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Reproduction and Sexual Health > Breast Pathology 2 > Flashcards

Breast Pathology 2 Flashcards

1
Q

When do most angiosarcomas occur?

A

Post-radiotherapy

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2
Q

After how many years of radiotherapy do angiosarcomas usually happen?

A

2-5 years

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3
Q

What are the 3 most common metastatic tumours to the breast?

A
  • Bronchial
  • Ovarian serous carcinoma
  • Clear cell carcinoma of kidney
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4
Q

Name a soft tissue tumour of the breast.

A

Leiomysarcoma

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5
Q

What, simply, is a breast carcinoma?

A

A malignant tumour of the breast epithelial cells

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6
Q

Where in the breast does a carcinoma arise?

A

Arises in the glandular epithelium of the terminal duct lobular unit (TDLU)

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7
Q

Name 4 ductal precursor lesions in the breast.

A
  • Epithelial hyperplasia of usual type
  • Columnar cell change
  • Atypical Ductal Hyperplasia
  • Ductal Carcinoma in situ
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8
Q

Name a lobular precursor lesion of the breast.

A

Lobular in situ neoplasia - Atypical lobular hyperplasia or Lobular carcinoma in situ

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9
Q

Where is an in situ carcinoma of the breast confined to?

A

This is confined to the basement membrane of acini and ducts

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10
Q

What is atypical about breast carcinoma?

A

They are described as being malignant but are non-invasive

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11
Q

Breast carcinoma can be either _______ or ______

A

Lobular or ductal

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12
Q

What are the 2 main sub-categories of lobular in situ neoplasia?

A
  • Atypical Lobular Hyperplasia (ALH) - <50% of lobule is involved
  • Lobular Carcinoma in situ (LCIS) - >50% of the lobule is involved
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13
Q

ALH is defined as …

A

<50% of lobule is involved

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14
Q

LCIS is defined as …

A

> 50% of the lobule is involved

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15
Q

In what is there ‘intralobular proliferation of characteristic cells’?

A

Lobular in situ neoplasia

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16
Q

List some of the features of cells in lobular in situ neoplasia.

A
  • Small-intermediate sized nuclei
  • Solid proliferation
  • Intra-cytoplasmic lumens/vacuoles
  • Oestrogen receptor positive (ER+)
  • E-cadherin negative (deletion and mutation of CDH1 gene on Chr 16q22.1)
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17
Q

What is E cadherin?

A

E cadherin is a cell adhesion molecule found in the membrane but not in this neoplasia (this process is lost)

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18
Q

Outline the main clinical features of lobular in situ neoplasia.

A
  • Frequently multifocal and bilateral
  • Incidence decreases after menopause
  • Not palpable or visible grossly
  • May calcify – which can be seen on mammography
  • Usually an incidental finding
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19
Q

When does the incidence of lobular in situ neoplasia decrease?

A

After menopause

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20
Q

Lobular in situ neoplasia are not palpable or visible grossly

A

TRUE

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21
Q

What may a lobular in situ neoplasia do? (hint: it can be seen on mammography)

A

Calcify

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22
Q

Why is incidence of lobular in situ neoplasia decreased after menopause?

A

ER (oestrogen receptor) drops

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23
Q

Outline the management of lobular in situ neoplasia.

A
  • Vacuum biopsy
  • Excision biopsy – this is less common now
  • Follow up
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24
Q

How can you tell what lobular in situ neoplasia will be invasive?

A

You can’t :(

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25
Q

List the 4 different types of ductal proliferation.

A
  • Epithelial hyperplasia of usual type
  • Columnar cell change (lesion)
  • Atypical ductal hyperplasia
  • Ductal carcinoma in situ
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26
Q

Different intraductal neoplasia’s have different risks of progression to invasive carcinoma. Comment on the different risks.

A
  • Epithelial hyperplasia of usual type – 2x RR
  • Atypical Ductal Hyperplasia – 4x RR
  • Ductal Carcinoma in situ (low grade) – 10x RR (25% over following 10 years)
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27
Q

15-20% of all breast malignancies are ____

A

DCIS

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28
Q

DCIS accounts for what % of all breast cancers?

A

15-20%

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29
Q

Where in the breast does ductal carcinoma in situ arise?

A

Arises in TDLU (terminal duct lobular unit)

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30
Q

DCIS is characteristically?

A

Unicentric (single duct system)

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31
Q

What is DCIS a risk factor for?

A

Risk factor for development of invasive carcinoma !! – a true precursor lesion of invasive carcinoma

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32
Q

What cancers are true precursors of invasive carcinoma?

A

DICS and LCIS

33
Q

Cytologically, what is seen in DCIS?

A

Malignant epithelial cells are seen

34
Q

Where is DCIS confined to?

A

** Confined within the basement membrane of a duct !! **

35
Q

What may DCIS involve?

A
  • May involve lobules (a process known as cancerisation)

* May involve nipple skin (Paget’s)

36
Q

What is Paget’s disease of the nipple?

A

High grade DCIS extending along the ducts to reach the epidermis of the nipple

37
Q

Describe Paget’s disease of the nipple.

A
  • In situ carcinoma
  • Non-invasive
    *
38
Q

Explain how in Paget’s disease the cancer can spread from the BM of the duct to the skin but still be in situ.

A

BM continuous from duct to the epidermis of the skin so this it is still in situ

39
Q

How is DCIS classified?

A
  • Cytological grade
  • Histological type
  • Presence of necrosis (comedo)
40
Q

Outline the management of DCIS.

