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Reproductive & Sexual Health > Breast pathology 2 > Flashcards

Breast pathology 2 Flashcards

1
Q

What are the metastatic tumours to the breast?

A
  • Carcinoma
    • bronchial
    • ovarian serous carcinoma
    • clear cell carcinoma of the kidney
  • malignant melanoma
  • soft tissue tumours
    • leiomyosarcoma
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2
Q

Define breast carcinoma

A

A malignant tumour of breast epithelial cells

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3
Q

Where does breast carcinoma arise?

A

Glandular epithelium of the terminal duct lobular unit (TDLU)

It is an adenocarcinoma but is usually just referred to as ‘breast carcinoma’

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4
Q

What are the precursor lesions of breast carcinoma?

A
  • ductal
    • epithelial hyperplasia of usual type
    • columnar cell change (+/- atypia)
    • atypical ductal hyperplasia
    • ductal carcinoma in situ
  • lobular
    • lobular in situ neoplasia
      • atypical lobular hyperplasia
      • lobular carcinoma in sity
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5
Q

What is in situ carcinoma?

A

confined within basement membrane of acini & ducts

Cytologically malignant but non-invasice

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6
Q

What is in situ carcinoma a precursor for?

A

Non-obligate precursor of invasive carcinoma

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7
Q

How is in situ carcinoma classified?

A

Lobular

Ductal

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8
Q

What are the two classifications of lobular in situ neoplasia?

A

Atypical lobular hyperplasia (ALH) <50% of lobule involved

Lobular carcinoma in situ (LCIS) >50% of lobule involved

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9
Q

Describe intra-lobular proliferation of characteristic neoplastic cells

A
  • small-intermediate sized nuclei
  • solid proliferation
  • intra-cytoplasmic lumens/vacuoles
  • ER positive
  • E-carherine negative (deletion and mutation of CDH1 gene on Chr 16q22.1)
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10
Q

Lobular in situ neoplasia is frequently ______ and ______.

A

Lobular in situ neoplasia is frequently multifocal and bilateral.

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11
Q

When does the incidence of lobular in situ neoplasia decrease?

A

After menopause

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12
Q

What is the significance of lobular in situ neoplasia?

A

relative risk of invasive carcinoma

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13
Q

What is the management of lobular in situ neoplasia?

A

LN discovered on core biopsy

  • proceed to excision or vacuum biopsy to exclude higher grade lesion

LN discovered on vacuum or excison

  • follow up
    • clinical trials*
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14
Q

What is intraductal proliferation?

A

Epithelial hyperplasia of usual type

  • Columnar cell change (lesion)
  • Columnar cell change with atypia
  • Atypical ductal hyperplasia
  • Ductal carcinoma in situ
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15
Q

What is the RR of progression of intraductal proliferation to invasive carcinoma?

A
  • epithelial hyperplasia of usual type= 2 x RR
  • Atypical ductal hyperplasia = 4 x RR
  • Ductal carcinoma in situ (low grade) = 10 x RR
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16
Q

Ductal carcinoma in situ are characteristically ________ (_____ duct system)

A

Ductal carcinoma in situ are characteristically unicentric (single duct system)

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17
Q

Describe the cytology of DCIS

A

Cytologically malignant epithelial cells confined within basement membrane of duct

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18
Q

What is cancerisation

A

DCIS involving lobules

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19
Q

What is paget’s disease of the nipple?

A

DCIS involving the nipple skin

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20
Q

Is paget’s disease invasive?

A

No still in situ carcinoma

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21
Q

How is DCIS classified?

A
  • cytological grade
  • histological type
  • presence of necrosis
22
Q

what is the significance of DCIS?

A

risk factor for progression of invasive carcinoma

23
Q

How is DCIS managed?

A
  • diagnosis
  • surgery
    • trials of mammographic follow-up in low risk DCIS
  • adjuvant chemotherapy
  • chemoprevention
    • endocrine therapy
24
Q

What is microinvasive carcinoma?

