premenopausal)
  3. multiple tumors in a single patient
51
Q

what are the two most important single gene mutations associated with hereditary breast cancer?

A

BRCA1 and BRAC2

52
Q

Mutation associated with breast and ovarian carcinomas

A

BRCA1

53
Q

Mutation associated with breast carcinoma in males

A

BRCA2

54
Q

women with a genetic predisposition to breast cancer may choose to undergo WHAT to reduce the risk of developing carcinoma

A

bilateral mastectomy

55
Q

why does a small risk for breast cancer remain after bilateral mastectomy?

A

breast tissue sometimes extends into the axilla or subcutaneous tissue of the chest wall

Pathoma Breast Pathology (3 decks)

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