Breast path II Flashcards
Fat necrosis of the breast is secondary to what
trauma
describe how fat necrosis occurs
liquefactive necrosis of fate releases cytoplasmic fat which causes acture foreign body granulomatous response in surrounding tissues with repair fibrosis
what causing dimpling of the breast skin
coopers ligament being retracted by a mass or fibrosis etc
Ddx for fat necoris
carcinoma with desmoplasia (tumoral fibrosis)
Bx is usually required
where can breast implants be inserted
inframammary, periareolar, transaxillary
location is subglandular or submuscular
complications of breast implants
capsule of fibrous layer forms and may be painful causing contraction
capsule can rupture and foreign body inflammation from leakage
lymphoma- anaplastic large cell lymphoma– rare
What can hyperplastic epithelial lobular unit progress to
either fibrocystic changes or atypical ductal hyperplasia
what is DCIS
ductal carcinoma in situ
what is IBC
invasive breast carcinoma
how do fibrocystic changes of the breast present
mass, pain, microcalcifications
what differentiates fibrocystic changes from proliferative fibrocystic change w/o atypia
epithelial cells are now >4 cells in thickness
What benign condition mimics carcinoma of the breast
radial scar- complex sclerosing lesion
what benign fibrocystic change can look like a breast polyp
intraductal papilloma
if suspect radial scar what do you need to do
surgical excision to confirm Dx and that it is not Breast CA
what is atypical ducta hyperplasia
low grade neoplastic cells idenntified by nuclear cytology
overlap with DCIS
When is atypical ductal hyperplasia called DCIS
when duct is completely filled with neoplastic cells and entire lesion is >2mm
What is atypical lobular hyperplasia
proliferation of low grade neoplastic cells in lobule
e-cadherin negative
what is e-cadherin positive
ductal cells
atypical hyperplasia of the breast increases risk by how much
3-5X
what breast CA type do you need to remove with clear margins
ductal
Age of presentation of DCIS and lobular CIS
DCIS 54-58
LCIS 44-47
clinical signs of LCIS
none
mammographic signs LCIS and DCIS
LCIS none
DCIS microcalcifications
if see necrotic tissue in CA of breast what is it
comido carcinoma, take out right away
what is the difference of ductal and lobular carcinoma
both arise from TDLU but there is different expression of gene patterns
invasion of ductal and lobular carcinomas is Dx how
based on absence of myoepithelial cells
definition low grade DCIS
mild nuclear atypia and micropapillary or cribiform architecture
definition high grade DCIS
malignant nuclear atypia and solid archtecture
comedonecrosis and microinvasion
what is comedonecrosis
central tumoral necrosis gives unique “toothpaste” finding grossly and necrotic cells prone to dystrophic calcification
what is definition on microinvasion
focus of invasion <2mm in dimension
LCIS on microscopy
dyshesive architecture with signet cell morphology
+ mucin
What is Paget disease of breast
eczematous red change to nipple and areola from underlying DCIS and invasion
infiltration of epidermis by malignant glandular cells
mucin+ CEA and EMA +
prognosis of paget disease of the breast
depends on grade and stage
what is cribiform histology
sieve- like
what is “pagetoid finding”
microscopic finding of upward infiltration of epidermis by glandular neoplastic cells
seen in melanoma and SCC
what are some biomarkers for paget disease
cytokeratin 7
risk factors for invasive carcinoma of the breast
lifetime exposure to E radiation exposure breast density proliferative fibrocystic changes life style: alcohol, obesity, sedentary familial and increasing age
what increases lifetime exposure to E
menarche <35 years
HRT for menopause
the luminal invasive CA of breast will be positive for what cytology and what mutations
E receptor positive
Her2neu negative
BRCA2 mutation, 1q gain 16ploss, PIK3CA mutations
the Her2 enrished breast CA have what mutations
P53 mutations
HER2amplification
the Basal like invasive CA of breast have what mutations and positive cytology for what
BRCA1 mutations with p53 mutations
ER negative
HER2 negative
What inhibits at G1 and G2 to allow for DNA repairs
GADD45
What mutation is involved in Li Fraumeni syndrome and change of developing breast CA
p53
85-90%
What cancers are also assoc with Li Fraumeni syndrome
soft tissue sarcoma, brain tumors, osteosarcoma, adrenocortical tumores, leukemia
when do you consider genetic testing for li fraumeni syndrome
multiple early onset cancers, breast CA usually <30 y.o
Genetic counseling is indicated for BRCA when
known family genetic disease (ashkenazy jews, french canadians)
early onset <50y.o
high risk breast cancer
+ family history
prevention for hereditary breast and ovarian cancer
prophylactic mastectomy
salpingo-oophorectomy
tamoxifen
if risk for hereditary breast and ovarian cancer what is screening schedule
annual mammogram and MRI starting at age 25
what chrom encodes for p53 mutated in Li Fraumeni syndrome
17p12
