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ENRP Exam 1 > Breast Pathology Dobson LO's > Flashcards

Breast Pathology Dobson LO's Flashcards

1
Q

What is poland syndrome a result of?

A

Loss of pectoralis muscles

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2
Q

What arteries supply breast and what lymph nodes drain it?

A
  • Lateral thoracic and internal thoracic which give off mammary arteries
  • Drains mostly to the axillary lymph nodes and some to internal mammary lymph nodes
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3
Q

Clinical significance of milk line remnants, accessory breast tissue and inverted nipples?

A
  • Milk line remnants can result in supranumery nipples
  • accessory breast tissue is usually in axilla and can pose a risk for breast cancer
  • Congenital inverted nipples are benign and can evert on own, but acquired inverted nipples are omnious as it is usually caused by cancer or inflammatory disesase
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4
Q

Common presenting symptoms of breast disease and clinical correlations to benign and malignant conditions.

A
  • Increased bumpiness, pain, nipple discharge, and inflammed breast are common complaints
  • Majority of symptomatic breast lesions are benign
    • soft round rubbery moveable mass, cysts & fibroadenomas are common palpable masses
  • Malignant: hard irregular immobile, most common palpable is invasive ductal carcinoma, 10% of breast cancers present with pain, 45% with sx
    • upper outer quadrant
    • bloody discharge suspect cancer
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5
Q

Describe malignant mammogram features.

A
  • Irregularly shaped densities
  • Small irregular numerous and clustered calcifications
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6
Q

Benign mammogram findings and what can cause the calcifications?

A
  • Round densities
  • Calcifications can form on secretions, fibroadenomas, and sclerosing adenomas
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7
Q

What happens when the BI-RADS score goes from 3 to 4?

A
  • Requires a biopsy now
  • 3 is most likely benign follow up in 3 mo
  • 4 is suspicious and most likely should be biopsied
  • 5 is highly suggestive of malignancy and needs biopsy
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8
Q

What are the inflammatory disorders fo the breast? (6)

A
  • Acute mastitis
  • SMOLD
  • Duct ectasia
  • Fat necrosis
  • Lymphocytic mastopathy
  • Granulomatous mastitis
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9
Q

When does Acute mastitis occur and how does it present? What is in differential?

A
  • Red swollen breast usually occurs within first month of breast feeding can lead to S. aureus infection
  • Inflammatory breast cancer mimics acute mastitis by blocking vessels with tumor emboli, need to differentiate these two bc this cancer is very deadly and presents with red swollen breast
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10
Q

How does Squamous metaplasia of lactiferous ducts (SMOLD) present, association, at risk for? (extra info from robbins)

A
  • Painful red subareolar mass mimicing a bacterial abscess
  • nipple inverts
  • 90% associated with smokers also vitamin A deficiency
  • at risk for SCC
  • nipple ducts undergo keratinizing squamous metaplasia and keratin sheds blocking the ducts causing eventual rupture
  • chronic granulomatous inflammatory response occurs and recurrence is common
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11
Q

Duct ectasia clinical presentation, who does it occur in, histology, what does it mimic?

A
  • Periareolar mass with thick white secretions ,+/- skin retractions
  • occurs in 50-60’s in multiparous women
  • lipid laden macrophages in dilated ducts
  • Mimics invasive carcinoma clinically and radiographically- need to perform ductography
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12
Q

Fat necrosis association, how does it present, histo and gross appearance?

A
  • mass of fat necrosis due to breast trauma or surgery
  • mimics cancer as a painless mass with skin retraction/thickening
  • acute lesion is hemorrhagic with liquafactive necrosis in center and neutrophils and macrophages eventually get replacedb y scar tissue
  • ill defined firm grey white nodules with chalky foci
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13
Q

Lymphocytic mastopathy presentation, association,?

A
  • single or multiple hard palpable masses or mammorgram densities
  • common in those with DM type I, AI thyroid disease
  • Needs to be distinguished from cancer
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14
Q

Granulomatous mastitis association and who does it occur in?

A
  • Associated with GPA, polyangiitis, sarcoidosis, TB or localized infection to breast
  • only in parous women due to a hypersensitivity reaction to antigen’s during lactation
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15
Q

What are the Nonproliferative benign epithelial lesions? Explain them. Is there an increased risk for cancer?