A
  • Diagnosis
  • Surgery – trials of mammographic follow-up in low risk DCIS)
  • Adjuvant radiotherapy
  • Chemoprevention (trial)
41
Q

Microinvasive carcinoma is common

A

FALSE - very rare

42
Q

What is micro invasive carcinoma?

A

DCIS (high grade) with invasion of <1mm

43
Q

How is micro invasive carcinoma treated?

A

As a high grade DCIS

44
Q

What are the characteristics of INVASIVE breast carcinoma?

A
  • Malignant epithelial cells which have BREACHED the BM
  • Infiltration of normal tissues
  • Risk of metastasis and death
45
Q

Outline all the risk factors you can think of for invasive breast carcinoma.

A
  • Age
  • Age at menarche (earlier is worse)
  • Age at first birth (<30 years is protective)
  • Parity (greater parity is protective)
  • Breastfeeding (protective)
  • Age at menopause (late menopause is worse)
  • Hormones – HRT, OCP
  • Previous breast disease
  • Lifestyle – bodyweight, physical activity (protective), alcohol conumption, diet, NSAID (lower risk), smoking
  • Genetics
  • Family history – an affected first degree relative doubles your risk
46
Q

Puberty starting at an older age is protective

A

True

47
Q

What % of breast cancers have increased oestrogen as a risk?

A

80%

48
Q

Greater parity is protective against breast cancer

A

TRUE

49
Q

An affected first degree relative doubles your risk of having breast cancer

A

True

50
Q

What is the most common breast cancer mutation?

A

BRCA 1 and BRCA 2

51
Q

How many women carry BRCA1/2?

A

1 in 450

52
Q

What is the commonest female cancer?

A

Invasive breast carcinoma

53
Q

2nd commonest cause of cancer death in women is?

A

Invasive breast cancer

54
Q

How many women will develop breast cancer?

A

1 in 8

55
Q

What are the 3 things used to assess progression of breast cancer?

A
  • Local invasion
  • Lymphatics
  • Blood borne
56
Q

Where are the 3 most common sites of local invasion of breast cancer?

A
  • Stroma of breast
  • Skin
  • Muscles of chest wall
57
Q

What lymph nodes are commonly invaded in breast cancer?

A
  • Axillary
  • Parasternal
  • Sub-clavicular
  • Intramammary nodes
58
Q

When breast cancer invades the blood, where is the most common site for mets?

A

Bone, liver, brain, lungs, abdominal viscera, female genital tract

59
Q

What 3 factors are used in the classification of invasive breast carcinoma?

A
  • Morphology
  • Gene expression profiling
  • Hormone receptor expression
60
Q

What are the different hormones that can be expressed in invasive breast cancer?

A
  • Oestrogen receptor (ER)
  • Progesterone receptor (PR)
  • HER2
61
Q

What is tumour grade a measure of?

A

Grade is a measure of tumour differentiation

62
Q

Very similar to parent tissue =

A

Well differentiated = Low grade = Good prognosis

63
Q

Very different to parent tissue =

A

Poorly differentiated = High grade = Poor prognosis

64
Q

In breast cancer grading, what is there an objective assessment of?

A

Tubular differentiation – scored from 1-3
Nuclear pleomorphism – scored from 1-3
Mitotic activity – scored from 1-3

Min score - 3
Max score - 9

65
Q

In breast cancer grading, what is there an objective assessment of? Also outline the different scores.

A

Tubular differentiation – scored from 1-3
Nuclear pleomorphism – scored from 1-3
Mitotic activity – scored from 1-3

Min score - 3
Max score - 9

Score 3, 4 or 5 = grade 1
Score 6 or 7 = grade 2
Score 8 or 9 = grade 3

66
Q

80% of breast carcinomas are oestrogen receptor (ER) positive

A

True

67
Q

67% of breast carcinomas are progesterone receptor positive

A

True

68
Q

14% of breast carcinomas are HER2 receptor positive

A

True

69
Q

What does oestrogen receptor predict?

A

This predicts the response of the carcinoma to anti-oestrogen therapy

70
Q

Give examples of anti-oestrogen receptor drugs.

A
  • Oophorectomy
  • Tamoxifen
  • Aromatase inhibitors (letrozole)
  • GnRH antagonists (Goserilin (Zoladex))
71
Q

What does HER2 stand for?

A

Human Epidermal growth factor Receptor 2

72
Q

HER 2 overexpression or amplification predict response to __________?

A

Trastuzamab

73
Q

HER 2 overexpression or amplification predict response to __________?

A

Trastuzamab

74
Q

What is Trastuzamab good for?

A

HER2 active disease

75
Q

What 3 factors would infer the worst prognosis for an invasive breast cancer?

A
  • Tumour size >50 mm
  • 3+ nodes
  • Lymphovascular invasion
76
Q

Outline the features of the Nottingham Prognostic Index.

A
  • 0.2 x tumour diameter (cm)
  • Tumour grade (1-3)
  • Lymph node status (1-3)
77
Q

Small tumours have a better prognosis than big

A

True

78
Q

Describe the TNM staging of breast cancer.

A

Direct invasion of adjacent tissues:

T0 - T4 – Local tumour growth (size of tumour and extent of involvement of adjacent structures)

Lymphatic spread:

N0 – N – Regional lymph nodes

Blood-borne spread:

M0 - M1 – Distant metastasis

Reproduction and Sexual Health (51 decks)

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