breast carcinoma 01-20 Flashcards
1
Q
the most common carcinoma in women?
A
breast tumor
2
Q
2nd most common cause of mortality in women?
A
breast tumor
3
Q
risk to breast cancer related to …..
A
estrogen exposure
4
Q
6 risk factors to breast carcinoma?
A
- Female gender
- Age - in postmenopausal women; exception - hereditary carcer
- Early menarche/late menopause
- Obesity - adipose tissue converts androstenedione (?) to estrogen)
- Atypical hyperplasia (x5
- First degree relative with breast cancer (mother, sister or daughter)
5
Q
- ….
- Age - in postmenopausal women; exception - hereditary carcer
- Early menarche/late menopause
- Obesity - adipose tissue converts androstenedione (?) to estrogen)
- Atypical hyperplasia (x5
- First degree relative with breast cancer (mother, sister or daughter)
A
- Female gender
6
Q
- Female gender
2.. - Early menarche/late menopause
- Obesity - adipose tissue converts androstenedione (?) to estrogen)
- Atypical hyperplasia (x5
- First degree relative with breast cancer (mother, sister or daughter)
A
- Age - in postmenopausal women; exception - hereditary carcer
7
Q
- Female gender
- Age - in postmenopausal women; exception - hereditary carcer
- ..
- Obesity - adipose tissue converts androstenedione (?) to estrogen)
- Atypical hyperplasia (x5
- First degree relative with breast cancer (mother, sister or daughter)
A
- Early menarche/late menopause
8
Q
- Female gender
- Age - in postmenopausal women; exception - hereditary carcer
- Early menarche/late menopause
- ….
- Atypical hyperplasia (x5
- First degree relative with breast cancer (mother, sister or daughter)
A
- Obesity - adipose tissue converts androstenedione (?) to estrogen)
9
Q
- Female gender
- Age - in postmenopausal women; exception - hereditary carcer
- Early menarche/late menopause
- Obesity - adipose tissue converts androstenedione (?) to estrogen)
- …..
- First degree relative with breast cancer (mother, sister or daughter)
A
- Atypical hyperplasia (x5
10
Q
- Female gender
- Age - in postmenopausal women; exception - hereditary carcer
- Early menarche/late menopause
- Obesity - adipose tissue converts androstenedione (?) to estrogen)
- Atypical hyperplasia (x5
- …
A
- First degree relative with breast cancer (mother, sister or daughter)
11
Q
Ductal carcinoma in situ (DCIS) definition?
A
malignant proliferation of cells in ducts with NO INVASION of the basement membrane
12
Q
Ductal carcinoma in situ (DCIS) - detection/symptoms?
A
detected on mammography as calcification. Usually does not produce mass.
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)
14
Q
Ductal carcinoma in situ (DCIS) - confirm??
A
biopsy of calcification is necessary to distinguish between benign and malignant
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.
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
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.
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)
19
Q
nipple ulceration and erythema.
Always assoc. with underlying carcinoma?
A
Paget disease of breast
20
Q
Invasive ductal carcinoma. Definition?
A
Invasive carcinoma that classically forms duct-like structures
21
Q
most common invasive carcinoma? (80 proc)
A
Invasive ductal carcinoma.
22
Q
Invasive ductal carcinoma. Symptoms?
A
detected by physical exam or mammography.
Firm, fibrous, rock-hard, sharp margin mass
23
Q
Invasive ductal carcinoma. What size should be to detect by physical exam?
A
> 2 cm size
24
Q
Invasive ductal carcinoma. What size should be to detect by mammography?
A
> 1 cm
25
Invasive ductal carcinoma. Advanced tumors - what symptoms may be?
dimpling of the skin or retraction of the nipple
26
Invasive ductal carcinoma. Biopsy?
Duct-like structures (cells) in a desmoplastic stroma
27
Invasive ductal carcinoma. types?
