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1 STEP women patho > breast carcinoma 01-20 > Flashcards

breast carcinoma 01-20 Flashcards

1
Q

the most common carcinoma in women?

A

breast tumor

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2
Q

2nd most common cause of mortality in women?

A

breast tumor

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3
Q

risk to breast cancer related to …..

A

estrogen exposure

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4
Q

6 risk factors to breast carcinoma?

A
  1. Female gender
  2. Age - in postmenopausal women; exception - hereditary carcer
  3. Early menarche/late menopause
  4. Obesity - adipose tissue converts androstenedione (?) to estrogen)
  5. Atypical hyperplasia (x5
  6. First degree relative with breast cancer (mother, sister or daughter)
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5
Q
  1. ….
  2. Age - in postmenopausal women; exception - hereditary carcer
  3. Early menarche/late menopause
  4. Obesity - adipose tissue converts androstenedione (?) to estrogen)
  5. Atypical hyperplasia (x5
  6. First degree relative with breast cancer (mother, sister or daughter)
A
  1. Female gender
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6
Q
  1. Female gender
    2..
  2. Early menarche/late menopause
  3. Obesity - adipose tissue converts androstenedione (?) to estrogen)
  4. Atypical hyperplasia (x5
  5. First degree relative with breast cancer (mother, sister or daughter)
A
  1. Age - in postmenopausal women; exception - hereditary carcer
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7
Q
  1. Female gender
  2. Age - in postmenopausal women; exception - hereditary carcer
  3. ..
  4. Obesity - adipose tissue converts androstenedione (?) to estrogen)
  5. Atypical hyperplasia (x5
  6. First degree relative with breast cancer (mother, sister or daughter)
A
  1. Early menarche/late menopause
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8
Q
  1. Female gender
  2. Age - in postmenopausal women; exception - hereditary carcer
  3. Early menarche/late menopause
  4. ….
  5. Atypical hyperplasia (x5
  6. First degree relative with breast cancer (mother, sister or daughter)
A
  1. Obesity - adipose tissue converts androstenedione (?) to estrogen)
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9
Q
  1. Female gender
  2. Age - in postmenopausal women; exception - hereditary carcer
  3. Early menarche/late menopause
  4. Obesity - adipose tissue converts androstenedione (?) to estrogen)
  5. …..
  6. First degree relative with breast cancer (mother, sister or daughter)
A
  1. Atypical hyperplasia (x5
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10
Q
  1. Female gender
  2. Age - in postmenopausal women; exception - hereditary carcer
  3. Early menarche/late menopause
  4. Obesity - adipose tissue converts androstenedione (?) to estrogen)
  5. Atypical hyperplasia (x5
  6. …
A
  1. First degree relative with breast cancer (mother, sister or daughter)
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11
Q

Ductal carcinoma in situ (DCIS) definition?

A

malignant proliferation of cells in ducts with NO INVASION of the basement membrane

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12
Q

Ductal carcinoma in situ (DCIS) - detection/symptoms?

A

detected on mammography as calcification. Usually does not produce mass.

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13
Q

Calcification on mammography - what 3 diseases?

A

Ductal carcinoma in situ (DCIS)
Fibrocyctic changes (Especcially sclerosing adenosis) and fat necrosis (both are bening findings)

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14
Q

Ductal carcinoma in situ (DCIS) - confirm??

A

biopsy of calcification is necessary to distinguish between benign and malignant

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15
Q

Ductal carcinoma in situ (DCIS). Histologic subtypes are based on architecture. How looks comedo type?

A

High grade cells- aplink, bet nekerta basement membrane;
Centre: necrosis and dystrophic calcification in the center of the ducts.

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16
Q

High grade cells with necrosis (aplinkui) and dystrophic calcification in the center of the ducts?

A

Ductal carcinoma in situ (DCIS), comedo type

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17
Q

What is Paget disease of breast?

A

Ductal carcinoma in situ (DCIS) that extends up the ducts to involve the skin of the nipple.

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18
Q

Paget disease of breast - presentation?

A

nipple ulceration and erythema.
Always assoc. with underlying carcinoma (extramammary disease of paget - tumor of vulva - is present without underlying carcinoma)

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19
Q

nipple ulceration and erythema.
Always assoc. with underlying carcinoma?

A

Paget disease of breast

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20
Q

Invasive ductal carcinoma. Definition?

A

Invasive carcinoma that classically forms duct-like structures

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21
Q

most common invasive carcinoma? (80 proc)

A

Invasive ductal carcinoma.

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22
Q

Invasive ductal carcinoma. Symptoms?

A

detected by physical exam or mammography.
Firm, fibrous, rock-hard, sharp margin mass

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23
Q

Invasive ductal carcinoma. What size should be to detect by physical exam?

