Breast Cancer Pathology Flashcards
The incidence of breast cancer increased in the 1980s due to _______________.
increased screening
Breast cancer dropped in the early 2000s due to ______________.
the stopping of long-term hormone-replacement therapy
The vast majority of breast cancers (70% - 80%) are __________.
sporadic
About _____ percent of breast cancer is due to BRCA mutations.
10 - 20
Although most hereditary breast cancer is due to BRCA, there are many other genes implicated in familial breast cancer: ___________.
PTEN, p53, and CHEK2
The most common tumors of the breast are _______________.
epithelial tumors (from the lining of the ducts and lobules) Note: tumors can also arise from the stroma and lymphoid tissue.
What are the three stages of epithelial hyperplasia in the breast?
Usual ductal hyperplasia Atypical ductal hyperplasia CIS
Paget’s disease arises from ___________ epithelium.
ductal
CIS can be cured with _______________.
surgery
Low-grade DCIS often expresses ____________, but is Her2/neu-negative. High-grade DCIS is just the opposite.
hormone receptors
Paget’s disease starts out as _____________.
crusty, dry nipples
What cells are typical of Paget’s disease?
Large cells with cleared-out cytoplasm
LCIS looks really ________________.
monotonous
How is lobular carcinoma distinguished from ductal carcinoma?
Lobular Lacks E-cadherin and ductal has it.
_____________ is often multicentric and bilateral.
LCIS
Invasive carcinoma most often arises in the __________ quadrant.
superolateral
_______________ can invade dermal lymphatics.
Invasive inflammatory
True or false: ductal carcinoma has a worse prognosis.
False. If matched stage for stage, ductal and lobular carcinomas have the same prognosis.
Which carcinoma presents as “Indian file” lines?
Invasive lobular carcinoma
_____________ is a type of ductal carcinoma that has an excellent prognosis.
Tubular carcinoma
Mucinous carcinoma tends to express ____________.
hormone expression
Talk about how hormone receptors and Her2/neu affect prognosis.
Best prognosis: hormone receptor positive Intermediate prognosis: Her2/neu positive Worst prognosis: negative for ER, PR, and Her2/neu
_______________ will appear with few epithelial cells and lots of pale material.
Mucinous carcinoma
What is the exception to the rule that triple-negative breast cancers have a poor prognosis?
Medullary carcinoma It is negative for all, but typically has a good prognosis.
Medullary carcinoma presents with ______________.
lymphocytic infiltrate and syncytial growth
______________ is not encapsulated but is still strangely well circumscribed.
Medullary carcinoma
Metaplastic carcinoma typically grows very fast and can present with _______________ on histologic examination. It can develop out of invasive ductal carcinoma.
heterologous tissue growth (like bone)
Which neoplasm can present with either lack of differentiation or chondroid-like growth?
Metaplastic carcinoma
Radiation therapy raises future risk of _______________.
angiosarcoma, a stromal tumor
Where does the name phyllodes come from?
Leaf-like! Phylogeny = branching like a leaf
Which hematologic malignancy “loves” to home in on carcinomas of the breast?
CLL (which can often appear alongside a breast tumor)
Most breast neoplasms have what molecular signature?
ER + Her2/neu –
What molecular signature is associated with breast cancers arising from Li-Fraumeni syndrome?
Her2/neu +
Which chromosome is the Her2 gene on?
17 (Think of the Broken Social Scene song “Anthems for a 17-Year-Old Girl.”)
What type of protein is BRCA?
Tumor suppressor (both types)
_____________ presents with expanded ducts with punched out holes.
DCIS
In terms of risk, what is the difference between DCIS and LCIS?
LCIS raises risk of cancer bilaterally while DCIS raises risk of cancer ipsilaterally.
What type of breast cancer presents with sparse stroma, no mucin, and occasional bizarre giant cells?
Medullary carcinoma
______________ raises risk of breast sarcoma.
Radiation (say, from a prior breast cancer)
Her2 is found on the _________ chromosome.
17th
For breast cancer, what’s the difference between stage II and stage III?
III has more than 3 lymph nodes involved
Which two cancers do not overexpress Her2/neu?
Medullary and mucinous
What is metaplastic carcinoma?
Any carcinoma with non-glandular growth (such as squamous cell, spindle cell, or heterologous cancer) These are usually ER/PR-negative
The majority of breast cancers proceed down the ____________ molecular pathway.
ER-positive
Only about _________ percent of breast cancers are Her2-positive.
20
list the syndromes associated with heritable breast cancers (4)
1) Li-Fraumeni syndrome (TP53 mutation, 5% of familial cancer)
2) Cowden syndrome (PTEN mutation, 1% of familial cancer)
3) Peutz-Jeghers syndrome (STK11/LKB1 mutation, 1% of familial cancer)
4) CHEK2 mutation (5% of familial cancers)
what is this imaige?
Pagets disease
what is in the left and right images
left = LCIS
right = DCIS
which malignant breast disease has a loss of cadherin?
LCIS, invasive lobular carcinoma (ILC)
what is this?
Invasive lobular carcinoma
-lose e cadherin, express hormone receptors, doesnt express HER2/Neu
describe the metastasis pattern of invasive lobular carcinoma (ILC)
to the CSF, GI, and ovaries mostly
-less frequent to the lungs and pleura (different from IDC)
whats this?
tubular carcinoma
whats this?
mucinous carcinoma
whats this?
medullary carcinoma
whats this?
metaplastic carcinoma
what cancer typically arises in association with poorly differentiated ductal carcinoma?
metaplastic carcinoma
whats this?
angiosarcoma
describe angiosarcomas
dervied from blood vessels, most common primary breast sarcoma
arise (1) spontaneously (2) after radiation (3) with chronic edema - Stewart Treves Syndrome
what is Stewart Treves syndrome
edema from lymphatic destruction (breast cancer treatment)
whats this?
phyllodes tumor
whats this?
lymphoma of the breast