Tubular, mucinous, medullary, inflammatory
28
Invasive ductal carcinoma. Tubular carcinoma. Histology? prognosis?
well-differentiated tubules that lack myoepithelial cells.
Relatively good prognosis
29
well-differentiated tubules that lack myoepithelial cells.
Relatively good prognosis?
Invasive ductal carcinoma. Tubular carcinoma.
30
Invasive ductal carcinoma. Mucinous carcinoma. histology?
characterized by carcinoma with abundant extracellular mucin (,,tumor cells floating in a mucus pool").
31
characterized by carcinoma with abundant extracellular mucin (,,tumor cells floating in a mucus pool")?
Invasive ductal carcinoma. Mucinous carcinoma.
32
Invasive ductal carcinoma. Mucinous carcinoma. In what population and what prognosis?
in older women (>70 y/o);
relatively good prognosis
33
Invasive ductal carcinoma. Medullary carcinoma. Histology?
Large, HIGH-grade wells growing in sheets with associated lymphocytes and plasma cells
34
Large, HIGH-grade cells growing in sheets with associated lymphocytes and plasma cells?
Invasive ductal carcinoma. Medullary carcinoma.
35
Invasive ductal carcinoma. Medullary carcinoma. grows in what forms, what resembles? what prognosis?
grows as a well circumscribed mass that can mimic fibroadenoma on mammography;
relatively good prognosis
36
Invasive ductal carcinoma. Medullary carcinoma. what gene?
BRCA1 carriers
37
Invasive ductal carcinoma. Inflammatory carcinoma. Histology?
carcinoma in dermal lymphatics
38
carcinoma in dermal lymphatics?
Invasive ductal carcinoma. Inflammatory carcinoma.
39
Invasive ductal carcinoma. Inflammatory carcinoma. presentation? prognosis?
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
Lobular carcinoma in situ (LCIS) - definition?
malignant proliferation of cells in LOBULES with no invasion of the basement membrane
41
malignant proliferation of cells in LOBULES with no invasion of the basement membrane?
Lobular carcinoma in situ (LCIS)
42
Lobular carcinoma in situ (LCIS) - when is discovered?
incidentally on biopsy, because it does not produce mass or calcifications
43
Discovered incidentally on biopsy, because it does not produce mass or calcifications?
Lobular carcinoma in situ (LCIS)
44
Lobular carcinoma in situ (LCIS). how is characterized?
Dyscohesive cells lacking E-carherin adhesion protein
45
Dyscohesive cells lacking E-carherin adhesion protein?
Lobular carcinoma in situ (LCIS).
46
Lobular carcinoma in situ (LCIS). which side?
multifocal and bilateral
47
Lobular carcinoma in situ (LCIS). treatment?
tamoxifen (to reduce risk of subsequent carcinoma) and close follow up.
tamoxifen - antiastrogen
48
Lobular carcinoma in situ (LCIS). risk to progress to invasive carcinoma?
low
49
Invasive lobular carcinoma. characterized grows?+ physical symptoms?
grows in single-file pattern; cells may exhibit signet-ring morphology + PALPALBLE MASS
50
grows in single-file pattern; cells may exhibit signet-ring morphology?
Invasive lobular carcinoma.
51
Invasive lobular carcinoma. whats about ductal formation?
no ductal formation due to lack of E-cadherin
52
no ductal formation due to lack of E-cadherin?
Invasive lobular carcinoma.
53
Prognostic factors. What is the most important?
metastasis. but usually patients present before metastasis occurs
54
Prognostic factors. what is the most USEFUL prognostic factor (if metastasis are not present)?
spread to axillary lymph nodes
55
Prognostic factors. What biopsy is performed when in lymph nodes?
sentinel lymph node biopsy
56
Predictive factors predicts response to treatment. What are 3 most important?
Estrogen receptors (ER)
Progesteron receptors (PR)
HER2/neu gene amplification (overexpression) status.
57
Predictive factors predicts response to treatment. If present ER and PR?
associated with response to ANTIESTROGENIC AGENTS (eg tamoxifen).
