breast cancer

Question 1

ductal carcinoma in situ: histologic definition, presentation

Answer 1

malignant proliferation of cells in ducts without invasion of the basement membrane. often detected as calcification on mammography. does not usually produce a mass. histologic subtypes are based on architecture; comedo type is characterized by high grade cells with necrosis and dystrophic calcification in the center of the ducts.

Question 2

What are benign conditions associated with mammographic calcification?

Answer 2

fibrocystic change (esp. scelorosing adenosis and fat necrosis)

Question 3

paget disease of the breast

Answer 3

ductal carcinoma in situ that extends up the ducts to involve the skin of the nipple. presents as ulceration and erythema. almost always associated with an underlying malignancy

Question 4

invasive ductal carcinoma

Answer 4

forms duct like structures. most common invasive carcinoma of the breast (>80%). presents as a mass detected by physical exam or mammography. masses are detected clinically at 2 cm, mammographically at 1 cm. advanced masses may cause dimpling or nipple retraction. biopsy shows duct like structures in a desmoplastic stroma (CT growing with the cancer)

Question 5

subtypes of invasive ductal carcinoma. include histo, prognosis, presentation.

Answer 5

1. tubular carcinoma: well-differentiated tubules that lack myoepthelial cells. relatively good prognosis.
2. mucinous carcinoma: carcinoma with abundant extracellular mucin (tumor cells in a mucus pool). usually seen in older women; relatively good prognosis.
3. medullary carcinoma: large, high grade cells in sheets with associated lymphocytes and plasma cells. grows as a well-circumscribed mass that can mimic fibroadenoma on mammography. relatively good prognosis. incr. incidence in BRCA1 carriers.
4. inflammatory carcinoma: carcinoma in dermal lymphatics. presents as an inflammed, swollen brease with no discrete mass. may be mistaken for acute mastitis. poor prognosis.

Question 6

lobular carcinoma in situ: histo, presentation, treatment.

Answer 6

malignant proliferation of the cells in lobules with no invasion of the basement membrane. does not produce a mass or calcifications- discovered incidentally on biopsy. characterized by dyscohesive cells lacking E-cadherin adhesion protein. often multifocal and bilateral. tx: tamoxifen and close follow up; low risk of progression ot invasive carcinoma.

Question 7

invasive lobular carcinoma

Answer 7

invasive carcinoma that characteristically grows in a single-file pattern. cells may exhibit signet ring morphology. no duct formation because no E-cadherin.

Question 8

What is the importance of estrogen and progestin receptors in breast cancer? where are they located? what about her2neu?

Answer 8

presence suggests response to antiestrogenic agents. both receptors are located in the nucleus. her2 neu is on the surface of the receptor.

Question 9

male breast cancer: presentation, risk associations

Answer 9

rare. usually presents as a subareolar mass in older males (highest breast density is underneath the nipple). usually invasive ductal carcinoma. associated with BRCA2 mutations and Klinefelter syndrome