Breast path III Flashcards
how will an inflammatory carcinoma present
redness and peau d’orange
invasion of dermal lymphatics and Coopers ligaments
what is the clinical presentation of breast CA that has mets
malaise, weight loos, pathologic fracture, leukoerythroblastic blood smear
half of invasive ductal carcinomas are wehre
RUQ
what does an invasive ductal carcinoma look like
stellate mass with gritty hard surface due to tumoral desmoplasia
how are ductal invasice carcinomas graded
degree of differentiation
“indian diling” patter of individual cells
invasive lobular carcinoma
e cadherin negative
lobular
where does invasive lobular carcinoma spread to
mesothelial surface and leptomeninges
what will invasive lobular carcinoma look like on mammogram
asymmetric density
what will biopsy look like for invasive lobular carcinoma
tumor invades along fibrous septae, no discrete mass
what type breast cancer has the worst outcome
inflammatory breast CA
breasts are red, the skin is thick and there is nipple retraction
worried about?
inflammatory breast CA
differentiation of breast CA regers to what
how closely the tumor recapitulates the tissue from which it arises
what are the four classes of architecture for breast CA
well, moderately well, moderatley, poorly differentiated
what does undifferentiated cytology mean
anaplastic
What is a T0 breast cancer
no evidence of primary tumor
what is a pT1 breast CA
tumor is <2 cm
What is a pT2
tumore >2 cm but <5 cm
what is pT3
tumor is >5cm
what is pN0
no cancer cells in regional lymph nodes based on microscopy
what is pN1
cancer cells in 1-3 axillary lymph nodes, in internal mammary nodes
what is pN2
cancer cells in 4-9 lymph nodes or in internal mammary nodes (clinically apparent)
what is pN3
cancer has spread to 10+ axillary lymph nodes
how do we Dx Mets
PET scan, warburg effect
Tamoxifen are useful in what breas CA
the ones the have ER +
What is arimidex and when is it used
aromatase inhibitor used in post-menopausal patients to block the adrenal/ fat cells from conversion of androgens to estrogen
role of Her2neu
Pi tyrosin and intiiates signaling pathways and inhibits apoptosis
Her2neu +
bade prognosis because aggressive
Herceptin
can block Her2neu
when is chemo used post Surgery in breast CA
T1 T2 and N0 because low probablity of recurrence
what is radiation dosing for lumpectomy with radiation
2 Gy/day for 25 days over 5 weeks
1Gy can cause what
hematopoietic damage
2Gy can cause what
acute radiation syndrome
how much Gy exposure in abdominal CT
.008
What is Mammaprint
decides if breast cancer has low or high risk of recurrence within 10 yrs of Dx
Mammaprint is used on what CA
stage I or II
invasice
smaller than 5 cm
in <3 lymph
if metastatic breast cancer is hormone response or no life threatening disease what Tx option comes first
hormon therapy
if hormone therapy fails or metastatic breast cancer patient was hormone unresponsive/life threatening what is Tx plan
chemotherapy
Tx for LCIS non invaive
observation and risk reduction counseling
Tx for stage I IIA IIb invasive breast carcinoma
lumpectomy/masectomy +/- adjuvant chemos
+/- tamoxifen
+/- trastuzumab
Tx for late invasive breast cancer
masectomy and axillary staging with chemo and radation
+/- tamoxifen and trastuzumab
wgat are the stromal tumors of the breast
intralobular: fibroadenoma, phyllodes
and interlobular: CT tumors
when do angiosarcomas of breast arise
post irradiation
most common benign tumor of breast
fibroadenoma
ages 20-40
how do fibroadenomas present
masses with calcification after involution (post menopausal)
gross appearance of fibroadenomas
india rubber balls with lobular cut surface
micro of fibroadenomas
biphasic stroma and epithelium
when to phyllodes tumors present and how to they appeat grossly
50-60 yeras
palpable mass
larger rubbery rounded
microscopin phyllodes
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
what is a lipoma
benign tumor of fat cells
how do lipomas appear
round circumscribed, soft, usually mobile and painless
what can cause gynecomastia in men
cirrhosis klinefelter syndrome E producing tumors medications, including marijuana and heroin exogenous
can men can carcinoma in breast tissue
yup
same risk factors and pathology as female cancers