A

> 2 cm size

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24
Q

Invasive ductal carcinoma. What size should be to detect by mammography?

A

> 1 cm

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25
Q

Invasive ductal carcinoma. Advanced tumors - what symptoms may be?

A

dimpling of the skin or retraction of the nipple

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26
Q

Invasive ductal carcinoma. Biopsy?

A

Duct-like structures (cells) in a desmoplastic stroma

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27
Q

Invasive ductal carcinoma. types?

A

Tubular, mucinous, medullary, inflammatory

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28
Q

Invasive ductal carcinoma. Tubular carcinoma. Histology? prognosis?

A

well-differentiated tubules that lack myoepithelial cells.
Relatively good prognosis

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29
Q

well-differentiated tubules that lack myoepithelial cells.
Relatively good prognosis?

A

Invasive ductal carcinoma. Tubular carcinoma.

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30
Q

Invasive ductal carcinoma. Mucinous carcinoma. histology?

A

characterized by carcinoma with abundant extracellular mucin (,,tumor cells floating in a mucus pool”).

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31
Q

characterized by carcinoma with abundant extracellular mucin (,,tumor cells floating in a mucus pool”)?

A

Invasive ductal carcinoma. Mucinous carcinoma.

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32
Q

Invasive ductal carcinoma. Mucinous carcinoma. In what population and what prognosis?

A

in older women (>70 y/o);
relatively good prognosis

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33
Q

Invasive ductal carcinoma. Medullary carcinoma. Histology?

A

Large, HIGH-grade wells growing in sheets with associated lymphocytes and plasma cells

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34
Q

Large, HIGH-grade cells growing in sheets with associated lymphocytes and plasma cells?

A

Invasive ductal carcinoma. Medullary carcinoma.

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35
Q

Invasive ductal carcinoma. Medullary carcinoma. grows in what forms, what resembles? what prognosis?

A

grows as a well circumscribed mass that can mimic fibroadenoma on mammography;
relatively good prognosis

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36
Q

Invasive ductal carcinoma. Medullary carcinoma. what gene?

A

BRCA1 carriers

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37
Q

Invasive ductal carcinoma. Inflammatory carcinoma. Histology?

A

carcinoma in dermal lymphatics

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38
Q

carcinoma in dermal lymphatics?

A

Invasive ductal carcinoma. Inflammatory carcinoma.

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39
Q

Invasive ductal carcinoma. Inflammatory carcinoma. presentation? prognosis?

A

inflamed, swollen breast (tumor cells blocks drainage of lymphatics) with no discrete mass; can be mistaken for acute mastitis. ,,peu’d orange”
Prognosis - poor

40
Q

Lobular carcinoma in situ (LCIS) - definition?

A

malignant proliferation of cells in LOBULES with no invasion of the basement membrane

41
Q

malignant proliferation of cells in LOBULES with no invasion of the basement membrane?

A

Lobular carcinoma in situ (LCIS)

42
Q

Lobular carcinoma in situ (LCIS) - when is discovered?

A

incidentally on biopsy, because it does not produce mass or calcifications

43
Q

Discovered incidentally on biopsy, because it does not produce mass or calcifications?

A

Lobular carcinoma in situ (LCIS)

44
Q

Lobular carcinoma in situ (LCIS). how is characterized?

A

Dyscohesive cells lacking E-carherin adhesion protein

45
Q

Dyscohesive cells lacking E-carherin adhesion protein?

A

Lobular carcinoma in situ (LCIS).

46
Q

Lobular carcinoma in situ (LCIS). which side?

A

multifocal and bilateral

47
Q

Lobular carcinoma in situ (LCIS). treatment?

A

tamoxifen (to reduce risk of subsequent carcinoma) and close follow up.
tamoxifen - antiastrogen

48
Q

Lobular carcinoma in situ (LCIS). risk to progress to invasive carcinoma?

A

low

49
Q

Invasive lobular carcinoma. characterized grows?+ physical symptoms?

A

grows in single-file pattern; cells may exhibit signet-ring morphology + PALPALBLE MASS

50
Q

grows in single-file pattern; cells may exhibit signet-ring morphology?

A

Invasive lobular carcinoma.

51
Q

Invasive lobular carcinoma. whats about ductal formation?

A

no ductal formation due to lack of E-cadherin

52
Q

no ductal formation due to lack of E-cadherin?

A

Invasive lobular carcinoma.

53
Q

Prognostic factors. What is the most important?

A

metastasis. but usually patients present before metastasis occurs

54
Q

Prognostic factors. what is the most USEFUL prognostic factor (if metastasis are not present)?

A

spread to axillary lymph nodes

55
Q

Prognostic factors. What biopsy is performed when in lymph nodes?

