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ENRP Exam 1 > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

When does the breast completely mature and become fully functional?

A

During pregnancy

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2
Q

What is the most commonly used screening test for breast cancer?

A

Mammographic screening

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3
Q

Why does the sensitivity and specificity for mammography increase with age?

A

At age 40, the probability that a mammographic lesion is cancer is only 10% but this rises to greater than 25% in women older than 50

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4
Q

What forms mammographic densities?

A

Breast lesions that replace adipose tissue with radiodense tissue

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5
Q

If a rounded density is seen on mammogram, this most likely indicates what kind of lesion?

A

Benign lesions such as fibroadenomas or cysts whereas carcinomas generally form irregular masses

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6
Q

What is the average size of invasive carcinoma detected by mammography?

A

About 1cm (significantly smaller than carcinoma detected by palpation)

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7
Q

Calcifications form on what?

A

Secretions, necrotic debris, or hyalinized stroma and are often associated with benign lesions such as apocrine cysts, hyalinized fibroadenomas and sclerosis adenosis

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8
Q

What are the characteristics of calcifications that are associated with malignancy?

A

Small, irregular, numerous and clustered

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9
Q

What percentage of invasive carcinomas aren’t detected by mammography?

A

10%; this could be due to the presence of surrounding radiodense tissue obscuring the tumor (esp in younger women), small size, a diffuse infiltration pattern with little or no desmoplastic response or a location close to the chest wall or in the periphery of the breast

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10
Q

All palpable masses require what?

A

Further investigation

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11
Q

What is digital breast tomosynthesis (3D mammography?

A

Integrates additional views of the breast and can detect subtle changes in breast parenchymal texture

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12
Q

US can distinguish between what?

A

Solid and cystic lesions and more precisely defines the borders of solid lesions

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13
Q

What can MRI detect?

A

Cancers by the rapid uptake of contrast agents due to increased tumor vascularity and blood flow and can be particularly helpful in the evaluation of breasts of high density

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14
Q

Which epithelial breast lesion has the greatest risk of developing invasive carcinoma?

A

CIS (LCIS and DCIS)

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15
Q

Which epithelial lesions have hte lowest risk of developing invasive carcinoma?

A

Nonproliferative breast changes such as mild hyperplasia, duct ectasia, cysts, apocrine metaplasia**, adenosine, fibroadenomas (without complex features)

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16
Q

Which drugs can cause gynecomastia?

A 
Digoxin; 
Isoniazid; 
Spironolactone; 
Cimiteidine; 
(O)Estrogens
Stillboestrol; 
(DISCOS)
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17
Q

Why are stromal tumors known as biphasic?

A

Because they include a non-neoplastic epithelial component, the proliferation of which may be stimulated by GFs elaborated by the stromal cells

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18
Q

What does the prognosis of breast cancer depend on?

A

Both biological features and the extent of cancer at the time of dx (anatomic stage)

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19
Q

How is DCIS treated?

A

Locally (as subsequent invasive carcinoma usually occurs at the same time whereas LCIS confers bilateral risk)

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20
Q

The incidence of breast cancer is highest in women of which descent?

A

European

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21
Q

Which women have the highest mortality rate from breast cancer?

A

Those of African descent

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22
Q

What are major factors that decrease risk of breast cancer?

A

Early pregnancy (prior to 20 years of age) and prolonged breast feeding

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23
Q

What are the greatest RF for development of breast cancer?

A

Female gender, increasing age, germline mutations of high penetrance, strong FHx (greatest if affects first degree relative at a young age and with multiple cancers), personal Hx of breast cancer and high breast density, lifetime exposure to estrogen

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24
Q

What are the greatest RFs for sporadic breast cancer?

A

All related to hormone exposure: gender, age at menarche and menopause, reproductive hx, breast feeding and exogenous estrogens

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25
Q

What is the function of BRCA1 and 2 genes?

A

Tumor suppressor proteins that help repair damaged DNA

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26
Q

Which gene has the greatest risk of breast cancer at age 70?

A

BRCA1 (familial breast and ovarian); most commonly TNBC

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27
Q

One quarter to one third of breast cancers occur due to what?

A

Inheritance of a susceptibility gene

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28
Q

Breast cancer is rare in women younger than what age?

A

25 and increases in incidence rapidly after age 30

29
Q

Which cancers comprise almost half of the cancers found in young women?

A

TNBCs and HER2 cancers; due to the incidence of them plateau-ing in middle age

30
Q

When does the incidence of luminal cancers peak?

A

Later in life (>50 yo)

31
Q

Which cancer has the lowest rate of recurrence in the first 10 years?

A

Luminal (ER+) but recurrences continue with a steady rate over a long period of time

32
Q

Almost all recurrences of TNBC (ER/HER2-) occur when?

A

Within the first 8 years; recurrences after this time are rare

33
Q

What is the pattern of HER2+ cancer recurrences?

