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Breast Pathology > Breast Cancer > Flashcards

Breast Cancer Flashcards

1
Q

What is the most common carcinoma in women by incidence? What is the second most cause of cancer mortality in women?

A

Breast Cancer.

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2
Q

What are the risk factors for breast cancer?

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

What is ductal carcinoma in situ (DCIS)? How is it detected? Is there a mass? What is necessary for diagnosis?

A

Malignant proliferation of cells in ducts with no invasion of the basement membrane. Often detected as calcification on mammography. DCIS does not usually produce a mass. Biopsy of calcifications is often necessary to distinguish between benign and malignant conditions.

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4
Q

What are the histologic subtypes of ductal carcinoma in situ based on?

A

Architecture

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5
Q

What is the Comedo type of ductal carcinoma in situ characterized by?

A

High-grade cells with necrosis and dystrophic calcification in the center of ducts.

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6
Q

What are the two types of ductal carcinoma in situ?

A
  1. Comedo type and 2. Paget disease of the breast
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7
Q

What are the two types of ductal carcinoma in situ?

A
  1. Comedo type and 2. Paget disease of the breast
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8
Q

What is Paget disease of the breast? How does it present? What is it associated with?

A

Ductal carcinoma in situ that extends up the ducts to invovle the skin of the nipple. Presents as nipple ulceration and erythema. Almost always associated with an underlying carcinoma.

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9
Q

How is invasive ductal carcinoma detected? What is the size of masses clinically detected? Mammographically? What do advanced tumors do?

A

Detected by physical exam or by mamography. Clinically detected masses are usually 2 cm or greater. mamographically detected masses are usually 1 cm or greater. Advanced tumors may result in dimpling of the skin or retraction of the nipple.

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10
Q

What is seen on biopsy of invasive ductal carcinoma? What are the two types?

A

Duct like structures in a desmoplastic stroma. Special subtypes include 1. Tubular carcinoma 2. Mucinous carcinoma

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11
Q

What is the characteristic of tubular carcinoma? What is the prognosis?

A

Characterized by well differentiated tubules that LACK myoepithelial cells. Relatively good prognosis.

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12
Q

What is the characteristic of mucinous carcinoma? Which population does it target? What is the prognosis?

A

Characterized by carcinoma with abundant extracellular mucin. Tends to occur in older women (average age is 70 years). Relatively good pronosis.

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13
Q

What is seen on biopsy of invasive ductal carcinoma? What are the four types?

A

Duct like structures in a desmoplastic stroma. Special subtypes include 1. Tubular carcinoma 2. Mucinous carcinoma 3. Medullary carcinoma 4. Inflammatory carcinoma

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14
Q

What is the characteristic of tubular carcinoma? What is the prognosis?

A

Characterized by well differentiated tubules that LACK myoepithelial cells. Relatively good prognosis.

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15
Q

What is the characteristic of mucinous carcinoma? Which population does it target? What is the prognosis?

A

Characterized by carcinoma with abundant extracellular mucin. Tends to occur in older women (average age is 70 years). Relatively good prognosis.

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16
Q

What is the characteristic of medullary carcinoma? Which population does it target? What is the prognosis?

A

Characterized by large, high-grade cells growing in sheets with associated lymphocytes and plasma cells. Grows as a well-circumscribed mass that can mimic fibroadenoma on mammography. Relatively good prognosis. Increased incidence in BRCA1 carriers.

17
Q

What is the characteristic of inflammatory carcinoma? How does it present? What can it be mistaken as and how is it identified? What is the prognosis?

A

Characterized by carcinoma in dermal lymphatics. Presents classically as an inflamed, swollen breast with no discrete mass. Can be mistaken for acute mastitis which won’t resolve with antibiotic treatment. Poor prognosis

18
Q

What is lobular carcinoma in situ? Does it produce a mass? What is it characterized by? What is its distribution and treatment?

A

Malignant proliferation of cells in lobules with no invasion of the basement membrane. LCIS does not produce a mass or calcificaions and is an incidental finding. Characterized by dyscohesive cells lacking E-cadherin a

19
Q

What is lobular carcinoma in situ? Does it produce a mass? What is it characterized by? What is its distribution and treatment? What is the risk of progression to invasive carcinoma?

A

Malignant proliferation of cells in lobules with no invasion of the basement membrane. LCIS does not produce a mass or calcifications and is an incidental finding. Characterized by dyscohesive cells lacking E-cadherin adhesion protein. Often multifocal and bilateral. Treatment is tamoxifen and close follow up. Low risk.

20
Q

What is prognosis of breast cancer based on? What is the most important factor? What is the most useful factor? How is it assessed?

A

TNM staging. Metastasis is the most important factor but spread to axillary lymph Nodes is the most useful factor and is assessed by sentinel lymph node biopsy.

21
Q

What are the three predictive factors that predict response to treatment breast cancer?

A
  1. Estrogen receptor (ER) 2. Progesterone receptor (PR) 3. HER2/neu gene amplification (overexpression) status
22
Q

What is the presence of Estrogen receptor (ER) and Progesterone receptor (PR) associated with? Where are these receptors located?

A

Associated with reposne to antiestrogenic agents such as tamoxifen. Both receptors are located in the nucleus.

23
Q

What is HER2/neu gene amplification associated with? Where is this receptors located?

A

Associated with response to trastuzumab (Herceptin) which is a designer antibody directed against the HER2 receptor. HER2/neu is a growth factor receptor present on the cell surface

24
Q

What are ‘Triple negative’ tumors? What is their prognosis? Which population do they target?

A

Negative for ER, PR and HER2/new and have a poor prognosis. African women have an increased propensity to develop triple-negative cacinoma.

25
Q

What are ‘Triple negative’ tumors? What is their prognosis? Which population do they target?

A

Negative for ER, PR and HER2/new and have a poor prognosis. African women have an increased propensity to develop triple-negative carcinoma.

26
Q

What are ‘Triple negative’ tumors? What is their prognosis? Which population do they target?

A

Negative for ER, PR and HER2/new and have a poor prognosis. African women have an increased propensity to develop triple-negative carcinoma.

27
Q

What are the clinical features of hereditary breast cancer? How many cases of breast cancer do they represent?

A

Represents 10% of breast cancer. Clinical features include multiple first-degree relatives with breast cancer, tumor at an early age (premenopausal) and multiple tumors in a single patient.

28
Q

What two mutations are associated with hereditary breast cancer?

A

BRCA1 and BRCA2

29
Q

What is BRCA1 associated with?

A

Breast and ovarian carcinoma

30
Q

What is BRCA2 associated with?

A

Breast carcinoma in males

31
Q

What is the issue with bilateral mastectomy to avoid breast cancer development?

A

A small risk remains because breast tissue sometimes extends into the axilla or subcutaneous tissue of the chest wall.

32
Q

What is the issue with bilateral mastectomy to avoid breast cancer development?

A

A small risk remains because breast tissue sometimes extends into the axilla or subcutaneous tissue of the chest wall.

33
Q

What is the prevalence of male breast cancer? Where does it present? What can it produce? What is the most common histological subtype? What is it associated with?

A

Rare in males (1% of all breast cancers). Usually presents as a subareolar mass in older males. May produce a nipple discharge. Most common histological subtype is invasive ductal carcinoma. Associated with BRCA2 mutations and Klinefelter syndrome.

Breast Pathology (4 decks)

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