A

sentinel lymph node biopsy

56
Q

Predictive factors predicts response to treatment. What are 3 most important?

A

Estrogen receptors (ER)
Progesteron receptors (PR)
HER2/neu gene amplification (overexpression) status.

57
Q

Predictive factors predicts response to treatment. If present ER and PR?

A

associated with response to ANTIESTROGENIC AGENTS (eg tamoxifen).

58
Q

Predictive factors predicts response to treatment. where are located ER and PR?

A

in nucleus

59
Q

Predictive factors predicts response to treatment. HER2/neu associated with what treatment?

A

response to trastuzumab (Herceptin).
Its antibody directed against HER2 receptors.

60
Q

Predictive factors predicts response to treatment. HER2/neu where is located?

A

its growth factor receptor present on the cell surface

61
Q

Predictive factors predicts response to treatment. Triple negative tumors. Prognosis? What population?

A

poor;
African americans

62
Q

Hereditary breast cancer. Prevalence?

A

10 proc.

63
Q

Hereditary breast cancer. Relations/risk factors?

A

multiple first-degree relatives with breast cancer, tumor at an early age (premenopausal), multiple tumors in a single patient.

64
Q

Hereditary breast cancer. What mutations?

A

BRCA1 and BRCA2 - most important single gene mutations assoc. with hereditary cancer.

65
Q

Hereditary breast cancer. BRCA1 - what cancers?

A

breast and ovarian carcinoma

66
Q

Hereditary breast cancer. BRCA2 - what cancers?

A

breast carcinoma in males

67
Q

breast and ovarian carcinoma?

A

BRCA1

68
Q

breast carcinoma in males?

A

BRCA2

69
Q

hereditary carcinoma. How to decrease risk?

A

bilateral mastectomy
Small risk remains, because breast tissue sometimes extends into the axilla or subcutaneous tissue of the chest wall.

70
Q

Male breast cancer. Prevalence?

A

1 proc.

71
Q

Male breast cancer. Presentation?

A

Subareolar mass in older males
(highest density of breast tissue in males is underneath the nipple)
May produce discharge

72
Q

Male breast cancer. what is the most common histologic type?

A

invasive ductal carcinoma
(lobular carcinoma is rare (the male breast develops very few lobules))

73
Q

Male breast cancer. assoc with what? 2

A

BRAC2 and Kleinfelter syndrome

74
Q

UW. what are invasive and what not?

A

noninvasive - DCIS and Paget disease
Invasive: Ductal carcinoma, lobular carcinoma, Inflammatory breast cancer

75
Q

UW. DCIS is precursor for what?

A

invasive ductal carcinoma

76
Q

UW. 2 female risk factors and what is protective?

A

risk - age and nuliparity
protective - breastfeeding

77
Q

UW. Normal breast, no symptoms, microcalcinations?

A

DCIS

78
Q

UW. DCIS is precursor for what?

A

Invasive ductal carcinoma

79
Q

UW. DCIS spreads to nipple?

A

Paget’s

80
Q

UW. DCIS histology?

A

Pleomorphic cells with prominent central necrosis without extension beyond the ductal basement membrane. + microcalcification (also in the centre)

81
Q

UW. Pagets - cross basement membrane?

A

No. It spreads from superficial DCIS into nipple skin without crossing the basement membrane.

82
Q

UW. Pagets - physical examination?

A

unilateral erythema and scale crust around the nipple

83
Q

UW table. Central necrosis?

A

DCIS

84
Q

UW table. Precancerous lesions?

A

DCIS -> invasive ductal carcinoma

85
Q

UW table. confined to ducts and lobules?

A

DCIS

86
Q

UW table. Eczematous nipple lesion?

A

Paget’s

87
Q

UW table. Extension of DCIS into ducts?

A

Paget’s

88
Q

UW. Usually triple-negative?

A

Invasive ductal - medulallary type

89
Q

UW. How is histology of medullary?

A

Solid sheets of vesicular, mitotically active cells + significant LYMPHOPLASMACYTIC (lymphocytes and plasma cells) infiltrate around and within tumor and pushing non-infiltrating border

90
Q

UW. Which more agressive - ductal or lobular carcinoma?

A

ductal

91
Q

UW. Unilateral, unifocal?

A

Invasive ductal

92
Q

UW. bilateral (20 proc.), frequently multifocal?

A

invasive lobular

93
Q

UW table. Mammary stoma invasion?

A

Invasive lobular

94
Q

UW. Why in peu’d orange people have lymphadenopathy (eg axillary)?

A

Tumor cells obstruct and spread to the dermal lymphatic spaces -> tends to metastasize to the lymphatic system.

95
Q

how differ peu’d orange and mastitis?

A

In mastitis systemic symptoms (fever, malaise, leukocytosis)

1 STEP women patho (4 decks)

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