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breat cancer Flashcards

1
Q

where do breast cancers arise

A

they arise in the ducts (terminal duct lobular unit)

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2
Q

ER (+)

A

HER (-) is seen in 50%-65%

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3
Q

HER2 (+) and ER(+/-)

A

seen in 10% - 20% cases

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4
Q

triple (-) ER,PR and HER2

A

seen in 10% - 20% cases

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5
Q

hereditary breast cancer genes

A

they are they BRCA-1 and BRCA-2 genes
- 1st degree relatives effected!

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6
Q

BRCA 1

A

breast + ovary; pancreas
- usually triple (-) ER, PR, HER2/NEU

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7
Q

BRCA 2

A

more in males breast and prostate

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8
Q

Li-Fraumeni syndrome gene

A

P53

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9
Q

cowen syndrome gene

A

PTEN

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10
Q

peutz-JEghers syndrome gene

A

LKB1/STK11

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11
Q

ataxia telengiectasia

A

AKM

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12
Q

what is the major risk factor to sporatic breast cancer

A

expososure to hormones

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13
Q

why does too much estrogen cause increase chance to cancer

A

estrogen stimulates TGFa and PDGF and fibroblast growth factor which will promote tumor development through paracrine and autocrine mechanisms

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14
Q

CF of ductal carcinoma in situ

A
  • no mass produced
  • CALCIFICATION seen
    *recall that calcifation is also seen in hte fibrocystic disease, sclerosing adenosis and fat necrosis. hence need to confrim via biopsy

tx: anti-estrogen ex- tamaxifen

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15
Q

morephology of ductal carcinoma in situ

A

5 patterns:
1. comendo carcinoma- centrally placed necrotic debris surronded by pleomorhphic cells in the duct. tooth paste like necrotic tissue extruded from transected ducts

  1. solid- filling and plugging of ductal lumina with tumor cells
  2. cribiform- neat punched out fenestrarions in the intraductal tumour
  3. papillary- intraductal papillary projections of tumour cells which lack a fibrovascular stalk
  4. micropapillary- papillae often have club shaped cells comprasing the micropapillae
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16
Q

path of lobular carcionoma in-situ

A

loss of E-cadherin

17
Q

CF of lobular carcinoma in-situ

A

bilateral
in younger women
no masses
no calcifaction

18
Q

lobular carcionoma in-situ morpholgy

A
  • uniform dyscohesive cells with round nuclei
    -tumor cells fill and distend the acini
    -lobular pattern is present
    -ER and PR +

tx- tamoxifen

19
Q

invasive infiltrating carcinoma
CF

A

palpable mass

dimpling of skin

retraction of nipple (desmoplasia)

lymphatic involvement- peau-d-orange

20
Q

invasive ductal carcinoma morphology

A

gross- firm to hard, gritty on cutting due to elastotic stroma and foci of calcifacation

micro- tumor comprises of malignant cells in cords, nests , tubules, anastomosing masses and mixtures of all these invading into the stroma

  • desmoplasis/retraction of the nipple is seen
21
Q

invasive lobular carcinoma CF

A

bilateral and multicentric within the same breast

no desmplasia

metasizes to peritoneum, retroperitoneum, leptomeninges, GIT and ovaries

22
Q

invasice lobular carcinoma path

A

biallelic loss of CDH1-E cadherin

23
Q

histology of invasive lobular carcinoma

A

dyscohesive tumor cells infiltrating the stroma in rows and cords of single cells

SIGNET RING CELLS

24
Q

medullary carcioma of breast morpholgy

A

gross- soft and fleshy well circumscribed

micro- syncitium like sheets of large cells with pleomorphic nuclei, pushing tumor border, mitosis ++

dense lymphocytic infiltration around tumor margins

triple (-)

25
Q

colloid/mucinous CA cf

A

slow rate of growth
soft or rubbery gelatinous
small islets of tumor cells floating in lakes of mucin

26
Q

inflammatory carcinoma path

A
  • extensive invasion and obstruction of dermal lymphatics
27
Q

inflammatory carcinoma CF

A
  • swollen, erythematous breast with pain and peau d’ orange skin
  • underlying cancer is diffusely infiltrative
    -does not form a palpable mass
    -poor prognosis- always widely metastatic
28
Q

pagets disease morphology

A
  • tumor cells are large and vacuolated cells with high N:C ratio and PAS (+)
29
Q

pagets diease path

A

it is a extension of the DCIS within the ductal system into the nipple skin without breaching the basement membrane

  • it basically a rare manifestation of underlying invasive breast cancer
30
Q

pagets diease CF

A

erythematous lesion, frequently fissures, ulcerated, crusted and oozing
*Pruritic- mistaken for eczema

31
Q

expressions of pagents disease

A
  • epithelial membrane antigen (EMA) and low molecular weight cytokeratins CK7 CK20
    -overexpress HER2 and ER and PR
32
Q

what are the prognositc factors of cancer of breast

A
  1. distant side metastasis
  2. lymph node spread is the 2nd most imporant
  3. tumor size
  4. ER/PR and CA- responds to hormonal manupulation
  5. HER2 expression has poor survival
33
Q

triple negative conditons

A

seen in medullary ca
and many ca with BRCA1 mutation have high proliferation rate and worse prognosis

34
Q

HER2 (+)

A

can be treated with Trastuzumab which is a monoclonal Ab specific to HER2

35
Q

phyllodes tumor morpholgy

A

gross- grey-white cystic cavaties

micro- bulbous nodules of proliferating stroma covered by epithelum
- cystic spaces contain LEAF LIKE extensions
-stroma is more celluar; increase in mitosis
- pleomorphism with atypia of stromal elements

36
Q

phyllodes tumor

A

arise from inta-lobular stroma
benign- mutation in MED12
malignant- mutation in TERT- encodes telomerase

presents at 60-70s

low grade- recur locally but rarely metastasize
high grade- behave aggressive and spread by stromal component

regardless of grade lymh node spread is rare . local recurrences common

37
Q

Fibroadenoma

A

new growth composed of both epithelial and stromal intralobular components

most common benign tumor of the female breast

  • palpable mass- freely movable from surrounding breast
  • it increases in size and tenderness in pregency and regresses after menopause
38
Q

fibroadenoma path

A
  1. specialized intralobular stroma elaborates GF- acts on the epithelium- causes proliferation: clonal cytogenetic aberrations confined to the stroma
  2. women receiveing cyclosporin after a renal transplant
  3. MED12 mutation 2/3rd- also in uterine leiomyoma and phyllodes

**lesions of the interlobular stroma include benign soft tissue found elsewhere in the body, such as hemangiomas, lipomas. the only maligancy of note is angisarcoma– occurs after local radiotherapy

39
Q

micro of fibroadenoma

A

biphasic- both components benign

proliferation of intra-loublar stroma surrounding and often pushing and distorting the associated epithelium, which forms slit like spaces or glands

FNAC (+)

breast (2 decks)

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