Breast Cancer Pathoma Flashcards
risk factors of breast cancer
estrogen exposure: female, age (postmenopausal), obesity, early menarche, late menopause (increased estrogen), atypical hyperplasia, family history- sister, mother, daughter
what is ductal carcinoma insitu
this is malignant proliferation of the cells in the duct of the breast that does not invade the basement membrane
how is ductal carcinoma detected
it is seen as calcification on mammography ( it does not typically present as a mass)
mammography calcifications can also seen in benign lesions of the breast like?
fat necrosis + sclerosing adenosis
if calcifications are found you must take a ____ to distinguish between benign and malignant conditions
biopsy
what is the most common subtype of ductal cell carcinoma in situ
comedo type
what is the comedo type of ductal cell carcinoma insitu
high grade cells with necrosis and dystrophic calcifications in the center of the ducts
what is pagets disease of the brease
ductal cell carcinoma insitu that extends to the skin of the nipple
presentation of Pagets disease
it is almost always associated with?
nipple ulceration and redness
underlying carcinoma
what is invasive ductal carcinoma?
this is invasive carcinoma that extends into the connective tissue and forms duct like structures,
presentation of IDC (invasive ductal carcinoma)
mass 2cm of greater on self exam
mass 1cm of greater on mammography
dimpling of the skin/retraction of the nipple
biopsy of IDC shows?
desmoplastic stroma and duct like structures (stroma supports the tumor)
what is tubular carcinoma (subtype of IDC)
invasive carcinoma that has well differentiated tubules and no myoepithelial cells (has a good prognosis)
what is mucinous carcinoma (subtype of IDC)
invasive carcinoma with a large amount of mucin (tumor cells floating in mucus) - has a good prognosis and is typically seen in older women
what is medullary carcinoma (subtype of IDC)
large high grade invasive carcinoma that is associated with inflammatory cells (lymphocytes and plasma cells)
has a good prognosis
medullar carcinoma has an increased incidence in ___ carriers
BRCA1
what is inflammatory carcinoma (IDC subtype)
carcinoma in the dermal lymphatics that blocks drainage (presents as a inflamed breast)
poor prognosis
inflammatory carcinoma can be mistaken for?
acute mastitis
what is lobular carcinoma insitu?
malignant proliferation of cells in the lobules that does not invade the basement membrane
LCIS does not produce ?
calcifications or a mass on biopsy it is usually discovered incidentally
LCIS is characterized by what types of cells, why?
dyscohesive cells because they lack E-Cadherin
how does LCIS typically present
bilaterally and multifocally
how do we treat LCIS
tamoxifen (antiestrogen)
invasive lobular carcinoma is?
when LCIS invades the basement membrane and grows is a single file pattern (signet ring morphology)
why does ILC create ducts?
because they lack E-Cadherin
prognosis of breast cancer is based on?
TNM staging
____ is the most important factor in breast carcinoma but most patients present before this occurs
metastasis
spread to ____ is the most useful prognostic factor
axillary lymph nodes
predictive factors in breast cancer predict the _____ to ____
response to treatment
what are the 3 predictive factors in breast cancer?
ER receptors, PR receptors, HER2/neu amplification
the presence of ER and PR is associated with response to ____ agents
antiestrogenic
PR and ER receptors are present in the _____
nucleus
HER2/Neu is a ________ and is associated in response to?
cell surface growth receptor
response to tratuzumab
triple negative breast tumors have a poor prognosis and are more often seen in ____ ____ women
african american
what are some signs that may indicate hereditary breast cancer?
multiple first degree relatives, tumor at an early age (most are postmenopausal), multiple tumors
what are the most important single gene mutations in breast cancer?
BRCA1 and BRCA2
BRCA1 is associated with both ____, _____, and ____ carcinoma
breast, ovarian, fallopian tube cancer
(medullary carcinoma)
BRCA2 is associated with?
breast cancer in males
breast cancer in males typically presents as?
a subareolar mass underneath the nipple with discharge
what is the most common type of breast cancer in males
invasive ductal carcinoma because men have few lobules
breast cancer of the male is associated with what mutation and what syndrome
BRCA2 mutation
klinefelter syndrome
what is the mnemonic to remember the subtype of ductal carcinoma insitu
TMMI
tubular carcinoma
mucinous carcinoma
medullary carcinoma
inflammatory carcinoma
