Breast - Dobson Flashcards by Alex Hamidi

Small, irregular, numerous, clustered calcifications on mammography indicate what?

DCIS

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Paget disease of the breast ER/HER2 profile?

Have what?

ER-, HER2+

Almost all have underlying cancer

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What has the morphology of monomorphic proliferation of regularly spaced cells w/cribriform spaces, only partially fills involved ducts?

Atypical ductal hyperplasia

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What presents w/button like subareolar enlargement and is more common in puberty or the very old?

What else?

Gynecomastia

B/l

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What tumor has equal occurence in men and women?

Myofibroblastoma

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What is used to inhibit HER2?

Trastuzumab

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What has the morphology of green-brown nipple discharge w/plasma cells on biopsy and lipid-laden macrophages?

Duct ectasia

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What tumor is sporadic or associated w/radiation or lymphedema, mean age of 35, and is high grade?

Prognosis?

Angiosarcoma

Poor

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Women receiving cyclosporin A after a renal transplant may get what?

Fibroadenoma

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What Nottingham score?

some tubule, solid clusters or single infiltrate, mitotic figures present

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Phyllodes tumor presents in whom?

What chromosome mutation?

What mutation is more aggressive type?

Women in 60s, palpable mass

GOF ch. 1

HOXB13

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Least favorable breast cancer subtype?

Poorly diff, ER-and/or HER2+

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What morphology shows uniform population of cells w/oval or round nuclei, mucin+ signet ring cells and lack of E-cadherin?

RF for what?

LCIS

Invasive carcinoma, BOTH breasts

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What presents w/an erythematous breast that is painful, and a fever is present?

From what?

Acute mastitis

Pregnancy and breast feeding

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HER2-, ER- occurs in what pts?

Metastases to where?

Relapse pattern?

Response to chemo?

Young women, AA and Hispanics, BRCA1 mutation

Bone, viscera, brain

Very short, < 5 years

30%

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HER2+, ER-/+ occurs in what pts?

Metastases to where?

Relapse pattern?

Response to chemo?

Young women, non-white women, TP53 mutation carriers (ER+)

Bone, visceral, brain

Short

ER+ –> 15%
ER- –> 30%

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AJCC stage 0?

DCIS or LCIS

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Basal like sporadic tumors often have mutation?

LOF TP53

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What drugs cause gynecomastia?

Some Drugs Create Awesome Knockers

Spironolactone 
Digoxin
Cimetidine
Alcohol 
Ketoconazole

Also Estrogens/hormones

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Where and how is breast cancer in men described?

Avg age?

Near the nipple, hard nontender mass, more involvement of LNs

60-70

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What morphology describes bulbous, leaf-like protrusions w/higher cellularity, higher mitotic rate, and nuclear pleomorphism?

What is contraindicated?

Phyllodes tumor

Axillary LN dissection

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What stage AJCC?

Invasive carcinoma > 2cm w/ 1-3(+) LNs OR
Invasive < or equal to 5 cm w/ 0-3(+) LNs?

Stage II

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What is a dramatic presentation of metastasis from the breast?

Carcinoma en cuirasse

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What ethnic group has the highest incidence of breast cancer?

Highest mortality?

White

AA’s

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Describe the tumor progression cycle with an ER+, TP53 mutation

HER2 amplification --> atypical apocrine adenosis --> DCIS --> HER2 enriched cancer

Gynecomastia may be due to what conditions?

``` Liver disease Drugs Decreased testosterone XXY Testicular neoplasms ```

Prognosis of metaplastic or micropapillary carcinoma?

Poor

Most favorable breast cancer subtype?

Well diff, ER+, HER2-, low proliferation

ER+, HER2- low proliferation occurs in what pts? Metastases to where? Relapse pattern? Response to chemo?

Older women, and men Bone, visceral, brain Late < 10%

What carcinoma has morphology of soft, rubbery, pale gray-blue gelatin in small cluster and islands of mucin.

Mucinous (colloid) carcinoma

AJCC stage if distant metastases present?

When does fibroadenoma present? Diagnose how? Morphology?

Women 20s-30s, multiple and b/l Palpable mass or mammographic density Well-circumscribed, rubbery, white nodules

What is the most common type of breast cancer to present as an occult primary? Metastases to where?

Lobular carcinoma Peritoneum/retroperitoneum Leptomeninges GI Ovary and uterus

Spontaneous unilateral discharge worrisome for what in women over 60?

Cancer

What cancer shows increased staining for Ki67?

ER+, HER2- high proliferation type

what is a painless palpable mass that may show saponification or calcification on mammography?

Fat necrosis

What morphology is described by poorly differentiated, 50% apocrine and 40% micropapillary carcinoma?

HER2+ carcinoma

What morphology is seen in well differentiated to poorly differentiated tumor w/mucinous, papillary, cribriform, and lobular patterns all possible?

ER+, HER2- carcinoma

What is the major subtype of breast cancers?

ER+, HER2- 50-65%

What are the intralobular tumors?

Fibroadenoma | Phyllodes

Inflammatory carcinoma has a higher incidence in whom? Prognosis? Described how and why>

AA's Very poor Peau d'orange due to blockage of lymphatics

What has the morphology of ER-, HER2-, softer than other carcinomas, minimal desmoplasia, presents as well-circumscribed mass, has solid sheets of large cells w/pleomorphic uncle and prominent nucleoli which compose more than 75% of the tumor mass, frequent mitotic figures, and mod-marked lymphoplasmacytic infiltrate surrounding and w/in the tumor?

Medullary carcinoma

AJCC stage if 4 or more + LNs and > 5cm?

III

ER-, HER2- most common with what mutation? ER+, HER2-?

BRCA1 BRCA2

Paget disease cells stains positive for what? Express what?

Pale cytoplasm containing MPS, PAS+ Cytokeratin 7

What presents as a bloody nipple discharge in premenopausal women and is characterized by a fibrovascular projection lined by epithelial and myoepithelial cells?

Intraductal papilloma

What mutation associated w/Li-Fraumeni syndrome? Describe it

TP53 Cancer at young age w/multiple organs

Name the types of proliferative breast disease without atypia Increased risk for cancer?

