Breast II/III- LM

Question 1

what is the description of proliferative breast disease with atypia?

Answer 1

clonal proliferation having some but not all of the histological feature of CIS

Question 2

proliferative breast disease with atypia is part of the beniegn category of breast disease, is it associated with cancer?

Answer 2

Yes, moderately increased risk

Question 3

what are the 2 types of proliferative breast disease with atypia?

Answer 3

atypical ductal and lobular hyperplasia

Question 4

loss of E-cadherin is specific to what disorders?

Answer 4

Atypical lobular hyperplasia

lobular CIS

Question 5

Beneign epithelial lesions

Symptoms

Precursor status

Prognosis

Answer 5

None

Not cancerous

Most pt will not develop cancer

Question 6

What are the most important risk factors for breast cancer?

Answer 6

Estrogenic stimulation

Age

Question 7

HOw do cancers arise?

Answer 7

accumulation of DNA alterations and epigenetic changes

Question 8

What function do the BRCA1/2 genes have?

Answer 8

Tumor suppressor

repair of DsDNA

transcriptional regulation

Question 9

Commonly poorly differentiated, triple negative, p53 mutations, describes what

Answer 9

BRCA1 breast cancer

TQ

Question 10

What does triple negative mean?

Answer 10

Negative for Estrogen receptors, progesterone receptors and HER2-NEU

Question 11

What are the 4 gene mutations we must know for breast cancer?

Answer 11

BRCA1/2

P53

CHEK2

Question 12

Earlier I said that estrogen expression and age were risk factors for breast cancer, expand on that if you can!

Answer 12

hormone exposure, gender, age at menarche and menopause, reproductive history, breastfeeding, and exogenous estrogens

Question 13

What are the pathways for luminal, HER2 and basal like to progress to CIS?

Answer 13

Question 14

Paget disease of the nipple is a rare manifestation of breast cancer. How does it present?

Answer 14

• Unilateral erythematous eruption with a scale crust.
• Puritis is common and may be mistaken for eczema

Question 15

In pagets disease of the nipple, malignant cells (paget cells) extend from DCIS within the ductal system via the lactiferous sinuses into mipple skin without crossing the basement membrane. The tumor cells disrupt the normal epithelial barrier allowing extracellular fluid to seep out onto the nipple surface.

Considering all this… how can we make the diagnosis?

Answer 15

Detection of Paget cells, which is readily done by nipple biopsy or even cytologic preparations of the exudate.

Question 16

How does a LCIS appear on mammography?

Answer 16

It does not, these are notably lacking calcium deposits, and does not involve a stromal reaction that produces a mammographic density. Thus LCIS are radiolucent.

Question 17

Ok, so LCIS is cloaked to mammography. How do we find it then?

Answer 17

LCIS is always an incidental biopsy finding, since it is not associated with calcification or stromal reactions.

Question 18

What will the ER and HER2 status of a BRCA2 derived luminal invasive cancer be?

Answer 18

ER positive

HER2 negative

Question 19

What will be the HER2 and ER status of the invasive cancer that atypical apocrine adenosis

Answer 19

HER2 pos

ER neg or pos

Question 20

What are the 2 major subtypes of DCIS?

Which is more malignant usually?

Answer 20

comedo- malignant

noncomedo

Question 21

WHAT DOES it mean when an cancer shows subtle architectural change on mammography?

Answer 21

Rarely invasive cancers produce little or no stromal response

Question 22

What are the stages between the precursor lesion to a luminal ductal carcinoma?

Answer 22

1. Flat epithelial Atypia
2. Atyical Ductal Hyperplasia
3. DCIS
4. Luminal Carcinoma (ER positive, HER2nu negative)

Question 23

What are the steps from precursor lesion to Her2 enriched ductal carcinoma?

Answer 23

1. Atypical apocrine adenosis
2. DCIS
3. HER2 Enriched carcinoma