Breast Carcinoma B&B Flashcards
in which patients does breast carcinoma most often occur?
most common non-skin cancer in women and 2nd most deadly (lung is first),
but mostly a disease of post-menopausal women with peak 70-80yo
(rare before age 25, rare in men)
what is detected in mammography?
micro-calcifications which occur in malignant lesions
[however, these also occur in fat necrosis and sclerosing adenosis]
in situ vs invasive carcinoma
in situ = limited by basement membrane
invasive = broken through basement membrane
almost all (95%) of breast carcinomas are ________ which arise from _______
adenocarcinomas arising from epithelial cells of ducts/lobules
70%+ have already invaded basement membrane at diagnosis
how does ductal carcinoma in situ appear?
it’s in the name - malignant growth of breast epithelial cells of terminal duct lobular unit (TDLU) fill ductal lumen, but are limited by an intact basement membrane (in situ)
form micro-calcifications that can be detected with mammogram!
contrast cribriform DCIS to comedo DCIS
DCIS = ductal carcinoma in situ (breast adenocarcinoma), many subtypes based on histology
cribriform / “cookie-cutter” DCIS: malignant cells constrained by basement membrane, so form well-defined circles with spots of white calcification (due to malignant secretions) - ends up looking like a white chocolate chip cookie (or walnuts, whatever you prefer)
comedo DCIS: large tumor cells with pleomorphic nuclei & area of central necrosis - high risk for subsequent invasive carcinoma
During a routine mammogram, calcifications are detected in a woman’s breast. A mass is identified and a biopsy is taken, which shows a well-defined circle of malignant cells, and spots of calcification within. What kind of tumor is this?
DCIS = ductal carcinoma in situ (breast adenocarcinoma): malignant growth of breast epithelial cells of terminal duct lobular unit (TDLU) fill ductal lumen, but are limited by an intact basement membrane (in situ)
form micro-calcifications that can be detected with mammogram!
many subtypes based on histology, this one is:
cribriform / “cookie-cutter” DCIS: form well-defined circles with spots of white calcification (due to malignant secretions) - ends up looking like a white chocolate chip cookie (or walnuts, whatever you prefer)
During a routine mammogram, calcifications are detected in a woman’s breast. A mass is identified and a biopsy is taken, which shows large tumors cells with pleomorphic nuclei constrained within a basement membrane, and an area of central necrosis. What type of tumor is this?
DCIS = ductal carcinoma in situ (breast adenocarcinoma): malignant growth of breast epithelial cells of terminal duct lobular unit (TDLU) fill ductal lumen, but are limited by an intact basement membrane (in situ)
form micro-calcifications that can be detected with mammogram!
many subtypes based on histology, this one is:
comedo DCIS: large tumor cells with pleomorphic nuclei & area of central necrosis - high risk for subsequent invasive carcinoma
how does Paget disease present?
occurs when DCIS (ductal carcinoma in situ) extends to the nipple, causing erythema and bloody discharge
due to underlying malignancy - usually there is a palpable mass with invasive carcinoma
DCIS (ductal carcinoma in situ) that has extended to the nipple, causing erythema and bloody discharge
what is?
Paget disease
due to underlying malignancy - usually there is a palpable mass with invasive carcinoma
A 62yo F presents to her physician with concern of an erythematous nipple and bloody discharge. A mammogram is performed, which shows a mass. What is the most likely cause of her bloody nipple discharge?
Paget disease: occurs when DCIS (ductal carcinoma in situ) extends to the nipple, causing erythema and bloody discharge
due to underlying malignancy - usually there is a palpable mass with invasive carcinoma
how does LCIS (lobular carcinoma in situ) of the breast appear histologically? why does it appear this way?
proliferation of cells in ducts/lobules which are limited by intact basement membrane (“in situ”)
show “discohesive growth” - round cells clumped together and loose intracellular connections due to loss of E-cadherin
what key protein is absent in lobular carcinoma in situ of the breast?
proliferation of cells in ducts/lobules which are limited by intact basement membrane (“in situ”)
show “discohesive growth” - round cells clumped together and loose intracellular connections due to loss of E-cadherin
how is LCIS (lobular carcinoma in situ) typically detected and managed?
LCIS does NOT produces micro-calcifications, so not picked up on mammogram
usually found incidentally on biopsy, multi-focal, and bilateral
non-invasive lesion itself, but there is risk of invasive carcinoma in both breasts (because it is usually bilateral) - manage with surveillance +/- chemoprevention (Tamoxifen - SERM)
A women undergoes a breast biopsy. Histological examination reveals discohesive growth of round cells clumped together and loose intracellular connections. This was not expected and was found incidentally. What kind of tumor is this most likely, and how will you counsel the patient?
LCIS (lobular carcinoma in situ): proliferation of cells in ducts/lobules which are limited by intact basement membrane (“in situ”)
show “discohesive growth” - round cells clumped together and loose intracellular connections due to loss of E-cadherin
not picked up on mammogram because it does not produce calcifications, and is usually multifocal/bilateral
non-invasive lesion itself, but there is risk of invasive carcinoma in both breasts (because it is usually bilateral) - manage with surveillance +/- chemoprevention (Tamoxifen - SERM)
