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2nd Repro > Breast carcinoma In situ > Flashcards

Breast carcinoma In situ Flashcards

1
Q

Etiology of breast cancer

A

1 in 8 women, nearlth 20% cancer deaths (2nd to lung) average age is mid 50s

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2
Q

Risk factors for breast carcinoma

A

75% are over 50

more in north america and northern europe

Highest in non-hispanic

early period adn late menopause = higher risk

first birth >35 higher risk

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3
Q

Family Hx and breast cancer

A

1st degree relative: 13% adn 87% wont get cancer

prior atypical breast biopsy or prior estrogen exposure, radtiation or carcinoma of other breast

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4
Q

Three main factors for breast pathogenesis

A

Genetics (proto-onco mutatio in Her2/Neu) (Tumor suppressor genes of BRCA1 or 2)

Hormonal

Environmental

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5
Q

Major risk = hormone exposure, seen in POST mentopauseal women with OVERexpression of estrogen receptor ER

A

Sporadic Breast Carcinoma

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6
Q

____ breast cancers are Hereditary

_____ are Familial

______ are Sporadic

A

5-10% Hereditary

15-20% Familial

70-80% are sporadic

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7
Q

Dx after menopause, low incidence of cancer in the family, influcenced by environmental factors, increases with age (hormones) and lifestyle (alcohol/obese)

A

Sporadic Breast cancer

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8
Q

Caused by a combination of factors: MULTI- FACTORIAL, Multiple low-penetrance genes may play a role and interact with Environmental triggers and see family ‘clustering’

A

Familial Breast Cancer

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9
Q

Main cause is a single germline gene mutation in the family, Multiple generations often affected Typically young age of breast cancer onset (<50 yrs)

A

Hereditary Breast Cancer

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10
Q

Hereditary Breast and Ovarian Cancer (HBOC)

 Ashkenazi Jewish

 Triple negative tumors (BRCA1)

Cowden syndrome (PTEN gene):  Breast, thyroid, uterine

Li Fraumeni syndrome (TP53 gene)  Breast, brain, leukemia, sarcoma

A

Examples of Hereditary Breast cancer with clustering

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11
Q

What is the 3-2-1 rule

A

3 family members with breast cancer REGARDLESS of age

2 family members with breast cancer, 1 dx <50 yrs

1 family member with Ovarian cancer

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12
Q

______is more relevant than the number of women with the disease

A

Age of onset of breast cancer

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13
Q

Ovarian cancer is an important indicator of

A

hereditary risk, although it is not always present.

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14
Q

BRCA1 and BRCA2 are associated with what cancers?

A

Breast, ovarian, pancreatic, prostate

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15
Q

What kind of genes are BRCA1 and BRCA2

A

they repaire ds DNA breaks; tumor suppresor gene

damage here in germline is bad news!

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16
Q

Pattern of inhericance for BRCA1 and BRCA2

lifetime risk of breast cancer:

associated cancer

A

Auto Dominant

45-85% risk of breast cancer

15-45% ovarian cancer risk

incrase prostate, male breast, pancreatic and melanoma

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17
Q

Key for Dx of neoplasm

A

is it benign or malignant, what tissue is it from, why type of cancer, did it met?

is it invasive,

Grade: how simuar to normal cells or differentiated

Stage: extent of spread

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18
Q

What is progression of breast disease to carcinoma

A

NOrmal–> Hyperplasia–> Atypical hyperplasia–> Carcinoma in situ

–> invasive cancer

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19
Q

Normal duct cells will have this intact and you can see it on staining, means cancer is still IN situ

A

intact myoepithelila layer of duct

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20
Q
A
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21
Q

What happens in INvasive ductal carcinoma in situ

A

normal duct, ductal cancer cells break through basement membrane

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22
Q

Ductal CArcinoma in situ (DCIS)

Mean age:

bilateral:

palpabel?

HOw do we find them?

A

ductal carcinoma in situ: mean age is 50-59, not often bilateral nor palpable

represents 30-40% cacrinomas found on mammograpy

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23
Q

See this on mammogram of 55 year old pt. No mass was noted. What is the likely dx?

A

Ductal carcinoma in situ

<20% palpable and found incidentally

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24
Q

Types of Ductal carsinoma in situ

A

Comedo, cribiform, micropapillary, papillary, solid, flat

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25
Q

Whats going on in this histology?

A

Comedo carcinoma in situ: ducts expanded by purple which is cellular, pink stuff is necrosis and looked like zits and purple shit is calcificaion

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26
Q

What are these nasty things?

A

Cribiform and Solid CDIS one of left is cribiform and other is solid type

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27
Q

What kind of lesion is this?

A
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28
Q

Form of DCIS extends into skin, ulcertates and looks excematous. See carcinoma cells in epidermis

often high grade or comedo type

A

Pagets

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29
Q

Pathophysiology of Pagets

A

Pagets is type of DCIS

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30
Q

Describe Pagets histology

A

Pale cytoplasm are neoplastic cells and are pagets cells, lots of inflammation

31
Q

Tx for DCIS

A

surgery, radiaiton, hormonal:

if untreated will progress to invasive carsinoma

32
Q

Average age for LObular carcinioma in situ

are they bilateral or multicentric?

are there calcifications?

A

LCIS age 44-54

70% multicentric

50-70%

rarely have calcification with no mass

33
Q

What is this?

A

LObular carcinoma in situ; marker for carcinoma and direct precursor in some cases

34
Q

Marker of risk for carcinoma with direct precursor of some cancers,

In 20 years 30% devo cancer; BOTH breasts at equal risk

A

LCIS

35
Q

What tx do we give pts with LCIS?

