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Repro 2 AH > Breast - Dobson > Flashcards

Breast - Dobson Flashcards

1
Q

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

A

DCIS

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2
Q

Paget disease of the breast ER/HER2 profile?

Have what?

A

ER-, HER2+

Almost all have underlying cancer

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4
Q

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

A

Atypical ductal hyperplasia

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6
Q

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

What else?

A

Gynecomastia

B/l

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7
Q

What tumor has equal occurence in men and women?

A

Myofibroblastoma

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8
Q

What is used to inhibit HER2?

A

Trastuzumab

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9
Q

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

A

Duct ectasia

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11
Q

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

Prognosis?

A

Angiosarcoma

Poor

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12
Q

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

A

Fibroadenoma

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13
Q

What Nottingham score?

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

A

2

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15
Q

Phyllodes tumor presents in whom?

What chromosome mutation?

What mutation is more aggressive type?

A

Women in 60s, palpable mass

GOF ch. 1

HOXB13

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19
Q

Least favorable breast cancer subtype?

A

Poorly diff, ER-and/or HER2+

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20
Q

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

RF for what?

A

LCIS

Invasive carcinoma, BOTH breasts

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21
Q

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

From what?

A

Acute mastitis

Pregnancy and breast feeding

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22
Q

HER2-, ER- occurs in what pts?

Metastases to where?

Relapse pattern?

Response to chemo?

A

Young women, AA and Hispanics, BRCA1 mutation

Bone, viscera, brain

Very short, < 5 years

30%

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25
Q

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

Metastases to where?

Relapse pattern?

Response to chemo?

A

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

Bone, visceral, brain

Short

ER+ –> 15%
ER- –> 30%

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26
Q

AJCC stage 0?

A

DCIS or LCIS

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27
Q

Basal like sporadic tumors often have mutation?

A

LOF TP53

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29
Q

What drugs cause gynecomastia?

A

Some Drugs Create Awesome Knockers

Spironolactone 
Digoxin
Cimetidine
Alcohol 
Ketoconazole

Also Estrogens/hormones

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30
Q

Where and how is breast cancer in men described?

Avg age?

A

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

60-70

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33
Q

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

What is contraindicated?

A

Phyllodes tumor

Axillary LN dissection

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34
Q

What stage AJCC?

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

A

Stage II

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35
Q

What is a dramatic presentation of metastasis from the breast?

A

Carcinoma en cuirasse

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36
Q

What ethnic group has the highest incidence of breast cancer?

Highest mortality?

A

White

AA’s

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37
Q

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

A

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

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38
Q

Gynecomastia may be due to what conditions?

A 
Liver disease
Drugs
Decreased testosterone
XXY
Testicular neoplasms
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39
Q

Prognosis of metaplastic or micropapillary carcinoma?

A

Poor

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41
Q

Most favorable breast cancer subtype?

A

Well diff, ER+, HER2-, low proliferation

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42
Q

ER+, HER2- low proliferation occurs in what pts?

Metastases to where?

Relapse pattern?

Response to chemo?

A

Older women, and men

Bone, visceral, brain

Late

< 10%

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44
Q

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

A

Mucinous (colloid) carcinoma

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46
Q

AJCC stage if distant metastases present?

A

4

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47
Q

When does fibroadenoma present?

Diagnose how?

Morphology?

A

Women 20s-30s, multiple and b/l

Palpable mass or mammographic density

Well-circumscribed, rubbery, white nodules

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51
Q

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

Metastases to where?

A

Lobular carcinoma

Peritoneum/retroperitoneum
Leptomeninges
GI
Ovary and uterus

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53
Q

Spontaneous unilateral discharge worrisome for what in women over 60?

A

Cancer

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54
Q

What cancer shows increased staining for Ki67?

A

ER+, HER2- high proliferation type

56
Q

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

A

Fat necrosis

59
Q

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

A

HER2+ carcinoma

60
Q

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

A

ER+, HER2- carcinoma

61
Q

What is the major subtype of breast cancers?

A

ER+, HER2-

50-65%

63
Q

What are the intralobular tumors?

A

Fibroadenoma

Phyllodes

67
Q

Inflammatory carcinoma has a higher incidence in whom?

Prognosis?

Described how and why>

A

AA’s

Very poor

Peau d’orange due to blockage of lymphatics

68
Q

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?

A

Medullary carcinoma

69
Q

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

A

III

70
Q

ER-, HER2- most common with what mutation?

ER+, HER2-?

A

BRCA1

BRCA2

75
Q

Paget disease cells stains positive for what?

Express what?

A

Pale cytoplasm containing MPS, PAS+

Cytokeratin 7

77
Q

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

A

Intraductal papilloma

83
Q

What mutation associated w/Li-Fraumeni syndrome?

