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REPRO > Breast Pathology 2 > Flashcards

Breast Pathology 2 Flashcards

1
Q

Name miscellaneous malignant tumors

A

Malignant phyllodes tumor
Angiosarcoma
Lymphoma
Metastatic tumors

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2
Q

What is the tumorous version of the fibroadenoma?

A

Malignant phyllodes tumor - has sacromatous stromal component

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3
Q

Which organ does the phyllodes tumor generally metastasize to?

A

Lung

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4
Q

Which malignant tumor usually occurs post radiotherapy?

A

Angiosarcoma

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5
Q

Which metastatic tumors usually spread to the breast?

A

Carcinoma : Bronchial / ovarian serous/ clear cell ca of kidney

Malignant Melanoma

Soft Tissue tumors ( leiomyosarcoma)

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6
Q

Where does breast cancer arise from?

A

The glandular epithelium of the TDLU

—an adenocarcinoma

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7
Q

What are the ductal precursor lesions?

A
  • epithelial hyperplasia type
  • columnar cell change (+/- atypia)
  • atypical ductal hyperplasia
  • ductal carcinoma in situ???
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8
Q

Name lobular precursor lesions.

A

Lobular in situ neoplasia

  • atypical lobular hyperplasia
  • lobular CA in situ
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9
Q

What is seen histologically with in situ carcinoma ?

A

Confined within BM of acini and ducts

- cytologically appear MALIGNANT but non invasive

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10
Q

Can in situ carcinoma still progress to invasive ca?

A

Yes.

if High Grade In situ carcinoma

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11
Q

What are 2 types of Lobular In situ hyperplasia ?

A

ALH ( atypical lobular hyperplasia) …<50% of lobulee involved

LCIS (lobular ca in situ)…>50% of lobule

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12
Q

What is characteristic of the cells proliferating in lobular in situ neoplasia?

A
  • ER positive
  • E-cadherin Negative (d/t mutation and deletion of CDH1 gene) `
  • small intermediate sized nuclei
  • —small, rounded, loosely cohesive cells fill and expand the acini
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13
Q

What is e-cadherin?

A
  • a surface protein responsible for the cohesion of NORMAL breast epithelial cells
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14
Q

What are the key fts of the LCIS?

A
  • FREQ. Multifocal and bilateral

- incidence decreases after menopause and is 0.4-4% present in benign biopsies

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15
Q

Gross and imaging ft of LCIS?

A
  • GROSS= not palpable or visible

- may calcify (seen on mammography)

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16
Q

What is the significance of Lobular in situ neoplasia?

A
  • marker of subsequent risk

- TRUE precursor lesion

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17
Q

How to manage Lobular in situ neoplasia?

And why is it done this way?

A
  • vacuum/ excision biopsy
    > do follow-ups
    > clinical trials

—-as lobular in situ neoplasia is multifocal; there is no point to perform a multiple lumpectomy

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18
Q

What is the risk of developing ductal carcinoma from A LOW gr. DCIS?

A

10x the risk

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19
Q

What are the fts of DCIS?

A
  • 15-20% OF BREAST malignancies are DCIS
  • arises in TDLU
  • unicentric
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20
Q

What are the histological fts of DCIS?

A
  • malignant looking cells confined within the BM of the duct
  • may involve the lobules (cancerisation) and nipple skin (Paget’s)
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21
Q

What is Paget’s disease? Is it invasive?

A
  • high gr. DCIS extending along the ducts REACH the epidermis of the nipple
  • —still in situ carcinoma (not invasive)
22
Q

How is DCIS classified?

A
  • cytological type
  • histological grade
  • presence of necrosis (COMEDO)
23
Q

What is the risk of ductal ca in situ progressing into an INVASIVE CA?

A
  • true precursor to invasive carcinoma

- 75% progress to INVASION following incisional biopsy

24
Q

How to manage DCIS?

A
  1. dx> Surgery
    ( mammographic follow-up in LOW risk DCIS pts)
  2. Adjuvant radiotherapy
  3. Chemoprevention (endocrine therapy)
25
Q

What is a key ft of Micro-invasive Carcinoma?

A
  • basically DCIS that extends <1mm past the BM

= treat as HIGH grade DCIS

26
Q

When is a tumour deemed to be invasive?