A

Tamoxifen; have risk for carcinoma

36
Q

How do invasive carcinomas present

A

Palpable mass, dimple of skin, retraction of nipple

On mammography: see mass/density and calcification

37
Q

Palpable mass, dimpling, retraction of nipple

mass and calcifications

A

Invasive carcinoma

38
Q

Most common area of breast carcinoma

second location

A

50% in UPper OUter quad

20% in subaerolar central area

39
Q

Microaarray see 4 molecular subtypes of breast carcinoma

A

Luminal A

Luminal B

HER2

Basal-like

40
Q

firm white masses with INDISTINCT borders, associated with DCIS and rarely LCIS

A

Invasive ductal carcinomas

41
Q

INvasive ductal carcinoma-NOS

____express ER/PR and ____express Her2/Neu

firm white masses

A

2/3 express ER/PR

1/3 expresses Her2/Neu

42
Q

MOre common in postmenopausal women and are more multicentric then other carcinomas, sometimtes have prior or concrrent contralateral carcinoma

A

Invasive Lobular Carcinoma

43
Q

E-cadherin negative

Mets to: CSF, Ovaries, uterus, BM,

A

Invasive lobular carcinoma

44
Q

Gross tumor: Very hard, with irregular borders, lacks margins and blends with surrounding tissue

see a spiculated mass/density

A

Invasive lobular carcinoma (ILC)

45
Q

small cells, SINGLE file pattern with targetoid growth pattern

no glands with signet rings

A

Invasive lobular carcinoma

46
Q

targetoid growth pattern, single file cells, seen in which age group, what type of mass?

A

invasive lobular carcinoma

hard tumor with irregular border

47
Q

What age group affected by Medullary cardcinoma, and what genetic defect incraes its incicence

A

MEdullary carcinoma seen in YOUNGER age with BRCA1 mutaion

48
Q

PRognosis of medullary carcinoma

A

better then invasive ductal carcinoma NOS, metastases

49
Q

No Her2/New expression, Negative for ER/PR

increased in BRCA1

A

MEdullary carcinoma

50
Q

What do we see on mammography of medullary carcinoma

A

oval circumscribed mass can be mistaken for fibroadenoma

51
Q

soft fleshy tumor, lobulated and bulging cut surface with circumscribed border

A

Gross findings of Medullary carcinoma

52
Q

Syncytial growth pattern in 75% of tumor cells with high grade nuclear

lymphoplastic infiltrate with a PUSHING border but non-infiltrative

A

MEdullary carcinoma

53
Q

Sheets of ugly tumors cells

NEG for ER/PR and HER2neu negative

lymphocytic infiltrate

A

MEdullary carcinoma

54
Q

Common in mid to late 40s

seen in PERIPHERY of breast

with excellent prognosis and

mets to axillary10%

A

Tubular carcinoma

55
Q

On mammograhpy see a small stellate lesion.. the woman had no symptoms

A

Tubular carcinoma

56
Q

biopsy shows a ill defined STELLATE mass: its gray-white and firm

less then 1 cm

A

Tubular carcinoma

57
Q

See single layer of epithelial cells lining glands with NO MYOMETRIAL layer

glands are scattered with desmoplastic stroma

A

tubular carcinoma

58
Q

Seen in postmenopausal women

very SLOOW growing mass

mets to axiallary <20% time

A

Colloid Mucinous carcinoma

59
Q

Colloid mucinous carcinoma see more in

A

women with BRCA1 mutation

goog prognosis

60
Q

Gross mass is circumstribed and soft

pale blue and gelatinous surface

A
61
Q

YOu see this microscopically

tumor cells and nests in pools of mucin

whats prognosis

A

Colloid carcinoma

good prognosis (BRCA1 association) seen postmenopausal

62
Q

skin erythema, peau d’orange

A

Inflammatory carcinoma

63
Q

see pt with Peau d’orange, THICK skin adn induration of breast parenchyma

what is the differential dx

A

INflitrative carcinoma

(could be acute mastitis)

64
Q

What do we look for microscopically in infiltrative breast disease?

A

Look for lymphhatic tumor emboli

BAD pronosis of only 10 year survival of 30%

65
Q

Staging of cancer involves:

A

Tumor sixe

Node staus

Mets

66
Q

Tumor grade involves

A

architectual type

nuclear grade

mitosis

67
Q

Prognostitc factors in breast CA

A

Stage (TNM), Grade, HIstology, HOrmoen receptors, overexpreeion of Her2/Neu

68
Q

histological grade of invasive breast carcinoma correlates with

A

prognosis

for tumor grading

69
Q

most important prognostic factor in INVASIVE carcinoma in the absence of distant mets

A

axillary lymph node status

70
Q

applicable only for pts with early carcinoma, small node negative and ER+

expression of set of genes predicts pts response to chemo

A

oncotype

71
Q

breast enlargement, uni or bilateral, may present as subaerolar mass

periductal hyaline and collagenous tissue

epitheilual hyperplasia of ducts with NO bresat lobules present

A

male gynecomastia

72
Q

When do we see male gynecomastia

A

Klinefeleter XX, cirhosis, drugs (alchol and weed) or funciton testitiucarl tumor

73
Q

risk factor for male breast carcinoma

A

BRCA2, 1st degree relative w/ breast cancer, decreaed testicuarl fucntino, exposure to estrogen, increaes age, INFERTIlty and obestity

74
Q

Presentation of male breast carcinoma

A

nipple discharge

palpable subaerolar mass

axillary lymph node involved

distant met to: liver, lung, brain

same tx for women

2nd Repro (16 decks)

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