Ch 12 Breast Pathology Continued Flashcards
List malignant breast masses?
-Non invasive caner (lobular + ductal in situ)
-Invasive cancer (lobular + ductal)
-Paget disease
-Inflammatory cancer
-Metastatic cancer
-Special types of invasive ductal cancer (medullary, colloid, papillary, tubular)
How common is breast cancer?
2nd m/c cancer in north american women
Breast cancer m/c develops in which quadrant?
UOQ
(b/c it has the greatest amount of glandular tissue)
Breast cancer m/c originates from ___?
The ducts (TDLU)
List the 2 main contributing factors to developing breast cancer?
-Increased age
-Female
(other factors include personal/family history of breast cancer + genetics, as BRCA1 + BRCA2 gene mutations significantly increase risk of developing it)
Cancers are classified by ___ + ___?
Histologic type + grade
(the higher the grade, the more aggressive)
What are the 3 cancer grades?
Grade 1:
-Cancer cells that resemble normal cells are not rapidly growing
Grade 2:
-Cancer cells that do not resemble normal cells are growing faster
Grade 3:
-Cancer cells that look abnormal are growing or spreading more aggressively now
What is the TNM classification system?
System used to stage malignant tumors:
T: tumor size
N: nodal status
M: evidence of distal metastasis
What does multicentric mean?
Co-existent cancers within different quadrants or separated by greater than 5cm within the breast
What does multifocal mean?
Additional malignant lesions within the breast quadrant or within 5cm of the primary tumor
Can non-invasive cancer become invasive?
Yes :(
Where does lobular carcinoma in situ (LCIS) arise from?
The small ducts of the breast lobule
(they are confined within the boundaries of the duct/lobule)
SF of LCIS?
-Often multifocal or multicentric
-Can be bilateral
Which pathology is not considered malignancy + is not treated as a true cancer?
LCIS, it is considered as lobular neoplasia
(it serves as a marker for significant increased future risk of developing invasive ductal or lobular cancer)
How is LCIS diagnosed?
-M/c incidentally from a biopsy or surgical specimen
-There are no specific clinical symptoms or sonographic/mammo features
What is ductal carcinoma in situ (DCIS) also known as?
Intraductal carcinoma
What is the m/c non-invasive cancer?
DCIS
What is the average age someone would develop DCIS?
50 y/o
Where does DCIS occur?
-Malignant cells stay confined within the ducts + do not extend to surrounding tissues
-Is classified as a stage 0 disease, but it can progress to invasive cancer if left untreated
What are the S/S of DCIS?
-Asymptomatic in early stages
-Nipple discharge
DCIS is best detected on which imaging modality?
Mammography
What is the earliest form of cancer that can be detected on imaging?
DCIS (best on mammograms)
Appearance of DCIS on mammo?
-Suspicious calcifications
-M/c microcals can be found in groups (more than 5 clustered within 1cm) or following a linear/branching pattern
SF of DCIS?
-M/c microcalcs
-Can be variable
-Distended duct
-Hypoechoic mass with microlobulations
What is paget disease?
Uncommon cancer of the epidermis of the nipple (often due to underlying DCIS within a main subareolar duct)
What are the 2 S/S of paget disease?
-Eczema crusting of nipple/areola, redness or ulceration
-Nipple discharge + itching
How is paget disease diagnosed? Is u/s needed?
-Diagnosis via biopsy
-U/s typically not needed, unless looking for a subareolar mass
What is invasive cancer?
-Malignant cells pass through the basement membrane of the duct/lobule + extend into adjacent tissues
-These cells can penetrate into blood vessels or lymphatic channels (pathways for mets)
What is the m/c breast cancer?
IDC (invasive ductal carcinoma)
What is invasive ductal carcinoma (IDC) also known as?
-Infiltrating ductal carcinoma
or
-Invasive ductal carcinoma of no special type
IDC is m/c in which quadrant?
UOQ
(has a poor prognosis)
What are the S/S of IDC?
-Breast is hard + fixed when palpated
-Unilateral bloody or serosanguineous nipple discharge (uncommon)
Know this one:
-Desmoplasia +/or reactive fibrosis (skin dimpling, nipple retraction or breast contour changes in advanced stages)
How does IDC appear on mammo?
-Asymmetric, irregular, radiodense mass with spiculated margins
-Clustered microcalcs (common)
-Thick + straight coopers ligaments
SF of IDC?
M/c:
-Irregularly shaped mass
-Hypoechoic
-Spiculated margins
-Clustered microclacs
-Shadowing
Others:
-Heterogeneous
-Indistinct, angular or microlobulated margins
-Sometimes non-parallel orientation (taller than wide)
What is the 2nd m/c invasive breast malignancy ?
ILC (invasive lobular carcinoma)
ILC follows a ___ growth pattern?
Diffuse
(it has a higher rate of being multifocal, multicentric + bilateral than IDC)
What are the S/S of ILC?
-Hard + fixed mass
-May feel like an area of nonspecific thickening
-Tissues can retract in advanced cases, this is known as shrinking breast + nipple retraction
SF of ILC?
-Irregular, ill-defined, hypoechoic solid area
-Shadowing
-Architectural distortion
-NO CALCS
Calcifications are common with malignancy, which 2 types of cancer does not have this SF?
ILC + medullary carcinoma
Is mammo good at detecting ILC?
No, it can underestimate or miss it due to its diffuse nature
Who m/c gets medullary carcinoma?
-Uncommon
-Younger women (<50 y/o)
-Strongly associated with BRCA1 gene mutation
SF of medullary carcinoma?
-Well marginated/circumscribed
-Central necrosis (large lesions)
-M/c located in UOQ
What are the S/S of medullary cancer?
A discrete, round, soft, mobile + palpable mass
(often confusing with benign clinical symptoms)
Are calcs common with medullary carcinoma?
No!
What is the D/D for medullary carcinoma?
Fibroadenoma, cyst, abscess
Colloid carcinoma is a ___ carcinoma?
Mucinous
Colloid carcinoma is m/c in who?
-Elderly women (although uncommon)
-It is slow growing
What is the main SF of colloid carcinoma?
Round/oval/lobulated circumscribed mass
Papillary carcinoma m/c occurs in who?
-Tend to occur in older women
-Higher incidence in men
(although this is rare cancer)
Papillary carcinoma can occur from what?
-Malignant transformation of a large duct papilloma (central)
or
-Within a peripheral TDLU
(slow growing)
What is the S/S of papillary carcinoma?
Bloody nipple discharge
SF of papillary carcinoma?
Overlap of benign + malignant features
