Breast Pathology II Flashcards
fibrocystic change
exaggerated physio response
-1/3 women age 30-50
stops at menopause
mass, pain, microcalcifications
no increased risk for carcinoma**
usual epithelial hyperplasia
like FCC - but >4 cells thick
radial scar
complex sclerosing lesion
-central fibroelastic scar with entrapped glands
mimic carcinoma
intraductal papilloma
benign epithelial cells on stalk
polyp obstructing lumen
atypical ductal hyperplasia
low grade neoplastic
-overlap with DCIS
DCIS - when duct completely filled and lesion is >2mm
atypical lobular hyperplasia
proliferation of low grade neoplastic cells in lobule
e-cadherin negative
overlap with LCIS
lobular carcinoma in situ
just a risk for DCIS
DCIS
needs to be removed
comido necrosis
in DCIS
medial breast drainage
to thoracic nodes
lateral breast drainage
to axillary nodes
stromal breast neoplasms
fibroadenoma
phyllodes tumors
difference between ductal and lobular carcinoma of breast
different gene expression
e-cadherin
invasion of ductal and lobular carcinoma
invasion diagnosed by absence of myoepithelial cells
comedonecrosis
with high grade DCIS
squeeze tissue and toothpaste squirts out
prone to dystrophic calcification
microinvasion
<2mm in dimension
high grade DCIS
microinvasion and comedonecrosis
dyshesive and mucin +
LCIS
e-cadherin positive
DCIS
eczema/red skin around nipple and areola
paget disease
-due to underlying DCIS +/- invasion
infiltration by malignant glandular cells
micropapillary, cribriform, mild atypia
low grade DCIS
e-cadherin negative
LCIS
upward infiltration of epidermis by glandular neoplastic cells
pagetoid
CK7
useful in diagnosis of pagets
risk factors for invasive carcinoma of breast
estrogen exposure radiation exposure breast density proliferative fibrocystic changes alcohol, obesity, sedentary familial increasing age
inhibits at G1>S and G2>M to allow DNA repair
GADD45
BRCA1
ER negative
no precursor lesion
basal like
tp53 mutations
BRCA2
ER positive
flat epithelial atypia
atypical ductal hyperplasia
luminal
16q loss and 1q gain
her2 positive cancers
ER positive or negative
HER2 enriched
p53 action
inhibits neoplastic transformation by:
- induces transient cell cycle arrest
- induces permanent cell cycle arrest
- induces apoptosis
genetic testing for breast cancer
family genetic disease
early age of onset
high risk breast cancer
positive family hx
li fraumeni syndrome
p53 - with 85-90% increased risk
associated cancers - soft tissue, brain, bone, adrenal, leukemia, etc.
multiple early onset cancers**
BRCA1 and 2
hereditary breast cancer
associated - ovarian, male breast, prostate, pancreatic, melanoma
cowden syndrome
PTEN
peutz jeghers syndrome
STK1
peau d’orange
inflammatory carcinoma
due to invasion of dermal lymphatics and coopers ligaments
invasive ductal carcinoma
50% RUQ
stellate mass with gritty hard surface
invasive lobular carcinoma
hard to detect
- indian filing pattern
- e-cadherin negative
- spread to mesothelial surfaces and leptomeninges
indian filing
invasive lobular carcinoma
worst of all breast cancer
inflammatory
undifferentiated
so poor original tissue cannot be ID’d
aka anaplastic
pTis
CIS
pT1
tumor <0.1cm
pT2
tumor 2cm-5cm
pT3
tumor >5cm
pT4
tumor any size and spread to chest wall/breast tissue
PET scan
or mets
utilizes warburg effect
should not be restricted by cancer type or testing indication
Her2/neu
membrane bound protein that phosphorylates tyrosine and initiates number of signalling pathways and inhibits apoptosis
overexpresion in 30% of breast cancer
conveys bad prognosis
herceptin
to tx her2/neu cancers - better prognosis
75% breast ca
ER positive
65% breast ca
PR positive
tamoxifen
competitive antagonist for ER receptor
aromatase inhibitors
inhibit conversion of androgen to estrogen
used in post menopausal women
patient with high risk of recurrence
given chemotherapy
radiation
for local control
stage 1 and 2
node negative - tamoxifen
node positive - tamoxifen and chemotherapy
mammaprint
test for risk of recurrence
to assess risk of mets
to determine benefit of chemo
hormone responsive tx
first line hormone therapy
second line
third line
hormone unresponsive tx
first line chemo
second line
third line
favorable histo
ER and PR positive
trastuzumab
tx of her2neu positive
post radiation
angiosarcoma
lobular stromal breast tumors
phyllodes
fibroadenoma
most common b9 breast tumor
fibroadenoma
age 20-40yo
mass with calcification after involution
india rubber balls
biphasic
most common soft tissue tumor of adulthood
lipoma
round, circumscribed, soft, mobile, painless
phyllodes tumor
50-60yo
palpable mass
large, rubbery rounded mass
low grade - local recurrence
high grade - aggressive local invasion with heme mets
gynecomastia
breast in males
-hyperestrogen
cirrhosis, klinefelter, estrogen producing tumors, meds, marijuana, heroin, exogenous
