Breast Path Flashcards
Normal breast density is due to ___ and little ___
During menstrual cycle, under influence of __ and rising ___, cell proliferation__ and more ___ are formed
during preg and lactation, ___ changes and branching of ____ produces larger, more lobules
___ fxnally mature and differentiate to produce __
w age, stroma is replaced by ___
fibrous stroma, adipose
E/P, inc, acini
stroma, terminal ducts
Luminal cells, milk
adipose tissue
Lesion
Non-proliferative __
proliferative dz w/out __
including ___ and ____
proliferative dz w ___
A and A
Carcinoma ___
D and L
risk for breast cancer inc moving ___
fibrocytic changes
atypia
sclerosing adenosis, papilloma
atypia
ADH, ALH
in situ
ductal and lobular
down
Fibrocytic changes
__ and __ and ___ to varying extent
Not ___, no __ changes
No assc w inc risk of __
common finding is ___
Cyst, fibrosis, epithelial hyperplasia
clonal, genetic
BC
lumpy, bumpy breasts
Adenosis
benign prolif of ___
Generally maintain normally arranged ____ and ___ components
__ lesion w variable inc number of ___
Types
S and C
Chief importance is occasional imaging/histo mimicry of ___
gland structures
epithelial/myoepithelial
lobular based, acinar structures
Sclerosing adenosis, complex sclerosing
invasive carcinoma
Papilloma
Discrete benign tumors of ___ w/in ___ (intraductal)
More common in ___ of breast from ___
can occur __
can be __ or __ in contiguous branches of ductal system
epithelium, ducts
central portion, lactiferous ducts
peripherally
solitary, multuple
Papilloma CM
Usually occur around ___ for peripheral
Solitary lesions in ___
MC primary sx soliatary
may be ___
____ or palpable tumo (peripheral) in on of quadrants
Typically grow ___
40s and 50s
6th decade
nipple discharge
bloody
subareolar mass
slow
Proliferative breast disease w ____ (atypical ___)
___ prolif
may have chromo abberations including loss of ___ or gain of ___
some features of ___
assc w moderate inc risk of __
Two forms
Atypical __ hyperplasia aka
Atypical __ hyperplasia aka
chromosomal aberrations more commonly found in ___
considered a RF for __ in both breast
atypia, hyperplasia
clonal
16q, 17p
CIS
carcinoma
ductal
lobular
ALH
BC
Ductal CIS
Malignant __ prolif of epithelial cells
inc risk of __
Harbor __ seen in invasive BC
limited to ducts/lobules by ___ (myoepithelial cells)
physical barrier and __ fxn
can be detected w ___, rarely as ___
freq assc w
clonal
BC
genetic alterations
basement membrane
tumor suppressor
mammogram, palpable mass
calcifications
Morpholgic subtypes of DCIS
Comedo w high grade ___ and ___
Noncomedo w variable __
Nuclear __, s__, and ___ status are predictors of recurrence
Most women tx w ___
if untx, pts w small low grade DCIS develop cancer __
Tx is ___ (conservative __ vs __) w or w/out
usually __
Recurrence is half __ and __
RF for recurrence: high __, __, extent of ___ and positive ___
nuclei, necrosis
nuclear features
grade, size, margin
excision, radiation
to a lower degree
excision, lumpectomy vs mastectomy
curative
DCIS, invasive carcinoma
nuclear grade, necrosis, dz, surgical margins
Lobular CIS
Clonal prolif w in ___
Grow in ___ fashion
Loss of ___ gene encodes for adhesion protein ___
can be ___ finding
Not assc w __ or __ that produces mammogram findings
RF for ___ in both breasts
tx options: __, __ w mammography, ___, and ___ mastectomies
lobules
dis-cohexive
TSG CDH1, E cadherin
incidental
calcifications, stromal rxn
invasive carcinoma
excision, close clinical follow up, tamoxifen, bilateral prophylactic
Invasive breast carcinoma
divided into multiple clinical subgroups based on M, G, and M__ (including ER, PR, HER2)
__ bc
___ bc
wide variety of ___
majority are grouped and called ___
