Breast Cancer Pathoma

Question 1

risk factors of breast cancer

Answer 1

estrogen exposure: female, age (postmenopausal), obesity, early menarche, late menopause (increased estrogen), atypical hyperplasia, family history- sister, mother, daughter

Question 2

what is ductal carcinoma insitu

Answer 2

this is malignant proliferation of the cells in the duct of the breast that does not invade the basement membrane

Question 3

how is ductal carcinoma detected

Answer 3

it is seen as calcification on mammography ( it does not typically present as a mass)

Question 4

mammography calcifications can also seen in benign lesions of the breast like?

Answer 4

fat necrosis + sclerosing adenosis

Question 5

if calcifications are found you must take a ____ to distinguish between benign and malignant conditions

Answer 5

biopsy

Question 6

what is the most common subtype of ductal cell carcinoma in situ

Answer 6

comedo type

Question 7

what is the comedo type of ductal cell carcinoma insitu

Answer 7

high grade cells with necrosis and dystrophic calcifications in the center of the ducts

Question 8

what is pagets disease of the brease

Answer 8

ductal cell carcinoma insitu that extends to the skin of the nipple

Question 9

presentation of Pagets disease

it is almost always associated with?

Answer 9

nipple ulceration and redness

underlying carcinoma

Question 10

what is invasive ductal carcinoma?

Answer 10

this is invasive carcinoma that extends into the connective tissue and forms duct like structures,

Question 11

presentation of IDC (invasive ductal carcinoma)

Answer 11

mass 2cm of greater on self exam

mass 1cm of greater on mammography

dimpling of the skin/retraction of the nipple

Question 12

biopsy of IDC shows?

Answer 12

desmoplastic stroma and duct like structures (stroma supports the tumor)

Question 13

what is tubular carcinoma (subtype of IDC)

Answer 13

invasive carcinoma that has well differentiated tubules and no myoepithelial cells (has a good prognosis)

Question 14

what is mucinous carcinoma (subtype of IDC)

Answer 14

invasive carcinoma with a large amount of mucin (tumor cells floating in mucus) - has a good prognosis and is typically seen in older women

Question 15

what is medullary carcinoma (subtype of IDC)

Answer 15

large high grade invasive carcinoma that is associated with inflammatory cells (lymphocytes and plasma cells)

has a good prognosis

Question 16

medullar carcinoma has an increased incidence in ___ carriers

Answer 16

BRCA1

Question 17

what is inflammatory carcinoma (IDC subtype)

Answer 17

carcinoma in the dermal lymphatics that blocks drainage (presents as a inflamed breast)

poor prognosis

Question 18

inflammatory carcinoma can be mistaken for?

Answer 18

acute mastitis

Question 19

what is lobular carcinoma insitu?

Answer 19

malignant proliferation of cells in the lobules that does not invade the basement membrane

Question 20

LCIS does not produce ?

Answer 20

calcifications or a mass on biopsy it is usually discovered incidentally

Question 21

LCIS is characterized by what types of cells, why?

Answer 21

dyscohesive cells because they lack E-Cadherin

Question 22

how does LCIS typically present

Answer 22

bilaterally and multifocally

Question 23

how do we treat LCIS

Answer 23

tamoxifen (antiestrogen)

Question 24

invasive lobular carcinoma is?

Answer 24

when LCIS invades the basement membrane and grows is a single file pattern (signet ring morphology)

Question 25

why does ILC create ducts?

Answer 25

because they lack E-Cadherin

Question 26

prognosis of breast cancer is based on?

Answer 26

TNM staging

Question 27

____ is the most important factor in breast carcinoma but most patients present before this occurs

Answer 27

metastasis

Question 28

spread to ____ is the most useful prognostic factor

Answer 28

axillary lymph nodes

Question 29

predictive factors in breast cancer predict the _____ to ____

Answer 29

response to treatment

Question 30

what are the 3 predictive factors in breast cancer?

Answer 30

ER receptors, PR receptors, HER2/neu amplification

Question 31

the presence of ER and PR is associated with response to ____ agents

Answer 31

antiestrogenic

Question 32

PR and ER receptors are present in the _____

Answer 32

nucleus

Question 33

HER2/Neu is a ________ and is associated in response to?

Answer 33

cell surface growth receptor

response to tratuzumab

Question 34

triple negative breast tumors have a poor prognosis and are more often seen in ____ ____ women

Answer 34

african american

Question 35

what are some signs that may indicate hereditary breast cancer?

Answer 35

multiple first degree relatives, tumor at an early age (most are postmenopausal), multiple tumors

Question 36

what are the most important single gene mutations in breast cancer?

Answer 36

BRCA1 and BRCA2

Question 37

BRCA1 is associated with both ____, _____, and ____ carcinoma

Answer 37

breast, ovarian, fallopian tube cancer

(medullary carcinoma)

Question 38

BRCA2 is associated with?

Answer 38

breast cancer in males

Question 39

breast cancer in males typically presents as?

Answer 39

a subareolar mass underneath the nipple with discharge

Question 40

what is the most common type of breast cancer in males

Answer 40

invasive ductal carcinoma because men have few lobules

Question 41

breast cancer of the male is associated with what mutation and what syndrome

Answer 41

BRCA2 mutation

klinefelter syndrome

Question 42

what is the mnemonic to remember the subtype of ductal carcinoma insitu

Answer 42

TMMI

tubular carcinoma
mucinous carcinoma
medullary carcinoma
inflammatory carcinoma