Breast pathology 2 Flashcards
what are the types of breast malignancy
Malignant phyllodes tumour
angiosarcoma
lymphoma
metastatic tumours
breast carcinoma
what types of tumour tends to metastasise to the lungs
carcinoma
- bronchial
- ovarian serous carcinoma
- clear cell carcinoma of the kidney
malignant melanoma
soft tissue tumours
-leiomyocarcoma
what is a breast carcinoma
a malignant tumour of Brest epithelial cells
arises in the glandular epithelium of the terminal duct lobar unit
its an adenocarcinoma but just called a breast carcinoma
what precursor lesions are there for breast carcinoma in the ducts
epithelial hyperplasia
columnar cell change
atypical ductal hyperplasia
ductal carcinoma in situ
what precursor lesions are there for lobular breast carcinoma
lobular in situ neoplasia
- atypical lobular hyperplasia (<50% of lobule involved)
- lobar carcinoma in situ (>50% of lobule involved)
what is an in-situ carcinoma
carcinoma confined within basement membrane of acini and ducts
cytologically malignant however non-invasive
precursor of invasive carcinoma
types of carcinoma in situ
lobar
ductal
what does lobular in situ neoplasia look like under a microscope
intra-lobular proliferation of characteristic cells
- small nuclei
- solid proliferation
- intra-cytoplasmic lumens/vacuoles
- ER positive
- E-cadherin negative
how does lobular in situ neoplasia present
incidental finding
not palpable or visible grossly
may calcify - mammography needed
what is the significants of a lobular in situ neoplasia
marker of subsequent risk
true precursor lesion
management of lobular in situ neoplasia
excision or vacuum biopsy to exclude higher grade lesion
what are the types of intraductal proliferation
epithelial hyperplasia of usual type
columnar cell change (lesion)
columnar cell change with atypic
atypical ductal hyperplasia
ductal carcinoma in situ
what are the features of ductal carcinoma in situ
15-20% of malignancies
Aries in the terminal ductal lobular unit
usually just effect a single duct system
what is a ductal carcinoma in situ
malignant epithelial cells
confined to basement membrane of dict
may involve lobules (cancerisation)
may involve nipple skin (pages)
what is a ductal carcinoma in situ involving nipple skin called
Paget’s disease of the nipple
high grade DCIS extending along ducts to reach the epidermis of the nipple
what is ductal carcinoma in situ involving lobules called
cancerisation
what is the significance of DCIS
risk for development of invasive carcinoma
true precursor lesion for invasive carcinoma
how do you manage DCIS
surgery
adjuvant radiotherapy
chemoprevention
endocrine therapy
what is a microinvasive carcinoma
rare
DCIS (high grade) with invasion of <1mm
treat as high grade DCIS
what is an invasive breast carcinoma
malignant epithelial cells which have breached the BM
infiltration of normal tissues
risk of metastasis and death
risk factors for invasive breast carcinoma
age
reproductive history
- age at menarche
- age at first birth
- parity
- breast feeding
- age at menopause
Hormones
- endogenous
- exogenous (OCP, HRT)
Previous breast disease
Geography
lifestyle
- body weight
- physical activity
- alcohol consumption
- diet
- NSAIDs (lowers risk)
- smoking
Genetics
- affected first degree relative doubles risk
- BRCA 1&2 (2% of all breast cancers)
- Other cancer syndromes
what is the life time risk of breast cancer if you have BRCA 1 or 2
45-64%
what’s the 1, 5 and 10 year survival rates for invasive breast carcinoma
1 year - 96%
5 year - 87%
10 year - 78%
what is the pathway for invasive breast carcinoma to spread
Local invasion (T)
- stroma of breast
- skin
- muscles of chest wall
Lymphatics (N)
-regional draining lymph nodes
Blood-borne (M)
- bone
- liver
- brain
- lungs
- abdominal viscera
- female genital tract
how is lymph drained from the breasts
intramammary nodes
internal mammary nodes
sentinel nodes
drain into axillary nodes, apical nodes, intraclavicular nodes, supraclavicular nodes
what are the different types of invasive breast carcinoma
Ductal (70%) Lobular (10%) Mucinous (2%) Medullary (3%) Tubular (2%) Cribriform (1%) Papillary (<1%) Mixed (10%)
how are breast carcinomas graded
assessment of (graded 1-3)
- tubular differentiation (1-3)
- nucleuar pleomorphism (1-3)
- mitotic activity (1-3)
(measure of how different it the tumour is to the parent tissue)
total score:
3-5 = grade 1
6 or 7 = grade 2
8 or 9 = grade 3
what hormone receptors can breast cancers have (the hormones make the cancer grow more)
Oestrogen receptors (ER)
Progesterone receptors (PhR)
Human epithelial growth hormone receptors (HER2)
what re the 3 major types of breast cancers divided by hormone receptors
ER+ HER2- (Most common, basal like)
ER- HER2+ (HER2 carcinoma)
ER- HER2- (normal breast like)
what does ER receptor expression predict the response to
anti-oestrogen therapy
- oophrectomy
- tamoxifen
- aromatase inhibitors
- GnRH antagonists
how are breast carcinomas staged
TNM
T0-4 - local tumour growth
N0-3 - regional lymph nodes
M0-M1- blood born spread
what are predictive and prognostic factors for invasive carcinoma
ER
PgR
HER2
