Breast Tis Flashcards
Considered a marker of increased risk for the subsequent development of invasive (usually ductal) carcinomas
LCIS
In LCIS
If associated with another malignancy?
If sole histologic diagnosis?
If associated with another malignancy
manage the breast according to the dominant malignant histology and disregard the LCIS
If sole histologic diagnosis
close observation with regular physical examination and mammographic surveillance
Bilateral prophylactic mastectomy indicated for “high risk”?
What are the high risk features?
Bilateral prophylactic mastectomy indicated for “high risk”:
young age
diffuse high-grade lesion
significant family history
Clinical presentation
Itching and burning of the nipple and areola
Slow progression toward a crusting eczematoid appearance that can extend to the periareolar skin.
If neglected, bleeding, pain, and ulceration can occur.
Can be asymptomatic and present as a pathologic finding after incidental surgical removal of the nipple–areolar complex
Palpable mass: 50% of patients at diagnosis
No palpable mass: 66% to 86% will have an underlying DCIS
Pagets disease of the nipple
In >____% of cases of Pagets disease, this will be an invasive carcinoma
90
large and have hyperchromatic cells with: round to oval nuclei abundant amphophilic to clear cytoplasm Location: Epidermis MITOSES Basal layer (Clusters)
Pagets cells
Motility factor
Chemotaxis of Paget’s cells that migrate to the overlying nipple epidermis
Heregulin alpha
Most practical management for Pagets?
Most practical breast-conserving approach:
combination of limited surgical resection and postoperative radiotherapy
lacks the ability to metastasize and is confined to the breast
axillary node involvement is rare (0% to 5%) and most likely is associated with an undetected focus of invasive carcinoma
Typical presentations (Pre-mammography era): palpable mass nipple discharge
DCIS
Most typical abnormality in mammography in DCIS
Microcalcifications
MOST TYPICAL abnormalities
linear and segmental calcifications associated with DCIS in up to 80% of cases
What are the diff Growth patterns of DCIS?
Describe each
Unicentric – one area only
Multicentric – 2 distinct areas separated by >4cm
Continuous – extension along ductal system without gaps
Discontinuous/multifocal – 2 or more areas separated by
Favery et al.
_____ cm margin of normal tissue around the lesion would lead to complete surgical clearance of histologically evident DCIS in 90% of cases
1 cm
Precursor lesion to invasive ductal carcinoma (10 fold risk)
DCIS
In DCIS: This modality has Locoregional control rate of 96% - 100% Cancer-specific mortality rates of ≤4% Local or regional recurrence rates
No significant differences in overall survival
Death-related within 10 years after diagnosis
Occurs 1-2% of all patients (irrespective whether mastectomy or BCT done)
Mastectomy
Chest wall failure rate was sufficiently low that a routine recommendation of postmastectomy radiation DCIS with high-risk features was not warranted
True or False?
True
Factors associated with an increased risk of local recurrence in DCIS that necessitates RT
In EORTC 10853 trial
Factors associated with an increased risk of local recurrence:
≤40 years of age
Clinically symptomatic presentation (nipple discharge or palpable mass)
Intermediate or poorly differentiated DCIS
Solid/comedo and cribriform histologic growth pattern
Involved or uncertain margins
Treatment by local excision alone
Radiotherapy was not adequate to compensate for involved margins because even with the application of irradiation, the recurrence rate was 20% in this group.
True or False?
True
Addition of _______:
NO benefit toward overall ipsilateral local control when administered in addition to radiotherapy
however, ______did appear to reduce the ipsilateral recurrence rate of DCIS (but not invasive carcinoma) in the absence of radiotherapy
What is the drug?
Tamoxifen
In EBCTG:
Demonstrated that the absolute greater benefits of radiotherapy in women at increased risk for tumor recurrence:
Demonstrated that the absolute greater benefits of radiotherapy in women at increased risk for tumor recurrence:
Involved surgical margins (identified on retrospective pathologic review)
younger women
Tumors: high-grade or comedonecrotic features
In DCIS
Local recurrences after breast-conserving surgery and radiotherapy are generally treated with ______
Local recurrences after breast-conserving surgery and radiotherapy are generally treated with mastectomy
Mastectomy is prefered than BCS in what features?
“Multicentric
(2 or more quadrants)”
Extensive/Diffuse DCIS
Suspicious Microcalcif.
Negative Margins but
Acceptable cosmesis cannot be achived w/ BCS”
Is there a role of RT in post BCS DCIS patients?
Yes
After breast-conserving surgery, radiotherapy is administered using tangential fields to the whole breast
standard dose of 45 to 50 Gy delivered in daily fractions of 180 to 200cGy
a radiation boost to the tumor bed may be added to whole-breast treatment
CLOSE SURGICAL MARGINS
Benefit: NOT established
Characterized by
loose discohesive epithelial cells
variable in shape
Normal C:N ratio.
Multicentric distribution up to 90% Bilateral involvement in 35-59% Commonly estrogen receptor positive C-erbB-2 and p53 uncommon Loss of e-cadherin often observed
LCIS