A
  • Cystic change:
    • granular eosinophilic cytoplasm resembling normal sweat apocrine glands
    • calcificatiosn common from secretions resulting in fibrosis
    • concern when solitary, but cysts dissapear with FNA
  • Fibrosis:
  • Adenosis:
    • individual mass occurs with breast feeding due to the increased number of acini per lobule

NOT associated with cancer risk

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16
Q

Proliferative lesions without atypia? Explain. Cancer risk?

A
  • small risk for cancer but not a direct precursor, more of a predictor of risk
  • Epithelial hyperplasia:
  • incr. in # of luminal and myoepithelial cells that distend ducts
  • Sclerosing adenosis:
    • incr. # acini that are compressed and distended in central part of lesion histologically mimics invasive carcinoma, but dense stroma is in swirling pattern with a circumscribed border
  • Complex Sclerosing:
    • looks bad but has benign histology
  • Papilloma:
    • bloody nipple discharge
  • Gynecomastia:
    • imbalance btw estrogen and androgens
      • DISCOS
        • digoxin, isoniazid, spironolactone, cimetidine, (o)estrogen, Stilbestol
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17
Q

Proliferative lesions with Atypia?

A
  • Atypical ductal hyperplasia:
    • resembles DCIS, monomorphoic proliferation of cells and can distinguish fromDCIS becasue only partly fills the ducts involved
  • Atypical lobular hyperplasia:
    • cells identical to lobular carcinoma in situe, but cells don’t fill more than 50% lobe and there is loss of E-cadherin
  • Moderate increased risk for arcinoma but still a predictor of risk NOT a direct precursor
18
Q

What are the two intralobular stromal tumors of the breast?

A
  • Fibroadenoma and phylloydes tumor
    • driven by MED12 mutations
19
Q

What is the most common benign tumor of breast? how does it present, who is it assoc. with, and risk for carcinoma?

A
  • Fibroadenoma
  • multiple and b/l masses
  • associated with 50% of women receiving cyclosporin A after renal transplant, but after treatment with this stops the fibroadenomas regress
  • Slight incresed risk for carcinoma
20
Q

What is a phylloydes tumor? How is it different from fibroadenomas?

A
  • palpable mass can be massive
  • peak age is 10-20 years older than fibroadenoma
  • distinguished from fibroadenoma by higher cellularity, higher mitotic rate, nuclear pleomprphism, infiltrative borders and stromal overgrowth
21
Q

Angiosarcoma? Where does it occur, genetics, and risk factors?

A
  • most common stromal malignant tumor of breast
  • sporadic in women <35
  • Prior radiation or Stweard Treves syndrome
22
Q

incidence of breast cancer, difference on ethnicity and geography, risk factors for developing breast cancer?

A
  • most common non skin malignancy in women, 2nd leading COD to lung cancer
  • 1 in 8 women develop breast cancer
  • Higher incidence in developed countries and those with european descent
  • women >63 yo, African american diagnosed ~59 yo, Hispanic women ~56 yo
    • African American women are more likely to die and more likely to have biologically aggressive cancers
  • Risks:
    • woman, age, fhx first degree, personal history, increased breast density, early menarch and late menopause, no pregnancies, no breast feeding, obesity, excess estrogen
23
Q

Most common genes involved in hereditary breast cancer, age risk, associations with other cancers/syndromes

A
  • BRCA1 and BRCA2 also TP53
  • rare younger than 25, incidence increases after 30 yo
  • BRCA’s associated with increased risk of ovarian carcinoma also
  • Li Fraumani with p53 mutation
    • HER2 type cancer
24
Q

ER positive pathway leads to what type of cancer, precursor lesion, what percentage of BC’s, and what gene is associated?

A
  • Leads to Luminal invasive cancer ER positive HER2 negative and this makes up 50-65% of breast cancers
  • associated with germline BRCA2 mutations
25
Q

ER negative pathway leading to HER2 positive cancer makes up what percentage of BC’s, precursor lesion and what mutation?

A
  • ER negative pathway with TP53 mutations leads to HER2 positive cancers making up 20% of breast cancers
  • there is no identifiable precursor lesion before DCIS occurs
26
Q

What gene is is triple negative breast cancer associated with, what is the precursor lesion what percentage does it make iup?

A
  • Germline BRCA1 mutation, also TP53 mutation leading to DCIS leading to ER negative, HER2 negative cancer
  • makes up 15%
27
Q

Prognosis and recurrence of Triple negative breast cancer?

A
  • nearly all recurrences occur within first 8 years, recurrences after this are rare, but its sadly because most patients have died by then
  • very aggressive cancer
28
Q

Luminal (ER positive) cancer recurrence?