1/3 classified into ___ assc w bio characteristics (better)
morph, grade, molecular features
Famial
Sporadic
morph appearances
ductal
special types
Sporadic
__ of cases
RF
H__ including age at __ and __, H__
Environmental __
__ fxn as promoter, stimulating ___ that can potentially accumulate ___ and give rise to ___
Once malignancy is established, hormoes can ___ growth, as well as ___ supportng __ and ___
majority
Hormone exposure, menarche/menopause, HRT
RF
Estrogen, epithelial cell prolif, DNA damage, carcinoma
stimulate growth, stromal cells, growth/development
Familial breast cancer
Inheritance of ___
May be __, such as __
__ in remaining allele leads to ___
Major genes
B, B, T, C
__ w roles in ___ and maintenance of ___
Assc w other cancers such as __, __, ____
susceptibility genes
AD, TSG
2nd hit, loss of fxn
BRCA1/2, TP53, CHEK2
TSG, DNA repair, genomic integrity
ovarian, fallopian tube, prostate
3 molecular subtypes
ER+/HER2
Dominated by genes regulated to __
Most common subtype in __
HER2+, ER+ or ER-
Arise through pathway strongly assc w amplification of ___ on chromo ___
Most common subtype in pt w __ in TP53 ( such as __)
ER-, PR-, HER2- (aka __)
Pathway independent of __
most common in ___ carriers
estrogen
BRCA2 cancers
HER2 gene, 17q
germline mutations, Li-Fraumeni
Triple neg breast cancer
ER and HER2
BRCA1
ER+ HER-
Usually __ to __ tumors
___ women
Usually have __ (Low ___)
may __ but usually after __
survival w __ possible
Respond well to __ such as __ and ___
Chemo is not ___
well to moderately differentiated
older
best prog, low relapse rate
metastasize, 6yrs
metastatic dz
hormonal tx
tamoxifen, aromatase inhib
helpful
HER2+, ER+/-
Arise through pathways assc w amplification of __ on 17q
usually in ___
___ mutation carriers
Gene expression patterns dominated by genes related to __ and __ pathways of downstream HER2 ___
metastasize to ___ >___ > ___
relapse pattern is __
survival w metastasis is
HER2 gene
non white, young women
TP53
prolif/signaling. RTK
bone, viscera, brain
short, rare
HER stands for
HER2 pathway activates __ and ___ leading to proliferation
__ leads to survival
___ is available
Anti HER antibodies
Ab binds to receptor,
blocks __ and prevents __
results in no ___
Human epidermal Receptor
RAS, MAPK
PI3K
Targeted therapy
ligand binding, dimerization
signaling
ER-, PR-, HER2- (Triple neg_
Typically ___ tumors
Common in __ (4/5 decade)
more common in __ and ___
relapse w in ___ yrs
survival w metastasis is ___
Complete response to chemo is ___
poorly differentiated
YW
AA and hispanics
5yrs
rare
rare
Mutated BRCA1 on chromo __
__ inheritance
BRCA1/2 important for
BRCA1 mutation inc __
BRCA2 activates ___ at site of lesion
17
AD
DNA repair
phosphorylation
RAD51
Invasive lobular carcinoma
May form ___
Infiltrative pattern w ___ borders
lack ___ (mammography)
Histo hallmark is ____ infiltrating tumor cells, single file w ___ cells
Typically __ and __ +
irregular masses
hard to determine
desmoplasia
discohesive, signet ring
ER and PR
Stromal tumors aka __
most common \_\_\_ Young age \_\_/\_\_s mass is \_\_\_ Composed of both \_\_ and \_\_ cells \_\_ responsive
may be ___ or replace __
fibroadenoma
benign tumor 20/30s palpable stromal/epithelial hormonally
small, whole breast
Stromal tumor P___
Tumor of both __ and ___ cells
Rare and occurs at __
Clonal w acquired ___
most commonly gains __
can be ___ or have ___
surgical exision w ___
phyllodes tumor
epithelial/stromal
any age
chromo change
1q
high grade, aggresive clincal behavior
clear margins
Paget’s dz of nipple (eczema appearance)
Palpable ___
majority have underlyin ___
tumor is __, typically ___
Tx is ___ w/wout ___
subareolar mass
invasive disease
poor diff, ER-
excision, radiation
