Breast Malignant Pathology Flashcards
What is a big risk factor for angiosarcoma of the breast?
Previous radiotherapy to breast for carcinoma
Where do metastatic tumours to the breast arise from?
Carcinoma - bronchial, ovarian, serous carcinoma, clear cell carcinoma of kidney
Malignant melanoma
Soft tissue tumours e.g. leimyosarcoma
Where does breast carcinoma arise?
Glandular (i.e. adenocarcinoma) of epithelium of the terminal duct lobular unit
What are the precursor lesions of breast carcinoma?
Ductal
Lobular
Where are in-situ breast carcinomas found?
Confined within basement membrane of acini and duts
How much of the lobule is involved in atypical lobular hyperplasia?
<50%
How much of the lobule is involved in lobular carcinoma in-situ?
> 50%
Pathological features of lobular carcinoma in situ?
Small - intermediate sized nucleus
Solid proliferation
Intra-cytoplasmic lumens/vacuoles
ER positive
Why does the incidence of lobular carcinoma in situ decrease after menopause?
Because they are ER (oestrogen receptor) positive
Management of lobualar carcinoma in situ?
Excise or vacuum biopsy to exclude malignancy
What is Paget’s disease of nipple?
High grade ductal carcinoma in situ (DCIS) extending along ducts to epidermis of nipple
What is a microinvasive carcinoma?
High grade DCIS with invasion of <1mm
What is the percentage risk that DICS will develop into invasive carcinoma?
About 50%
What is an invasive breast carcinoma?
Malignant epithelial cells which have breached the basement membrane.
Risk factors for breast carcinoma?
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
What cancer syndromes do BRCA1 and BRCA2 code for?
Breast and ovarian
What cancer syndrome does TP53 code for?
Li Fraumeni syndrome - aut dom
Childhood sarcoma. brain, leukaemia, adrenocoritcal carcinoma, early-onset breast
What cancer syndrome does PTEN code for?
Cowden’s syndrome
Breast, GI, thyroid
What cancer syndromes does ATM code for?
Ataxia telengiectasia
Non-hodgkin’s lymphoma, ovarian, breast
Where do breast carcinomas haematogenously spread to?
Brain Bone Liver Lungs Abdo viscera (lobular cancer) Female genital tract
What hormone receptors do basal-like breast cancers express?
ER -
HER2 -
(i.e. triple negative - worst prognosis)
Basal CK+
What hormone receptors do HER2 breast cancers express?
ER -
HER2 + (obvs)
What is grade a measure of?
Cancer differentiation
What 3 categories does grade assess?
Tubular differentiation
Nuclear polymorphism
Mitotic activity
What is stage a measure of?
How far the cancer has spread
What does ER expression predict in terms of breast cancer management?
Response to anti-oestrogen therapy
What is the treatment of ER negative breast cancers?
Can’t give anti-oestrogens
Oophorectomy
Tamoxifen
Aromatase inhibitors (letrozole)
GnRH antagonists (Goserilin/ Zoladex)
What does HER2 expression predict in terms of breast cancer management?
Response to tratuzamab (herceptin)
What type of drug is tratuzamab?
Humanised mouse monoclonal antibody
What tools are used to make a prognosis of breast carcinoma?
Nottingham prognostic index
Adjuvant online
PREDICT