58
Predictive factors predicts response to treatment. where are located ER and PR?
in nucleus
59
Predictive factors predicts response to treatment. HER2/neu associated with what treatment?
response to trastuzumab (Herceptin).
Its antibody directed against HER2 receptors.
60
Predictive factors predicts response to treatment. HER2/neu where is located?
its growth factor receptor present on the cell surface
61
Predictive factors predicts response to treatment. Triple negative tumors. Prognosis? What population?
poor;
African americans
62
Hereditary breast cancer. Prevalence?
10 proc.
63
Hereditary breast cancer. Relations/risk factors?
multiple first-degree relatives with breast cancer, tumor at an early age (premenopausal), multiple tumors in a single patient.
64
Hereditary breast cancer. What mutations?
BRCA1 and BRCA2 - most important single gene mutations assoc. with hereditary cancer.
65
Hereditary breast cancer. BRCA1 - what cancers?
breast and ovarian carcinoma
66
Hereditary breast cancer. BRCA2 - what cancers?
breast carcinoma in males
67
breast and ovarian carcinoma?
BRCA1
68
breast carcinoma in males?
BRCA2
69
hereditary carcinoma. How to decrease risk?
bilateral mastectomy
Small risk remains, because breast tissue sometimes extends into the axilla or subcutaneous tissue of the chest wall.
70
Male breast cancer. Prevalence?
1 proc.
71
Male breast cancer. Presentation?
Subareolar mass in older males
(highest density of breast tissue in males is underneath the nipple)
May produce discharge
72
Male breast cancer. what is the most common histologic type?
invasive ductal carcinoma
(lobular carcinoma is rare (the male breast develops very few lobules))
73
Male breast cancer. assoc with what? 2
BRAC2 and Kleinfelter syndrome
74
UW. what are invasive and what not?
noninvasive - DCIS and Paget disease
Invasive: Ductal carcinoma, lobular carcinoma, Inflammatory breast cancer
75
UW. DCIS is precursor for what?
invasive ductal carcinoma
76
UW. 2 female risk factors and what is protective?
risk - age and nuliparity
protective - breastfeeding
77
UW. Normal breast, no symptoms, microcalcinations?
DCIS
78
UW. DCIS is precursor for what?
Invasive ductal carcinoma
79
UW. DCIS spreads to nipple?
Paget's
80
UW. DCIS histology?
Pleomorphic cells with prominent central necrosis without extension beyond the ductal basement membrane. + microcalcification (also in the centre)
81
UW. Pagets - cross basement membrane?
No. It spreads from superficial DCIS into nipple skin without crossing the basement membrane.
82
UW. Pagets - physical examination?
unilateral erythema and scale crust around the nipple
83
UW table. Central necrosis?
DCIS
84
UW table. Precancerous lesions?
DCIS -> invasive ductal carcinoma
85
UW table. confined to ducts and lobules?
DCIS
86
UW table. Eczematous nipple lesion?
Paget's
87
UW table. Extension of DCIS into ducts?
Paget's
88
UW. Usually triple-negative?
Invasive ductal - medulallary type
89
UW. How is histology of medullary?
Solid sheets of vesicular, mitotically active cells + significant LYMPHOPLASMACYTIC (lymphocytes and plasma cells) infiltrate around and within tumor and pushing non-infiltrating border
90
UW. Which more agressive - ductal or lobular carcinoma?
ductal
91
UW. Unilateral, unifocal?
Invasive ductal
92
UW. bilateral (20 proc.), frequently multifocal?
invasive lobular
93
UW table. Mammary stoma invasion?
Invasive lobular
94
UW. Why in peu'd orange people have lymphadenopathy (eg axillary)?
Tumor cells obstruct and spread to the dermal lymphatic spaces -> tends to metastasize to the lymphatic system.
95
how differ peu'd orange and mastitis?
In mastitis systemic symptoms (fever, malaise, leukocytosis)
