Breast Malignant Pathology

Question 1

What is a big risk factor for angiosarcoma of the breast?

Answer 1

Previous radiotherapy to breast for carcinoma

Question 2

Where do metastatic tumours to the breast arise from?

Answer 2

Carcinoma - bronchial, ovarian, serous carcinoma, clear cell carcinoma of kidney
Malignant melanoma
Soft tissue tumours e.g. leimyosarcoma

Question 3

Where does breast carcinoma arise?

Answer 3

Glandular (i.e. adenocarcinoma) of epithelium of the terminal duct lobular unit

Question 4

What are the precursor lesions of breast carcinoma?

Answer 4

Ductal

Lobular

Question 5

Where are in-situ breast carcinomas found?

Answer 5

Confined within basement membrane of acini and duts

Question 6

How much of the lobule is involved in atypical lobular hyperplasia?

Answer 6

<50%

Question 7

How much of the lobule is involved in lobular carcinoma in-situ?

Answer 7

> 50%

Question 8

Pathological features of lobular carcinoma in situ?

Answer 8

Small - intermediate sized nucleus
Solid proliferation
Intra-cytoplasmic lumens/vacuoles
ER positive

Question 9

Why does the incidence of lobular carcinoma in situ decrease after menopause?

Answer 9

Because they are ER (oestrogen receptor) positive

Question 10

Management of lobualar carcinoma in situ?

Answer 10

Excise or vacuum biopsy to exclude malignancy

Question 11

What is Paget’s disease of nipple?

Answer 11

High grade ductal carcinoma in situ (DCIS) extending along ducts to epidermis of nipple

Question 12

What is a microinvasive carcinoma?

Answer 12

High grade DCIS with invasion of <1mm

Question 13

What is the percentage risk that DICS will develop into invasive carcinoma?

Answer 13

About 50%

Question 14

What is an invasive breast carcinoma?

Answer 14

Malignant epithelial cells which have breached the basement membrane.

Question 15

Risk factors for breast carcinoma?

Answer 15

Age
Reproductive history - decreased risk with high parity, breastfeeding and normal number of menstrual cycles (i.e. not early merache or late menopause)
Hormones
Previous breast disease
Lifestype 
Genetics

Question 16

What cancer syndromes do BRCA1 and BRCA2 code for?

Answer 16

Breast and ovarian

Question 17

What cancer syndrome does TP53 code for?

Answer 17

Li Fraumeni syndrome - aut dom

Childhood sarcoma. brain, leukaemia, adrenocoritcal carcinoma, early-onset breast

Question 18

What cancer syndrome does PTEN code for?

Answer 18

Cowden’s syndrome

Breast, GI, thyroid

Question 19

What cancer syndromes does ATM code for?

Answer 19

Ataxia telengiectasia

Non-hodgkin’s lymphoma, ovarian, breast

Question 20

Where do breast carcinomas haematogenously spread to?

Answer 20

Brain
Bone
Liver
Lungs
Abdo viscera (lobular cancer)
Female genital tract

Question 21

What hormone receptors do basal-like breast cancers express?

Answer 21

ER -
HER2 -
(i.e. triple negative - worst prognosis)
Basal CK+

Question 22

What hormone receptors do HER2 breast cancers express?

Answer 22

ER -

HER2 + (obvs)

Question 23

What is grade a measure of?

Answer 23

Cancer differentiation

Question 24

What 3 categories does grade assess?

Answer 24

Tubular differentiation
Nuclear polymorphism
Mitotic activity

Question 25

What is stage a measure of?

Answer 25

How far the cancer has spread

Question 26

What does ER expression predict in terms of breast cancer management?

Answer 26

Response to anti-oestrogen therapy

Question 27

What is the treatment of ER negative breast cancers?

Answer 27

Can’t give anti-oestrogens

Oophorectomy
Tamoxifen
Aromatase inhibitors (letrozole)
GnRH antagonists (Goserilin/ Zoladex)

Question 28

What does HER2 expression predict in terms of breast cancer management?

Answer 28

Response to tratuzamab (herceptin)

Question 29

What type of drug is tratuzamab?

Answer 29

Humanised mouse monoclonal antibody

Question 30

What tools are used to make a prognosis of breast carcinoma?

Answer 30

Nottingham prognostic index
Adjuvant online
PREDICT