A

Rare, high grade DCIS with invasion of <1mm

25
Q

How is microinvasive carcinoma treated?

A

as high grade DCIS

26
Q

What is invasive breast carcinoma?

A

Malignant epithelial cells have breached the basement membrane

Infiltration of normal tissues

27
Q

What is the risk with invasive breast carcinoma?

A

Metastasis and death

28
Q

What are the risk factors for carcinoma of the breast?

A
  • age
  • reproductive history
  • hormones
  • previous disease
  • geography
  • lifestyle
  • genetics
29
Q

What are the reproductive history risk factors for carcinoma of the breast?

A
  • age at menarche
  • age at first birth
  • parity
  • breastfeeding
  • age at menopause
30
Q

What hormones affect risk of carcinoma of the breast?

A

Endogenous

Exogenous

  • OCP
  • HRT
31
Q

How increased is the risk of breast cancer with OCP use, how long does it take to return to population risk

A

1.0 -> 1.24

10 years

32
Q

What aspects of lifestyle contribute to risk of carcinoma of the breast?

A
  • body weight- higher oestrogen from fatty tissue conversion
  • physical activity (protective)- lowers oestrogen levels
  • alcohol consumption- higher oestrogen levels
  • diet- high fat intake
  • NSAID- reduces risk slightly
  • smoking
33
Q

first degree Affected by breast cancer _______ relative risk

A

doubles

34
Q

What are the cancer syndromes contributing to genetic risk of breast cancer?

A
  • BRCA1- breast/ovarian predispostion
  • BRCA2- breast/ovarian predisposition
  • TP53- li fraumeni syndrome
  • PTEN- cowden’s syndrome
  • STK11/LKB1- peutz-jeghers syndrome
  • ATM- ataxia telengiectasia
35
Q

What is the lifetime risk of breast cancer with BRCA1 AND 2 mutations?

A

45-64%

36
Q

What is the net 10 year survival from carcinoma of the breast??

A

78%

37
Q

What is the commonest female cancer

A

Invasive breast carcinoma

38
Q

Describe the natural history of invasive breast carcinoma?

A
  • 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
39
Q

Which lymph nodes does the breast drain to?

A

Internal mammary

Intramammary

Sentinel nodes

Axillary nodes

Atypical nodes

Infraclavicular nodes

Supraclavicular nodes

Cervical nodes

40
Q

How can invasive breast cancer be classified morphologically?

A

Type

Grade

41
Q

How can invasive breast cancer be classified through gene expression profiling?

A

Intrinsic sub-types

42
Q

How can invasive breast cancer be classified through hormone receptor expression?

A

Oestrogen receptor

Progesterone receptor

HER2

43
Q

How is breast carcinoma graded?

A

Objective assessment of;

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

Score 3,4 or 5 = grade 1

Score 6 or 7 = grade 2

Score 8 or 9 = grade 3

44
Q

What are the intrinsic breast cancer subtypes?

A
  • 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
45
Q

__% of breast cancers are ER positive

__% of breast cancers are PgR positive

__% of breast cancers are HER2 positive

A

80% of breast cancers are ER positive

67% of breast cancers are PgR positive

14% of breast cancers are HER2 positive

46
Q

What does ER expression predict?

A

Response to anti-oestrogen therapy

  • oophorectomy
  • tamoxifen
  • aromatase inhibitors (letrozole)
  • GnRH antagonists (goserlinin [zoladex])
47
Q

What is HER2?

A

Human epidermal growth factor receptor 2

48
Q
  • HER 2 overexpression and amplification seen in ~__%
  • HER 2 overexpression or amplification predict response to ________ (________)
A
  • HER 2 overexpression and amplification seen in ~15%
  • HER 2 overexpression or amplification predict response to trastuzamab (herceptin)
49
Q

What are the predictive and prognostic factors for invasive carcinoma?

A

ER (PgR)

HER2

50
Q

What is the nottingham prognostic index?

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

Reproductive & Sexual Health (54 decks)

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