``` Sclerosing adenosis Epithelial hyperplasia Complex Sclerosing Lesion Papilloma Gynecomastia ``` Yes, about 2x in Either breast

ER+, HER2- high proliferation occurs in what pts? Metastases to where? Relapse pattern? Response to chemo?

BRCA2 mutation carriers Bone most often, then viscera Intermediate < 10 %

Flat epithelial atypia is what? What common deletion?

Inc # of acini/lobule, normal in pregnancy Ch 16

What are the 2 types of atypical hyperplasia?

Atypical ductal | Atypical lobular

What is an incidental finding and has morphology of Inc # of luminal and myoepithelial cells?

Epithelial hyperplasia

What proto-oncogene encodes HER2? Member of what family? Promotes what?

ERBB2 RTK Mutation promotes growth and survival of tumor cells

How is DCIS detected?

Mammography as calcifications or mass

What morphology is described by poorly differentiated, pushing bodies, central necrosis, lymphocytic infiltrate w/medullary features?

ER-, HER2- basal-like carcinoma

AJCC stage I?

Invasive carcinoma < or equal to 2cm

What morphology of DCIS has cribriform "cookie cutter", solid, bulbous or true papillae w/fibrovascular core w/no myoepithelial layer?

Noncomedo

What organisms cause acute mastitis and what complications may be caused respectively?

S. Aureus - abscess Strep - cellulitis

What Nottingham score? Tubular w/small round nuclei, low proliferation rate

What DCIS shows pruritit, unilateral erythematous eruption w/scale crust, and is almost always associated w/poorly differentiated invasive carcinoma? What ER/HER2 profile?

Paget's disease ER-, HER2 amplification

What Nottingham score? Invade as ragged nests/solid sheets w/enlarged irregular nuclei

3 (poorly differentiated)

LCIS is always what? Loss of what? B/l? Expresses what?

Incidental finding E-Cadherin Yes, 20-40% ER+, PR+ HER2-

What are the most common palpable lesions?

Cysts Fibroadenomas Invasive carcinomas

Granulomatous mastitis occurs in what setting?

Parous women w/sarcoidosis or Tb Can occur w/breast prostheses or nipple piercing

What morphology of DCIS has tumor cells w/pleomorphic, high grade nuclei and areas of central necrosis?

Comedo DCIS

What chromosome abnormalities are common in proliferative breast disease with atypia? Increased risk for cancer?

Loss of ch. 16 Gain of ch. 17 Yes, 5x in either breast

What has the morphology of a "radial scar" and the nidus of entrapped glands in hyaline stroma?

Complex sclerosing lesion

What are some features of familial breast cancer?

Variable age of onset | No classic features of hereditary cancer syndromes

Fat necrosis undergoes what kind of necrosis?

Liquefactive

Bloody or serous discharge from the nipple suggests what?

Intraductal papilloma

What other cancers are associated with BRCA1?

``` Ovarian Male breast Prostate Pancreas Fallopian tube ```

Describe the tumor progression cycle with an ER-, BRCA1 mutation

Unkown --> TP53 mutation and BRCA1 inactivation --> DCIS --> "basal like" cancer (ER-, HER2-)

Does early menarche increase or decrease risk of breast cancer? Age at 1st live birth?

Increases Decreases

Cowden syndrome has what mutation?

PTEN

What some features of hereditary breast cancer?

Earlier age of onset B/l 1st degree relatives of carriers at 50% risk AD inheritance

Describe the tumor progression cycle with a ER+, BRCA2 mutation

Ch1 gain, ch16 loss --> flat epithelial atypia --> PIK3CA mutation --> atypical ductal hyperplasia --> DCIS --> luminal cancer (ER+, HER2-)

What has the morphology of keratinizing squamous metaplasia of nipple ducts leading to dilation and rupture?

Periductal mastitis

Morphology of nonproliferative breast changes?

Cysts or fibrosis beget apocrine metaplasia (NO inc risk for cancer) Lumpy breast, blue-dome appearance

Function of BRCA gene?

Repair dsDNA through homologous recombination

What has the morphology of a "swirling pattern" and may appear as solid cords or double strands of cells?

Sclerosing adenosis

Presentation of squamous metaplasia of lactiferous ducts (aka Zuska disease/Periductal Mastitis)? Occurs in whom? What other setting?

Painful subareolar mass, inverted nipple 90% smokers Vit A deficiency

1/3 of cancers detected how? The rest?

Palpable mass Mammography

What presents as multiple hard palpable masses, atrophic ducts and lobules , thickened BM and is associated w/women that have T1DM and autoimmune thyroid?

Sclerosing Lymphocytic lobuitis OR Lymphocytic mastitis

Duct ectasia sx? Occurs in whom?

Palpable subareolar mass w/white nipple secretions and skin retraction Multiparous women 50s-60s

What are the presenting sx of breast issues?

Pain Nipple discharge Abnormal screening exam Mass - lumpiness

Localized pain differential dx?

Ruptured cyst Infection Trauma

What are the 3 developmental disorders of the breast?

Milk line remnants Accessory axillary breast tissue Congenital nipple inversion