Breast Cancer: Pathoma

Question 1

Which CIS is detected as calcifications on mammogram?

Answer 1

DCIS, bound by the BM.

If they walk up lactiferous duct => Paget disease of the nipple.

Question 2

What BENIGN lesions undergo calcifications, which can be detected by a mammogram?

Answer 2

1. Fat necrosis
2. Sclerosing adenosis

Question 3

What is this

Answer 3

Paget Disease of the nipple:

Large cells (bigger than keratinocytes) in the epidermis w pale cytoplasm that contains mucopolysaccharide seen on PAS stain.

Question 4

What is the most common type of invasive carcinoma?

Answer 4

Invasive ductal carcinoma, wihch forms duct like structures.

Question 5

How does invasive ductal carcinoma present?

Answer 5

• Mass detected by PE (2-3cm) or mammogram (1cm)

Question 6

Advanced invasive cancer can cause what findings?

Answer 6

1. Skin dimpling
2. Nipple retraction

Question 7

Invasive ductal carcinoma

What do we see on biopsy?

Answer 7

Duct-like structures in a desmoplastic stroma

Question 8

Subtypes of Invasive ductal carcinoma (4)

Answer 8

1. Tubular carcinoma
2. Mucinous carcinoma
3. Medullary carcinoma
4. Inflammatory carcinoma

Question 9

What is this?

Answer 9

• Tubular carcinoma
  
  • Ducts are lined by ONE type of cell
  • Desmoplastic stroma
  • Excellent prognosis

Question 10

What is this?

Answer 10

Mucinous carcinoma

• Malignant cells are floating in pools of mucus
• Excellent prognosis
• Usually occurs in elderly women

Question 11

What is this?

What could be a DDX?

Answer 11

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

Question 12

Medullary carcinoma

• Histology
• Mammogram finding
• Increased incidence in who
• Prognosis

Answer 12

• 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

Question 13

LCIS

• How is it discovered?
• Special feature
• Treatment

Answer 13

• 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.

Question 14

What is this?

Answer 14

• Invasive lobular carcinoma
  
  • Cells grow in a single-file pattern
  • Exhibit signet-ring morphology.
  • No ducts form bc no E-cadherin

Question 15

Prognosis of breast cancer

• Most important factor
• More useful factor
  *

Answer 15

• Based on TNM staging
  
  • Most important = metasis
  • More useful = spread to axillary LN bc most patients dont metastize

Question 16

How do we access spread to axillary LN?

Answer 16

Sentinal LN biopsy

Question 17

What is the purpose of the predictive factors?

Answer 17

Predict RESPONSE to treatment

Question 18

ER+ or PR+ cancers will respond to what treatment?

Answer 18

Antiestrogenic therapies (Tamoxifin)

Question 19

HER2/neu amplification can be treated with

Answer 19

Trastuzumab (Herceptin), an antibody directed against HER2 receptor

Question 20

HER2-R is located where?

Answer 20

Cell surface

Question 21

Which predictive markers have the worst prognosis?

Who is most likely to get?

Answer 21

Triple negative tumors; AA women

Question 22

If a patient presents with cancer premenopausal or multiple tumors, it is more likely to be what kind of cancer?

Answer 22

Hereditary breast cancer

Question 23

Male breast cancer

• How does it usually present?
• Usually, what type of cancer?
• Associated with what?

Answer 23

• Subareolar mass under the nipple in older males; can cause nipple discharge
• Invasive ductal carcinoma
• BRCA2 mutation/Klinefelter syndrome