Breast Pathology part 4

Question 1

Almost ALL breast carcinomas are what type?

Answer 1

Adenocarcinoma

Question 2

What do Breast Adenocarcinomas arise from?

Answer 2

TDLU

- terminal ductal lobular unit

Question 3

What is Carcinoma in Situ?

Answer 3

Cancer cells are confined within ducts/lobules by the basement membrane

Question 4

With Carcinoma in Situ of the breast, where does it metastasize? What cells are preserved?

Answer 4

CANNOT METASTASIZE

- Myoepithelial cells are preserved

Question 5

What are the 2 types of breast CIS?

Answer 5

Ductal (DCIS)

Lobular (LCIS)

Question 6

DCIS is detected by? What is seen?

Answer 6

Mammography

– Calcifications are seen

Question 7

Besides calcifications, how else can DCIS be detected?

Answer 7

Fibrosis that causes a mass or density

Nipple discharge

Question 8

How does LCIS differ from DCIS?

Answer 8

Cells grow in a dyscohesive fashion

Question 9

LCIS is detected by?

Answer 9

INCIDENTAL biopsy

Question 10

What usually causes the cells to grow dyscohesively with LCIS?

Answer 10

Dysfunction of E-cadherin (CDH1 gene)

– loss of cell adhesion

Question 11

What usually causes the cells to grow dyscohesively with LCIS?

Answer 11

Loss of cell adhesion due to dysfunction of E-Cadherin (CDH1 gene)

Question 12

Which CIS type is more often bilateral?

Answer 12

LCIS

Question 13

LCIS usually has what molecular changes besides E-cadherin?

Answer 13

ER and PR (+)

Question 14

With Invasive breast carcinomas, 1/3 are classified as special types and the rest are considered?

Answer 14

Ductal/No Special Type

Question 15

Lobular Carcinomas involve what genetic change?

Answer 15

Biallelic loss of CDH1 (e-cadherin)

Question 16

Are Lobular Carcinomas easy to detect?

Answer 16

No – difficult to detect by palpation and imaging

Question 17

What cells will be present with Lobular Carcinomas?

Answer 17

Mucinous Signet Ring Cells

Question 18

What 5 locations do Lobular Carcinomas spread to?

Answer 18

Peritoneum
Leptomeninges
GI
Ovaries and Uterus

Question 19

What 5 locations do Lobular Carcinomas often spread to?

Answer 19

Peritoneum
Leptomeninges
GI
Ovaries and Uterus

Question 20

Carcinoma with Medullary Pattern has what genetic changes?

Answer 20

Hypermethylation of BRCA1 promoter

–> Decreased BRCA1 expression

Question 21

What cells are often present with Carcinoma with Medullary Pattern?

Answer 21

T cells

Question 22

Carcinoma with Medullary Pattern has what type of prognosis?

Answer 22

BETTER prognosis than other invasive carcinomas

Question 23

How will Mucinous (colloid) Carcinomas look?

Answer 23

Gray-Blue gelatin appearance

Question 24

How will the cells look with Mucinous (colloid) Carcinoma?

Answer 24

Cells in clusters within large lakes of mucin

Question 25

What are the symptoms of Inflammatory carcinoma?

Answer 25

Breast erythema Swelling Skin thickening = orange peel

Question 26

What are the symptoms of Inflammatory carcinoma?

Answer 26

Breast erythema Swelling Skin thickening = orange peel

Question 27

How does Inflammatory carcinoma cause the symptoms and what is weird about it?

Answer 27

Cancer cells plug lymphovascular dermis spaces | ** NO INFLAMMATION **

Question 28

Is there inflammation present with Inflammatory Carcinoma?

Answer 28

NO

Question 29

How is the prognosis with Inflammatory Carcinoma?

Answer 29

POOR

Question 30

Ductal Carcinomas are usually hard radiodense masses. When they are cut, what sound is heard?

Answer 30

Grating sound

Question 31

Paget's disease often occurs with what molecular type of breast cancer?

Answer 31

HER2

Question 32

What is the symptom of Paget's Disease?

Answer 32

Fluid seeping out of nipple and a mass felt

Question 33

What is the symptom of Paget's Disease?

Answer 33

Fluid seeping out of nipple and mass usually felt too

Question 34

Describe how Paget's Disease arises

Answer 34

- Paget cells extend from DCIS to the nipple skin - Disrupt the epithelial barrier = Nipple discharge

Question 35

Do Paget cells cross the basement membrane with Paget's Disease?

Answer 35

No

Question 36

What is the most important prognostic factor with breast cancer?

Answer 36

Metastasis beyond regional lymph nodes

Question 37

What specific lymph node status is important with breast cancers?

Answer 37

Axillary

Question 38

TNM staging with breast cancers goes from 0-4. Describe Stage 1 and 4

Answer 38

1: size is < 2 cm; no metastases 4: any size; +/- lymph node involvement; metastases present

Question 39

What will be seen histologically with Gynecomastia?

Answer 39

Collagenous CT | Ductal Hyperplasia

Question 40

What causes a button-like subareolar enlargement in men?

Answer 40

- Estrogen increase/Testosterone decrease - Liver disease - Meds - 47XXY/neoplasm

Question 41

Male breast cancer is usually what type and what stage at presentation?

Answer 41

Luminal type | - HIGH stage at presentation

Question 42

Male breast cancer may present how?

Answer 42

Mass | Skin ulceration

Question 43

Intralobar stroma can give rise to what 2 benign tumors?

Answer 43

Fibroadenoma | Phyllodes tumor

Question 44

What is the most common benign tumor of the breast and where does it arise from?

Answer 44

Fibroadenoma | -- intralobar stroma

Question 45

The 2 benign tumors that arise from intralobar stroma have what mutation?

Answer 45

MED12

Question 46

Which tumor from Intralobar stroma is likely multiple and bilateral and may be associated with Cyclosporin A use?

Answer 46

Fibroadenoma

Question 47

Which tumor from Intralobar stroma usually affects older women and has more cells/mitotic rate/pleomorphism?

Answer 47

Phyllodes tumor

Question 48

Intralobar stromal derived benign tumors have an extra?

Answer 48

Extra epithelial component -- biphasic

Question 49

Tumors from where do NOT have an accompanying epithelial componant?

Answer 49

Interlobar stroma

Question 50

What germline mutation is common in male breast cancer?

Answer 50

BRCA2