breast pathology 2 Flashcards
Miscellaneous malignant breast tumours:
name 4 and their characteristics
malignant Phyllodes tumour (sarcomatous stromal component)
Angiosarcoma (post XRT)
Lymphoma (breast and/or lymph nodes
Met tumours
metastatic tumours to breast
name the 3 categories of tumour that met to breast and give examples
Carcinoma: Bronchial, ovarian serous carcinoma, clear cell carcinoma of the kidney
Malignant melanoma
Soft tissue tumours: leiomysarcoma
definition of breast carcinoma
-origin?
a malignant tumour of breast epithelial cells
-arises in the glandular epithelium of the terminal duct lobular unit
precursor lesions
- ductal
- lobular
-epithelial hyperplasia of usual type
columnar cell change
atypical ductal hyperplasia
ductal carcinoma in situ
-lobular in situ neoplasia
atypical lobular hyperplasia
lobular carcinoma in situ
In situ carcinoma
- location?
- cytology?
- classification?
- confined within the basement membrane of acini and ducts
- Cytologically malignant but non-invasive
- lobular and ductal
Lobular in situ neoplasia
- 2 subgroups?
- describe cell characteristics? (6)
- features?(6)
- cancer risk?
- management?
-atypical lobular hyperplasia (<50% lobule involved)
Lobular carcinoma in situ (>50%of lobule involved)
-small-intermediate sized nuclei solid proliferation Intra cytoplasmic lumens/vacuoles ER positive E-Cadherin negative (this is a self adhering protein and so it's absence causes a discohesive pattern and so cancer can infiltrate as single cells
-frequently multifocal and bilateral incidence 0.5-4% in benign biopsies incidence decreases after menopause non palpable not visible grossly May calcify- mammography usually incidental finding
-higher risk of subsequently developing invasive carcinoma
-present on core biopsy then proceed to excision or vacuum biopsy to exclude higher grade lesion
present on vacuum or excision biopsy then follow up/clinical trial
Ductal proliferations
- name the 4 different types
- risk of progression to invasive carcinoma?
- grades?
- features? (3)
- epithelial hyperplasia usual type
- columnar cell change
- atypical ductal hyperplasia
- ductal carcinoma in situ
- epithelial hyperplasia usual type
- depends on the subtype;
1. 2x relative risk
3. 4x relative risk
4. 10x RR
-3 grades, low, int and high
-arises in TDLU characteristically unicentric (single duct system)
Ductal carcinoma in situ
- what is it?
- classification involves what 3 factors?
- management
-cytologically malignant epithelial cells
confined within bm of duct
may involve lobules and nipple skin (paget’s)
-cytological grade
histological type
presence of necrosis
-diagnosis via biopsy
surgery (wide local excision)
radiotherapy
chemoprevention
what is Paget’s disease of the nipple?
high grade DCIS extending along ducts to reach the epidermis of the nipple, still considered in situ, I.e non invasive
Micro invasive carcinoma
-what is it?
-high grade DCIS with invasion of <1mm
treat as you would a high grade DCIS
what is an invasive breast carcinoma?
- where can invasive breast carcinoma spread? (3 cat)
- histopathological classifications?
- Grading- what 3 categories and scores?
- staging- what 3 categories determine the stage?
- prognostic factors?
malignant cells have reached the basement membrane
NOT BREAST CANCER
1 in 8 with this will develop breast cancer
-Local invasion (storm of breast, Skin, Muscles of chest wall)
Lymphatics (regional draining lymph nodes)
Blood borne (Bone, liver, lungs, brain, abode viscera, female genital tract)
-Ductal most common, 2nd is lobular and then medullary
-Tubular differentiation Nuclear pleomorphism Mitotic activity all graded 1-3 scores: Score 3-5= Grade 1 Score 6-7= Grade 2 Score 8-9= Grade 3
-Direct invasion of adjacent tissues (size of tumour and involvement of adjacent structures) T0-T4
Lymphatic spread N0-N3
Blood borne spread M0-M1
-ER- oestrogen receptors (predicts response to anti oestrogen therapy)
HER 2
risk factors for breast carcinoma?
-Age
-Reproductive hx: age at menarche (younger ^) age at first birth (older ^) parity (fewer ^) breastfeeding age at menopause (young ^)
-Hormones
endogenous
Exogenous (OCP, HRT)
- prev breast disease
- Geography
-Lifestyle bodyweight (higher BMI, higher oestrogen) physical activity Alcohol consumption Diet NSAID Smoking
-Genetics
intrinsic breast cancer subtypes?
Basal-like (ER-, HER2-, Basal CK+ ) HER2 (ER-, HER2+) Normal breast-like (ER-, non-epithelial) Luminal A (ER+, low proliferation) Luminal B (ER+, high proliferation) Luminal C (ER+, high proliferation)
Give 4 examples of anti oestrogen therapy
Oophorectomy
Tamoxifen
Aromatase inhibitors (letrozole)
GnRH antagonists (Goserilin)
what is HER 2?
human epidermal growth factor Receptor 2
- HER 2 over expression and amplification can be seen in 15% of invasive carcinoma
- the degree of over expression predicts response to Trastuzamab