A
  • when the malignant epithelial cells have BREACHED the Bm
  • infiltration of normal tissues
  • risk of death and metastasis
27
Q

What is said to be the primary risk factor of developing CA of the breast?

A

-the more estrogen in your life; the greater the chance of you to develop INVASIVE breast cancer

28
Q

What should be explored with the pt for risk factors?

A
  • age at menarche
  • age at first birth
  • parity
  • breastfeeding
  • age at menopause
  • exogenous/endogenous hormones ( OCP/HRT)
  • previous breast disease
  • genetics
  • lifestyle
29
Q

IS there greater risk of breast cancer with estrogen-only HRT or estrogen-progesterone HRT?

A
  • greater risk with estrogen and progesterone HRT
30
Q

What factors of lifestyle predisposes one to carcinoma of the breast?

A
  • body weight
  • alcohol consumptiom
  • food types (smoked food)
  • smoking
  • inactivity
  • NSAID (lowers risk)
31
Q

2 MAJOR gene mutations a.w breast cancer?

A
  • BRCA 1 and BRCA 2
    (but only 1 in 450 people carry the mutation)
  • 45-64% LIFE-time risk
32
Q

How does invasive carcinoma usually arise?

A
  • genes along with external factors may further predispose on to the cancer
  • —lifestyle and hormones
33
Q

What are the stats like with breast cancer incidence and mortality?

A
  • Incidence is risng

- Mortality is falling

34
Q

Name the MOST common female cancer!

A
  • invasive breast carcinoma—– 1 in 8! may develop

2nd most common cause of cancer death

35
Q

How may the breast cancer be staged?

A

TNM
1. Local invasion of the tumor (stroma/ skin/ muscles of chest wall)

  1. Lymphatics (regional draining LN)
  2. Blood-borne (M) —> bone/ liver/ brain/ lungs/ abd. viscera/ female genital tract
36
Q

Where are the possible nodes for the cancer to spread to?

A
  • internal mammary and intra-mammary nodes
  • supra-/ infra-clavicular nodes
  • apical and AXILLARY nodes
  • cervical nodes
37
Q

What are the 3 things invasive breast cancer is classified by?

A
  1. Morphology (type and grade)
  2. Gene Expression Profiling (intrinsic sub-types)
  3. Hormone Receptor Expression (ER/ PR/ HER2)
38
Q

What are the diff. types of invasive breast CA?

A
  • ductal/ lobular/ mucinous/ medullary/ tubular/ cribriform/ papillary/ mixed
39
Q

What is meant by tumour grade?

A
  • MEASURE of tumour differentiation
    a) well differentiated= low grade= GOOD PROGNOSIS

b) poorly differentiated= high grade= POOR prog.

40
Q

What is the tumor grading based on?

A
  • tubular differentiation (1-3)
  • nuclear pleomorphism (1-3)
  • mitotic activity (1-3)
41
Q

Survival rate reduces with _____

A

higher tumor grade

42
Q

What hormone receptors may be found on malignant cells of the breast?

A
  • ER
  • PgR
  • HER2
43
Q

Significance of knowing which receptor is predominantly found on the tumor cells?

A
  • ER expression indicates response to anti-estrogen therapy
44
Q

What is invovlved in anti-estrogen therapy?

A
  • oophorectomy
  • Tamoxifen
  • Aromatase Inhibitors
    (Letrozole)
  • GnRH antagonists (Zoladex)
45
Q

WHich tumor is likely have better prognosis, er +/-?

A
  • ER +

same with PR

46
Q

What is HER2?

A
  • Human epidermal growth factor receptor 2

- —-amplification seen in 15%

47
Q

Which drug is responsive to HER2 + tumor?

A

Trastuzumab

48
Q

Which poses as having poor prognosis, HER2 +/- ?

A

HER2 -

49
Q

Which breast tumor has the worst prognosis?

A

being triple negative

50
Q

What TNM hold worst prognosis?

A
    • bigger tumors
  • -more than 1 LN metastasis
  • -presence of lymphovascular invasion
51
Q

What prognostic indices are used for breast cancer?

A
  • Nottingham Prognostic Index (histopathology only)
  • Adjuvant online (ER+ Clinical factors+ histopathology)
  • NHS predict (ER+ clinical factors+ HER2+ histopathology+ mode of detection)

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