Breast Pathology part 4 Flashcards
Almost ALL breast carcinomas are what type?
Adenocarcinoma
What do Breast Adenocarcinomas arise from?
TDLU
- terminal ductal lobular unit
What is Carcinoma in Situ?
Cancer cells are confined within ducts/lobules by the basement membrane
With Carcinoma in Situ of the breast, where does it metastasize? What cells are preserved?
CANNOT METASTASIZE
- Myoepithelial cells are preserved
What are the 2 types of breast CIS?
Ductal (DCIS)
Lobular (LCIS)
DCIS is detected by? What is seen?
Mammography
– Calcifications are seen
Besides calcifications, how else can DCIS be detected?
Fibrosis that causes a mass or density
Nipple discharge
How does LCIS differ from DCIS?
Cells grow in a dyscohesive fashion
LCIS is detected by?
INCIDENTAL biopsy
What usually causes the cells to grow dyscohesively with LCIS?
Dysfunction of E-cadherin (CDH1 gene)
– loss of cell adhesion
What usually causes the cells to grow dyscohesively with LCIS?
Loss of cell adhesion due to dysfunction of E-Cadherin (CDH1 gene)
Which CIS type is more often bilateral?
LCIS
LCIS usually has what molecular changes besides E-cadherin?
ER and PR (+)
With Invasive breast carcinomas, 1/3 are classified as special types and the rest are considered?
Ductal/No Special Type
Lobular Carcinomas involve what genetic change?
Biallelic loss of CDH1 (e-cadherin)
Are Lobular Carcinomas easy to detect?
No – difficult to detect by palpation and imaging
What cells will be present with Lobular Carcinomas?
Mucinous Signet Ring Cells
What 5 locations do Lobular Carcinomas spread to?
Peritoneum
Leptomeninges
GI
Ovaries and Uterus
What 5 locations do Lobular Carcinomas often spread to?
Peritoneum
Leptomeninges
GI
Ovaries and Uterus
Carcinoma with Medullary Pattern has what genetic changes?
Hypermethylation of BRCA1 promoter
–> Decreased BRCA1 expression
What cells are often present with Carcinoma with Medullary Pattern?
T cells
Carcinoma with Medullary Pattern has what type of prognosis?
BETTER prognosis than other invasive carcinomas
How will Mucinous (colloid) Carcinomas look?
Gray-Blue gelatin appearance
How will the cells look with Mucinous (colloid) Carcinoma?
Cells in clusters within large lakes of mucin
What are the symptoms of Inflammatory carcinoma?
Breast erythema
Swelling
Skin thickening = orange peel
What are the symptoms of Inflammatory carcinoma?
Breast erythema
Swelling
Skin thickening = orange peel
How does Inflammatory carcinoma cause the symptoms and what is weird about it?
Cancer cells plug lymphovascular dermis spaces
** NO INFLAMMATION **
Is there inflammation present with Inflammatory Carcinoma?
NO
How is the prognosis with Inflammatory Carcinoma?
POOR
Ductal Carcinomas are usually hard radiodense masses. When they are cut, what sound is heard?
Grating sound
Paget’s disease often occurs with what molecular type of breast cancer?
HER2
What is the symptom of Paget’s Disease?
Fluid seeping out of nipple and a mass felt
What is the symptom of Paget’s Disease?
Fluid seeping out of nipple and mass usually felt too
Describe how Paget’s Disease arises
- Paget cells extend from DCIS to the nipple skin
- Disrupt the epithelial barrier
= Nipple discharge
Do Paget cells cross the basement membrane with Paget’s Disease?
No
What is the most important prognostic factor with breast cancer?
Metastasis beyond regional lymph nodes
What specific lymph node status is important with breast cancers?
Axillary
TNM staging with breast cancers goes from 0-4. Describe Stage 1 and 4
1: size is < 2 cm; no metastases
4: any size; +/- lymph node involvement; metastases present
What will be seen histologically with Gynecomastia?
Collagenous CT
Ductal Hyperplasia
What causes a button-like subareolar enlargement in men?
- Estrogen increase/Testosterone decrease
- Liver disease
- Meds
- 47XXY/neoplasm
Male breast cancer is usually what type and what stage at presentation?
Luminal type
- HIGH stage at presentation
Male breast cancer may present how?
Mass
Skin ulceration
Intralobar stroma can give rise to what 2 benign tumors?
Fibroadenoma
Phyllodes tumor
What is the most common benign tumor of the breast and where does it arise from?
Fibroadenoma
– intralobar stroma
The 2 benign tumors that arise from intralobar stroma have what mutation?
MED12
Which tumor from Intralobar stroma is likely multiple and bilateral and may be associated with Cyclosporin A use?
Fibroadenoma
Which tumor from Intralobar stroma usually affects older women and has more cells/mitotic rate/pleomorphism?
Phyllodes tumor
Intralobar stromal derived benign tumors have an extra?
Extra epithelial component – biphasic
Tumors from where do NOT have an accompanying epithelial componant?
Interlobar stroma
What germline mutation is common in male breast cancer?
BRCA2
