Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pathology > Breast Pathology > Flashcards

Breast Pathology Flashcards

1
Q

What are risk factors for locoregional recurrence in DCIS

A

Four most important
-age <50
-size >2cm
-grade 3
-<2mm surgical margins (less considered a positive margin)

Additional
-comedo/solid subtype
-palpable/bloody discharge
-ER/PR negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are risk factors for invasive breast cancer recurrence

A

Patient
-age
-menopausal status
-race

Tumour
-size
-node status
-grade
-LVSI
-Genomic score
-receptor status

Treatment related
-surgical margin status (no ink on margin negative)
-systemic therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are common symptoms of papilloma and what is the cause of these symptoms

A

Blood discharge: due to tortion of papilloma stalk
Serous discharge: due to intermittent blockage of duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the median age of diagnosis by TCGA molecular subtypes

A

Luminal: older Medan age
Basal/ HER2: peak incidence in middle age. Almost half of breast cancers in younger women, 20% in older women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are risk factors for the development of breast cancer

A

Female gender
Lifetime exposure to estrogen
Age
Genetic mutation inheritance
Environmental/lifestyle factors ( less relevance)

Reduced risk
-early pregnancy aged less than 20
-prolonged breast feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What proportion of breast cancers are thought to occur due to an inherited susceptibility

A

Quarter to one third

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What percentage of breast cancers are associated with BRCA1 or BRCA2

A

3-6%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which BRCA mutation is most commonly associated with ovarian cancer

A

BRCA1: 20-40% lifetime risk
BRCA2: 10-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the typical ER profile of BRCA associated breast cancers

A

BRCA1: Triple negative
BRCA2: more often ER positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What pathway are the products of BRCA genes part of

A

Homologous recombination for repair of double stranded DNA breaks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the response rates to chemotherapy of difference TCGA subtypes of breast cancer

A

Luminal A: <10% (but good response to hormone therapy)
Luminal B: 10%
HER2: good response if ER negative
Basal: 30% response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What TCGA subtype of breast cancer is most commonly associated with Li Fraumeni syndrome

A

HER2+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In triple negative breast cancer without germline BRCA1 mutation, what is the most common change to the BRCA1 gene

A

Epigenetic silencing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Where are the more common metastasis sites for TNBC

A

Visceral sites and brain (rather than bone with luminal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the typical recurrence pattern for TNBC

A

Recurrence by 8 years. From 10 years recurrence is very rare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What layer does a breast in situ carcinoma need to breach to become an invasive carcinoma

A

The basement membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the microscopic features of comedo DCIS

A

Polymorphism of cells, high grade
Central necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the process that results in Paget’s disease of the breast. What is the relevance of the presence of a mass?

A

Malignant cells travel through ducts of breast and break through the lactiferous sinuses onto the skin of the nipple. Cause pruritis and eczema like chance ( unilateral)

If mass palpable then it is likely there is an underlying invasive breast cancer (commonly HER2+)
If no mass palpable then more likely that the underlying pathology is DCIS

19
Q

What are the pathological features that distinguish LCIS from DCIS

A

Both form in ducts and lobules (ie the naming of them is historic and now misleading)
LCIS has the microscopic appearance of discohesive cells ( not penetrating basement membrane)
Usually have dysfunction of e-cadherin
Cells are rounded due to loss of adhesion to other cells
LCIC is not associated with Paget’s disease of the breast ie, nipple skin involvement (but does have a Pagetoid appearance within the ducts ie, discohesive cells)
LCIS is not associated with calcification

20
Q

What is the natural history of LCIS, including following surgical resection

A

1% per year risk of invasive cancer
Ipsilateral breast only slightly more likely to be site of invasive disease
Most invasive cancers are morphologies other than lobular. 3x rate of lobular compared to general population.
It is unclear if resection of LCIS lesion lowers risk of invasive cancer
Most are ER/PR positive, so Tamoxifen is a treatment option

21
Q

What are the 5 most common subtypes of DCIS, and which have worst prognosis

A

Cribriform
Papillary
Micropapillary
Solid (poor)
Comedo (poor)

22
Q

What mutation do Lobular breast carcinomas often have

A

CDH1 (e-cadherin)

