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Breast Pathology II Flashcards

1
Q

What are some miscellaneous malignant tumours?

A

Malignant Phyllodes tumour (sarcomatous stromal component), angiosarcoma, lymphoma, metastatic tumours

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2
Q

What are some examples of metastatic tumours?

A

Carcinoma = bronchial, ovarian serous carcinoma, clear cell carcinoma of kidney
Malignant melanoma, soft tissue tumours

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3
Q

What are some ductal precursor lesions?

A

Epithelial hyperplasia of usual type, columnar cell change (+/- atypia), atypical ductal hyperplasia, ductal carcinoma in-situ

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4
Q

What are some lobular precursor lesions?

A

Atypical lobular hyperplasia, lobular carcinoma in-situ

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5
Q

What is a breast carcinoma?

A

A malignant tumour of breast epithelial cells = technically an adenocarcinoma but just called a carcinoma

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6
Q

Where do breast carcinomas arise?

A

Glandular epithelium of the terminal duct lobular unit

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7
Q

What is an in-situ breast carcinoma?

A

Carcinoma confined within basement membrane of acini and ducts = cytologically malignant but non-invasive

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8
Q

How are in-situ breast carcinomas classed?

A

Lobular or ductal = non-obligate precursors of invasive carcinoma

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9
Q

What are the two types of lobular in-situ carcinoma?

A

Atypical lobular hyperplasia = <50% lobule involved

Lobular carcinoma in-situ = >50% lobule involved

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10
Q

What occurs in lobular in-situ carcinoma?

A

Intra-lobular proliferation of characteristic cells = solid proliferation

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11
Q

What are some features of lobular in-situ carcinomas?

A

Small intermediate-sized nuclei
ER positive
Intracytoplasmic lumens/vesicles
Frequently multifocal and bilateral

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12
Q

What gene mutation is associated with lobular in-situ carcinomas?

A

Deletion and mutation of CDH1 gene = E-cadherin negative

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13
Q

How are lobular in-situ carcinomas usually detected?

A

Usually incidental finding = calcification on mammogram

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14
Q

Can you detect lobular in-situ carcinomas grossly?

A

No = not palpable or visible grossly

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15
Q

What happens to the incidence of lobular in-situ carcinomas after menopause?

A

It decreases

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16
Q

What is the risk of progression of lobular in-situ carcinomas?

A

Atypical lobular hyperplasia = 10% risk

Lobular carcinoma in-situ = 20%

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17
Q

What is the management of lobular in-situ carcinoma?

A

If found on core biopsy = excision or vacuum biopsy

If found on vacuum/excision biopsy = follow up

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18
Q

What are the different types of intraductal proliferation?

A

Epithelial hyperplasia of usual type, columnar cell change, columnar cell change with atypia, atypical ductal hyperplasia, ductal carcinoma in-situ

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19
Q

What is the risk of progression to invasive carcinomas associated with intraductal proliferation?

A

Epithelial hyperplasia = 2x risk
Atypical ductal hyperplasia = 4x risk
Low grade ductal carcinoma in-situ = 10x risk

20
Q

How common is ductal carcinoma in-situ?

A

Accounts for 15-20% of breast malignancies

21
Q

Where do ductal carcinomas in-situ occur?

A

Terminal duct lobular unit = characteristically unicentric

22
Q

What is the cytological appearance of ductal carcinoma in-situ?

A

Malignant epithelial cells = confined within basement membrane of duct, may involve lobules

23
Q

What is it called when ductal carcinoma in-situ involves the nipple skin?

A

Paget’s disease of nipple = high grade ductal carcinoma in-situ extending along ducts to reach epidermis of nipple

24
Q

How common is progression of ductal carcinoma in-situ?

A

75% progress to invasion following incisional biopsy

25
Q

What is the management of ductal carcinoma in-situ?

A

Surgery, adjuvant radiotherapy, chemotherapy

26
Q

What is a microinvasive carcinoma?

A

Rare = high grade ductal carcinoma in-situ with invasion <1mm, treat as high grade ductal carcinoma in-situ

27
Q

What is an invasive breast carcinoma?

A

Malignant epithelial cells which have breeched the basement membrane = infiltration of normal tissues with risk of metastasis and death

28
Q

What are the risk factors for developing invasive breast carcinoma?

A

Age, previous breast disease, Western European, obesity and low levels of physical exercise, alcohol, high fat intake, smoking, hormones (HRT, OCP, endogenous)

29
Q

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

A

Age at menarche, age at first birth, parity, breastfeeding, age at menopause

30
Q

What are some genetic influences for developing invasive breast carcinoma?

A

BRAC1/2 = 2% of all breast cancers, 45-65% risk
TP53 mutation = early onset, Li Fraumeni syndrome
PTEN mutation = Peutz-Jeghers syndrome

31
Q

What is the 5 year survival rate of invasive breast carcinoma?

A

87%

32
Q

How common is invasive breast carcinoma?

A

Commonest female cancer and 2nd commonest cause of cancer death in women

33
Q

What are the stages of invasive breast carcinoma?

A

Local invasion = stroma of breast, skin, muscles of chest
Lymphatics = regional draining lymph nodes
Blood-borne metastases = bone, liver, lungs, abdominal viscera, brain, female genital tract

34
Q

What is the classification of invasive breast carcinoma?

A

Ductal (70%), lobular (10%), mixed (10%), mucinous, medullary, tubular, cribriform, papillary

35
Q

How are invasive breast carcinomas graded?

A

3 categories each given a score of 1-3 = tubular differentiation, nuclear pleomorphism, mitotic activity

36
Q

What is the grading of invasive breast carcinomas?

A

Grade 1 = score of 3-5
Grade 2 = score of 6 or 7
Grade 3 = score of 8 or 9

37
Q

What are the intrinsic breast cancer subtypes?

A 
Basal-like = ER-, HER2-, basal CK+
Normal breast-like = ER-, non-epithelial
Luminal A = ER+, low proliferation
Luminal B = ER+, high proliferation
Luminal C = ER+, high proliferation
HER2 = ER-, HER2+
38
Q

How common is hormone receptor involvement in invasive breast carcinomas?

A

80% are ER positive, 67% are PgR positive, 14% are HER2 positive

39
Q

What does oestrogen receptor (ER) expression predict?

A

Response of invasive breast carcinoma to anti-oestrogen therapy

40
Q

How common is HER2 involvement in invasive breast carcinoma?

A

Overexpression and amplification seen in 15% and predicts response to trastuzamab

41
Q

What are the predictive factors of invasive breast carcinomas?

A

ER and HER2 involvement

42
Q

How are invasive breast carcinomas staged?

A

Direct invasion of adjacent tissues = T0-4
Lymphatic spread = N0-3
Blood-borne spread = M0-1

43
Q

What prognostic indices can be used for invasive breast carcinomas?

A

Nottingham prognostic index, Adjuvant!Online, NHS predict

44
Q

What does the Nottingham prognostic index consist of?

A

Histopathology only = grade and stage

0.2 x tumour diameter (cm), tumour grade (1-3), lymph node status (1-3)

45
Q

What does the Adjuvant!Online prognostic index consist of?

A

Histopathology + ER + clinical factors

46
Q

What does the NHS predict prognostic index consist of?

A

Histopathology + ER + HER2 + clinical factors + mode of detection

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