Breast Cancer: Pathoma Flashcards
Which CIS is detected as calcifications on mammogram?
DCIS, bound by the BM.
If they walk up lactiferous duct => Paget disease of the nipple.
What BENIGN lesions undergo calcifications, which can be detected by a mammogram?
- Fat necrosis
- Sclerosing adenosis
What is this
Paget Disease of the nipple:
Large cells (bigger than keratinocytes) in the epidermis w pale cytoplasm that contains mucopolysaccharide seen on PAS stain.
What is the most common type of invasive carcinoma?
Invasive ductal carcinoma, wihch forms duct like structures.
How does invasive ductal carcinoma present?
- Mass detected by PE (2-3cm) or mammogram (1cm)
Advanced invasive cancer can cause what findings?
- Skin dimpling
- Nipple retraction
Invasive ductal carcinoma
What do we see on biopsy?
Duct-like structures in a desmoplastic stroma
Subtypes of Invasive ductal carcinoma (4)
- Tubular carcinoma
- Mucinous carcinoma
- Medullary carcinoma
- Inflammatory carcinoma
What is this?
-
Tubular carcinoma
- Ducts are lined by ONE type of cell
- Desmoplastic stroma
- Excellent prognosis
What is this?
Mucinous carcinoma
- Malignant cells are floating in pools of mucus
- Excellent prognosis
- Usually occurs in elderly women
What is this?
What could be a DDX?
Inflammatory carcinoma
- Tumor cells in dermal lymphatic => decreases drainage from breast => swollen, erythematous breast
- Clinical pathologic entity: must see inflammation AND tumors in dermal lymphatics
- Bad prognosis
- DDx = acute mastitis
Medullary carcinoma
- Histology
- Mammogram finding
- Increased incidence in who
- Prognosis
- Large, high grade tumor cells surrounded many inflammatory cells (lymphocytes and plasma cells).
- Grows as a well-circumscribed mass that can mimic fibroadenoma on mammogram.
- Increased incidence in pts with BRCA1 mutations.
- Good prognosis
LCIS
- How is it discovered?
- Special feature
- Treatment
- Incidentally because it does not form calcification or mass.
- Multifocal and bilateral
- Treatment: RF for the future development of BC. Not excised. Tamoxifan and close follow-up.
What is this?
-
Invasive lobular carcinoma
- Cells grow in a single-file pattern
- Exhibit signet-ring morphology.
- No ducts form bc no E-cadherin
Prognosis of breast cancer
- Most important factor
- More useful factor
*
- Based on TNM staging
- Most important = metasis
- More useful = spread to axillary LN bc most patients dont metastize
How do we access spread to axillary LN?
Sentinal LN biopsy
What is the purpose of the predictive factors?
Predict RESPONSE to treatment
ER+ or PR+ cancers will respond to what treatment?
Antiestrogenic therapies (Tamoxifin)
HER2/neu amplification can be treated with
Trastuzumab (Herceptin), an antibody directed against HER2 receptor
HER2-R is located where?
Cell surface
Which predictive markers have the worst prognosis?
Who is most likely to get?
Triple negative tumors; AA women
If a patient presents with cancer premenopausal or multiple tumors, it is more likely to be what kind of cancer?
Hereditary breast cancer
Male breast cancer
- How does it usually present?
- Usually, what type of cancer?
- Associated with what?
- Subareolar mass under the nipple in older males; can cause nipple discharge
- Invasive ductal carcinoma
- BRCA2 mutation/Klinefelter syndrome