A

Show a mixed pattern with both early and late peaks; a late peak may be due to acquired resistance to targeted therapy or to selection of HER2- tumor cell populations

34
Q

Almost all breast malignancies are what?

A

Adenocarcinomas

35
Q

Which breast cancer has the highest prevalence?

A

Luminal A (40-55%)

36
Q

What is the MC gene mutation seen in luminal A breast cancer?

A

PIK3CA (majority) and TP53 (12%)

37
Q

What are the special histologic types of luminal A breast cancer?

A

Tubular, grade 1 or 2 lobular, mucinous, papillary

38
Q

What is the typical pt group affected by luminal A breast cancer?

A

Older women, men, cancers detected by mammographic screening

39
Q

What is the metastatic pattern for luminal A and B breast cancer?

A

Bone (70-80%), more common than viscera (25-30%) or brain (<10%)

40
Q

What is the relapse pattern for luminal A breast cancer?

A

Low rate over many yers, long survival possible with bone Metz

41
Q

What is the MC gene mutation seen with luminal B breast cancer?

A

PIK3CA and TP53 equally

42
Q

What is the special histologic type for luminal B breast cancer?

A

Grade 3 lobular

43
Q

What is the typical pt group presenting with luminal B breast cancer?

A

BRCA2 mutation carriers

44
Q

What is the relapse pattern for luminal B breast cancer?

A

Early peak at <10 years, late recurrence possible

45
Q

What is the MC gene mutation seen with HER2+ cancer?

A

PI3KCA (39%) and TP53 (70-80%)

46
Q

What are the special histo types for HER2+ breast cancer?

A

Some apocrine, some micropapillary

47
Q

What is the typical pt group presenting with HER2+ breast cancer?

A

Young women, TP53 mutation carriers (ER+)

48
Q

Which type of HER2 breast cancer has a better response to chemo?

A

ER-

49
Q

What is the metastatic pattern for HER2+ breast cancer?

A

Bone (70%), viscera and brain all common

50
Q

What is the relapse pattern for HER2+ breast cancer?

A

Bimodal with early and late (10 years) peaks

51
Q

What is the MC gene mutation seen with TNBC?

A

PI3KCA, TP53 (70-80%)

52
Q

What are the special histo types for TNBC?

A

Medullary features and metaplastic

53
Q

What is the typical pt group presenting with TNBC?

A

Young women, women of African heritage, BRCA1 mutation carriers

54
Q

What is the metastatic pattern for TNBC?

A

Bone (40%), viscera (35%), brain (25%)

55
Q

What is the relapse pattern for TNBC?

A

Early peak at <8 years, late recurrence rare, survival with metastases rare

56
Q

What is the definition for CIS?

A

A clonal proliferation that is confined to ducts and lobules; no extension beyond BM; myoepithelial cells are preserved

57
Q

What are the features of malignancy?

A

Anaplasia, pleomorphism, abnormal nuclear morphology, mitoses, vascular changes

58
Q

What does the outcome for women with breast cancer depend on?

A

The biological features of the carcinoma (molecular or histo type) and the extent to which the cancer has spread (stage) at the time of dx

59
Q

What is the most important prognostic factor?

A

Metastasis beyond regional lymph nodes

60
Q

What are poor prognostic factors?

A

Tumor cells seen in vascular spaces at the periphery of carcinomas; survival diminishes with higher histo grade

61
Q

Survival is the highest for which group of breast cancers?

A

The most favorable combination (high ER and PR, absent HER2)

62
Q

Survival is the lowest for which type of breast cancer?

A

The least favorable combination, absent ER, PR and HER2

63
Q

What are favorable prognostic factors?

A

Tubular and adenoid cystic histologic types are favorable for survival

64
Q

What is the most important prognostic factor for invasive carcinoma in the absence of distant metastases?

A

Axillary LN status

65
Q

What are the characteristics for stage I invasive carcinoma?

A

<2cm; no Metz or only micro-Metz; no distant Metz; 87% 10 year survival

66
Q

What are the characteristics for stage II invasive carcinoma?

A

> 2cm but less than 5cm; 0-3 positive LNs; absent distant Metz; 65% 10 year survival

67
Q

What are the characteristics for stage III invasive carcinoma?

A

> 5cm, also includes invasive carcinoma with skin or chest wall involvement or inflammatory carcinoma; negative or positive LNs; absent distant Metz; 40% 10 year survival

68
Q

What happens to the majority of pts with breast cancer in the absence of adequate surgery?

A

They die with extensive local dz causing ulceration of the skin

69
Q

What is carcinoma en cuirasse (carcinoma of the breast plate)?

A

A dreaded complication that must be prevented in order to maintain the best possible quality of life even in women with distant metastatic dz ; a common presentation for women living in areas with limited resources

ENRP Exam 1 (10 decks)

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