Describe it

A

TP53

Cancer at young age w/multiple organs

84
Q

Name the types of proliferative breast disease without atypia

Increased risk for cancer?

A 
Sclerosing adenosis
Epithelial hyperplasia
Complex Sclerosing Lesion
Papilloma
Gynecomastia

Yes, about 2x in Either breast

86
Q

ER+, HER2- high proliferation occurs in what pts?

Metastases to where?

Relapse pattern?

Response to chemo?

A

BRCA2 mutation carriers

Bone most often, then viscera

Intermediate

< 10 %

87
Q

Flat epithelial atypia is what?

What common deletion?

A

Inc # of acini/lobule, normal in pregnancy

Ch 16

89
Q

What are the 2 types of atypical hyperplasia?

A

Atypical ductal

Atypical lobular

90
Q

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

A

Epithelial hyperplasia

91
Q

What proto-oncogene encodes HER2?

Member of what family?

Promotes what?

A

ERBB2

RTK

Mutation promotes growth and survival of tumor cells

92
Q

How is DCIS detected?

A

Mammography as calcifications or mass

94
Q

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

A

ER-, HER2- basal-like carcinoma

95
Q

AJCC stage I?

A

Invasive carcinoma < or equal to 2cm

97
Q

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

A

Noncomedo

98
Q

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

A

S. Aureus - abscess

Strep - cellulitis

99
Q

What Nottingham score?

Tubular w/small round nuclei, low proliferation rate

A

1

102
Q

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

What ER/HER2 profile?

A

Paget’s disease

ER-, HER2 amplification

104
Q

What Nottingham score?

Invade as ragged nests/solid sheets w/enlarged irregular nuclei

A

3 (poorly differentiated)

109
Q

LCIS is always what?

Loss of what?

B/l?

Expresses what?

A

Incidental finding

E-Cadherin

Yes, 20-40%

ER+, PR+
HER2-

110
Q

What are the most common palpable lesions?

A

Cysts
Fibroadenomas
Invasive carcinomas

111
Q

Granulomatous mastitis occurs in what setting?

A

Parous women w/sarcoidosis or Tb

Can occur w/breast prostheses or nipple piercing

114
Q

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

A

Comedo DCIS

115
Q

What chromosome abnormalities are common in proliferative breast disease with atypia?

Increased risk for cancer?

A

Loss of ch. 16
Gain of ch. 17

Yes, 5x in either breast

116
Q

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

A

Complex sclerosing lesion

117
Q

What are some features of familial breast cancer?

A

Variable age of onset

No classic features of hereditary cancer syndromes

120
Q

Fat necrosis undergoes what kind of necrosis?

A

Liquefactive

121
Q

Bloody or serous discharge from the nipple suggests what?

A

Intraductal papilloma

122
Q

What other cancers are associated with BRCA1?

A 
Ovarian
Male breast
Prostate
Pancreas
Fallopian tube
128
Q

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

A

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

130
Q

Does early menarche increase or decrease risk of breast cancer?

Age at 1st live birth?

A

Increases

Decreases

131
Q

Cowden syndrome has what mutation?

A

PTEN

132
Q

What some features of hereditary breast cancer?

A

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

133
Q

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

A

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

135
Q

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

A

Periductal mastitis

137
Q

Morphology of nonproliferative breast changes?

A

Cysts or fibrosis beget apocrine metaplasia (NO inc risk for cancer)

Lumpy breast, blue-dome appearance

138
Q

Function of BRCA gene?

A

Repair dsDNA through homologous recombination

139
Q

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

A

Sclerosing adenosis

140
Q

Presentation of squamous metaplasia of lactiferous ducts (aka Zuska disease/Periductal Mastitis)?

Occurs in whom?
What other setting?

A

Painful subareolar mass, inverted nipple

90% smokers
Vit A deficiency

141
Q

1/3 of cancers detected how?

The rest?

A

Palpable mass

Mammography

149
Q

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

A

Sclerosing Lymphocytic lobuitis

OR

Lymphocytic mastitis

154
Q

Duct ectasia sx?

Occurs in whom?

A

Palpable subareolar mass w/white nipple secretions and skin retraction

Multiparous women 50s-60s

160
Q

What are the presenting sx of breast issues?

A

Pain
Nipple discharge
Abnormal screening exam
Mass - lumpiness

164
Q

Localized pain differential dx?

A

Ruptured cyst
Infection
Trauma

168
Q

What are the 3 developmental disorders of the breast?

A

Milk line remnants

Accessory axillary breast tissue

Congenital nipple inversion

Repro 2 AH (6 decks)

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