Breast path III

Question 1

how will an inflammatory carcinoma present

Answer 1

redness and peau d’orange

invasion of dermal lymphatics and Coopers ligaments

Question 2

what is the clinical presentation of breast CA that has mets

Answer 2

malaise, weight loos, pathologic fracture, leukoerythroblastic blood smear

Question 3

half of invasive ductal carcinomas are wehre

Answer 3

RUQ

Question 4

what does an invasive ductal carcinoma look like

Answer 4

stellate mass with gritty hard surface due to tumoral desmoplasia

Question 5

how are ductal invasice carcinomas graded

Answer 5

degree of differentiation

Question 6

“indian diling” patter of individual cells

Answer 6

invasive lobular carcinoma

Question 7

e cadherin negative

Answer 7

lobular

Question 8

where does invasive lobular carcinoma spread to

Answer 8

mesothelial surface and leptomeninges

Question 9

what will invasive lobular carcinoma look like on mammogram

Answer 9

asymmetric density

Question 10

what will biopsy look like for invasive lobular carcinoma

Answer 10

tumor invades along fibrous septae, no discrete mass

Question 11

what type breast cancer has the worst outcome

Answer 11

inflammatory breast CA

Question 12

breasts are red, the skin is thick and there is nipple retraction
worried about?

Answer 12

inflammatory breast CA

Question 13

differentiation of breast CA regers to what

Answer 13

how closely the tumor recapitulates the tissue from which it arises

Question 14

what are the four classes of architecture for breast CA

Answer 14

well, moderately well, moderatley, poorly differentiated

Question 15

what does undifferentiated cytology mean

Answer 15

anaplastic

Question 16

What is a T0 breast cancer

Answer 16

no evidence of primary tumor

Question 17

what is a pT1 breast CA

Answer 17

tumor is <2 cm

Question 18

What is a pT2

Answer 18

tumore >2 cm but <5 cm

Question 19

what is pT3

Answer 19

tumor is >5cm

Question 20

what is pN0

Answer 20

no cancer cells in regional lymph nodes based on microscopy

Question 21

what is pN1

Answer 21

cancer cells in 1-3 axillary lymph nodes, in internal mammary nodes

Question 22

what is pN2

Answer 22

cancer cells in 4-9 lymph nodes or in internal mammary nodes (clinically apparent)

Question 23

what is pN3

Answer 23

cancer has spread to 10+ axillary lymph nodes

Question 24

how do we Dx Mets

Answer 24

PET scan, warburg effect

Question 25

Tamoxifen are useful in what breas CA

Answer 25

the ones the have ER +

Question 26

What is arimidex and when is it used

Answer 26

aromatase inhibitor used in post-menopausal patients to block the adrenal/ fat cells from conversion of androgens to estrogen

Question 27

role of Her2neu

Answer 27

Pi tyrosin and intiiates signaling pathways and inhibits apoptosis

Question 28

Her2neu +

Answer 28

bade prognosis because aggressive

Question 29

Herceptin

Answer 29

can block Her2neu

Question 30

when is chemo used post Surgery in breast CA

Answer 30

T1 T2 and N0 because low probablity of recurrence

Question 31

what is radiation dosing for lumpectomy with radiation

Answer 31

2 Gy/day for 25 days over 5 weeks

Question 32

1Gy can cause what

Answer 32

hematopoietic damage

Question 33

2Gy can cause what

Answer 33

acute radiation syndrome

Question 34

how much Gy exposure in abdominal CT

Answer 34

.008

Question 35

What is Mammaprint

Answer 35

decides if breast cancer has low or high risk of recurrence within 10 yrs of Dx

Question 36

Mammaprint is used on what CA

Answer 36

stage I or II
invasice
smaller than 5 cm
in <3 lymph

Question 37

if metastatic breast cancer is hormone response or no life threatening disease what Tx option comes first

Answer 37

hormon therapy

Question 38

if hormone therapy fails or metastatic breast cancer patient was hormone unresponsive/life threatening what is Tx plan

Answer 38

chemotherapy

Question 39

Tx for LCIS non invaive

Answer 39

observation and risk reduction counseling

Question 40

Tx for stage I IIA IIb invasive breast carcinoma

Answer 40

lumpectomy/masectomy +/- adjuvant chemos
+/- tamoxifen
+/- trastuzumab

Question 41

Tx for late invasive breast cancer

Answer 41

masectomy and axillary staging with chemo and radation

+/- tamoxifen and trastuzumab

Question 42

wgat are the stromal tumors of the breast

Answer 42

intralobular: fibroadenoma, phyllodes

and interlobular: CT tumors

Question 43

when do angiosarcomas of breast arise

Answer 43

post irradiation

Question 44

most common benign tumor of breast

Answer 44

fibroadenoma

ages 20-40

Question 45

how do fibroadenomas present

Answer 45

masses with calcification after involution (post menopausal)

Question 46

gross appearance of fibroadenomas

Answer 46

india rubber balls with lobular cut surface

Question 47

micro of fibroadenomas

Answer 47

biphasic stroma and epithelium

Question 48

when to phyllodes tumors present and how to they appeat grossly

Answer 48

50-60 yeras
palpable mass
larger rubbery rounded

Question 49

microscopin phyllodes

Answer 49

cellular and mitotically active
there are low and high grades
low grade: local recurrence
high grade: aggressive with local invasion and hematogenous mets in 1/3

Question 50

what is a lipoma

Answer 50

benign tumor of fat cells

Question 51

how do lipomas appear

Answer 51

round circumscribed, soft, usually mobile and painless

Question 52

what can cause gynecomastia in men

Answer 52

cirrhosis
klinefelter syndrome
E producing tumors
medications, including marijuana and heroin
exogenous

Question 53

can men can carcinoma in breast tissue

Answer 53

yup

same risk factors and pathology as female cancers