A
  • has lowest recurrence rate at recurrence occuring in first 10 years but they occur at a steady rate over long period of time after
29
Q

Describe “everything you know about” the Low proliferation Luminal A cancer. (ER+, HER2-)

A
  • makes up 40-55% of luminal cancers (total luminal makes up 50-65% of breast cancer)
  • major type in older women and in men
  • detected at early stage
  • usually low grade with low recurrence rate and cured surgically
  • mets after long period of time to the bone
  • responds well to antiestrogenic drugs
30
Q

Describe “everything you know about” the High proliferation Luminal B cancer. (ER+, HER2-)

A
  • makes up 10% of luminal cancers
  • increased staining for Ki67
  • most commonly associated with BRCA2
  • higher epressionb of genes related to cellular proliferation
  • only 10% have complete response to chemo
31
Q

What is the major risk factor for luminal breast cancers? How?

A
  • Excess estrogen exposure
  • stimulates breast growth normally during puberty menstrual cycle and pregnancy, but repeated cycles of proliferation of breast epithelium leads to increased risk of cancer and damage can become fixed
  • once premalignant changes are present hormones stimulate growth of cells and stromal cells aiding in tumor development
32
Q

Describe “everything you know” about HER2+ cancers

A
  • 10-20% of cancers
  • most of these carcinomas are poorly diffrentiated with no specific morphologic pattern assoc.
  • Most common subtype in patients with TP53 germline mutations (Li-Fraumeni Syndrome)
  • amplification of HER2 is found in 95% of these cancers and can be treated with Herceptin
33
Q

Describe “everything you know” about triple negative cancers (ER- HER2-, aka basal like)

A
  • 15% of cancers
  • young premenopausal women, African Americans, Hispanics
  • likely to present as palpable mass btw mammograms bc it grows rapidly
  • almost all are poorly differentiated
  • chemo in tumors assoc. with BRCA1 result in complete or almost complete response in ⅓ of cases
34
Q

Are myoepithelial cells preserved or not in CIS?

A

Preserved

35
Q

Paget disease of the nipple

A
  • rare form of ductal carcinoma in situe under the nipple, the cells go out to surface of nipple (w/o breaking basement mem.) and present as red eruption of skin
    • mimics inflammatory process and itches
  • palpable mass is in 50-60% of cases and almost all of these masses are invasive ductal adenocarcinoma usually ER - and HER2 +
36
Q

Describe Lobular Carcinoma in Situ?

A
  • cells grow in discohesive fasion due to mutation of CDH1 leading to loss of E cadherin
  • always incidnetal NO mammographic findings, most patients do b/l mastectomies
  • doesn’t present as mass
  • higher incidence of being b/l than ductal CIS
  • LCIS almost always luminal type express ER and PR, and HER2 -
37
Q

What are the cancers that make up ⅓ of breast cancers that are classified morphologically into special histologic types?

A
  • lobular carcinoma
  • carcinoma with medullary pattern
  • Mucinous (colloid) carcinoma
  • Inflammatory
38
Q

Features of Malignancy?

A
  • anaplasia
  • pleomorphism
  • abnormal nuclear morphology
  • mitoses
  • vascular changes
39
Q

Lobular carcinoma?

A
  • Discohesive tumor cells due to biallelic loss of CDH1 so E-cadherin
  • most common type of breast cancer to present as occult primary
  • characteristic pattern of metastasis
    • peritoneum and retroperitoneum
    • leptomeninges
    • GI tract
    • ovaries
40
Q

Carcinoma with medullary pattern?

A
  • Half of BRCA1 associated carcinomas have this appearance
  • circumcribed yellow mass looks like benign and radiologically benign but not and microscope shows malignancy
  • most carcinomas with medullary pattern are not assoc. with BRCA1 germline mutations, but hypermethylation of BRCA1 promoter leading to down regulation of BRCA1
  • most are triple negative but behave better bc they are associated with inflammatory reaction of T cells
41
Q

Mucinous colloid tumor

A
  • soft rubbery and has pale grey blue gelatin appearance
  • microscopy shows small islands of cells in clusters with large mucin lakes
  • can have good prognosis
42
Q

Inflammatory carcinoma?

A
  • only 3% of cancers with very poor prognosis 3-10% survival in 3 years
  • High incidence in african americans
  • Peau d’dorange due to plugging of lymphovascular spaces of dermis with carcinoma
  • mimics acute mastitis

ENRP Exam 1 (7 decks)

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