23
Q

What are common metastatic sites for lobular carcinoma

A

Peritoneum, retroperitoneum, leptomeninges, GI tract, ovaries, uterus

24
Q

What localised reaction do lobular carcinomas often lack, making their detection more difficult

A

Desmoplastic reaction

25
Q

Invasive breast carcinomas with medullary pattern are associated with abnormalities in what gene. How does prognosis compare to other poorly differentiated breast cancers

A

Associated with BRCA1. Either germline mutation or down regulation of expression.
Tend to have better prognosis
Associated with T-cell infiltration which may produce an anti tumour immune response

26
Q

What are examples of Luminal special types of breast cancer

A

Lobular
Mucinous
Tubular
Papillary

27
Q

What is a common microscopic feature of lobular breast cancer

A

Signet ring appearance due to intracellular mucin droplets

28
Q

What is the microscopic appearance of mucinous breast cancers

A

Clusters of cells in large lakes of mucin

29
Q

What special histological types of breast cancer frequently over express HER2

A

Apocrine: similar appearance to cells lining sweat glands. Round nuclei, prominent nucleoli, abundant eosinophilia cytoplasm
micropapillary: hollow balls of cells floating within intracellular fluid

30
Q

Which special histological type of breast cancer is most associated with TNBC. What are it’s gross and histological features

A

Carcinoma with medullary pattern
Grossly softer than others due to minimal desmoplasia
Microscopically:
-solid sheets of large cells with pleomorphic nuclei and prominent nucleoli
-frequent mitotic figures
-moderate to marked lymphoplasmacytic infiltrate
-pushing, non infiltration border

31
Q

What are examples of rare histological subtypes of TNBC that have favourable prognosis

A

Low grade adenosquamous
Adenoid cystic
Secretory carcinoma

32
Q

What is the reason for the inflamed breast appearance in inflammatory breast cancer, and what causes the peau d’orange.

A

Usually NO inflammation involved. Ie stupid name.
Tumour cells block lymphovascular channels, causing swelling
Tethering of coopers ligaments causes the skin puckering.

33
Q

What are the two types of intralobular stromal tumours of the breast

A

Fibroadenoma
Phyllodes tumour

34
Q

What is the typical presentation of a breast fibroadenoma

A

Women aged in 20’s and 30’s
Hormone responsive with rapid growth during pregnancy
Slight increased risk of invasive carcinoma

35
Q

What is the typical presentation of phyllodes tumour of the breast

A

Median age of presentation 6th decade
High grade tumours can metastasise via haematogenous spread.
Node spread in very rare and node dissection contraindicated

36
Q

What is the most common interlobular stromal malignant tumour of the breast

A

Angiosarcoma
Associated with post therapy chronic angioedema of the breast and radiation therapy

37
Q

What is the lifetime risk of breast cancer and ovarian cancer for BRCA1 and BRCA2 carriers respectively

A

Both about 70% at age 80 for breast cancer
Ovarian cancer: 44% BRCA1, 17% BRCA2 (to age 80)

38
Q

Is BRCA1 or BRCA2 most associated with increased cancer risk in men

A

BRCA2; for both breast and prostate. Breast 7% at age 70, prostate 27% at age 75, 60% at age 85

39
Q

What is the histological pattern of phyllodes tumour, and how are they graded

A

Biphasic: epithelial and stromal elements
Epithelial component usually benign
Stromal component used for grading: benign, borderline, malignant

Components of grading:
-stromal atypia
-stromal cellularity
-stromal cell overgrowth
-mitotic rate
-tumour border
-if a malignant heterologous element is present (Ie a sarcoma such as liposarcoma, chondrosarcoma, then it is automatically classified as malignant

40
Q

Which subtypes of breast invasive ductal carcinoma are most favourable

A

Mucinous
Tubular

41
Q

What are components of the main grading system for invasive breast cancers

A

Nottingham system
-tubule formation
-nuclear pleomorphism
-mitotic count

42
Q

What receptor status are Li Fraumeni associated breast cancers often associated with

A

HER2 over expression

43
Q

What IHCstaning can be used to distinguish between invasive and in situ breast carcinomas

A

Invasion is associated with loss of smooth muscle layer

Therefore loss of staining of SMA

Pathology (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions