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MIDS 227 (module 1 + 2) > Ch 12 Breast Pathology Continued > Flashcards

Ch 12 Breast Pathology Continued Flashcards

1
Q

List malignant breast masses?

A

-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)

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2
Q

How common is breast cancer?

A

2nd m/c cancer in north american women

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3
Q

Breast cancer m/c develops in which quadrant?

A

UOQ

(b/c it has the greatest amount of glandular tissue)

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4
Q

Breast cancer m/c originates from ___?

A

The ducts (TDLU)

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5
Q

List the 2 main contributing factors to developing breast cancer?

A

-Increased age
-Female

(other factors include personal/family history of breast cancer + genetics, as BRCA1 + BRCA2 gene mutations significantly increase risk of developing it)

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6
Q

Cancers are classified by ___ + ___?

A

Histologic type + grade

(the higher the grade, the more aggressive)

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7
Q

What are the 3 cancer grades?

A

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

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8
Q

What is the TNM classification system?

A

System used to stage malignant tumors:

T: tumor size
N: nodal status
M: evidence of distal metastasis

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9
Q

What does multicentric mean?

A

Co-existent cancers within different quadrants or separated by greater than 5cm within the breast

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10
Q

What does multifocal mean?

A

Additional malignant lesions within the breast quadrant or within 5cm of the primary tumor

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11
Q

Can non-invasive cancer become invasive?

A

Yes :(

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12
Q

Where does lobular carcinoma in situ (LCIS) arise from?

A

The small ducts of the breast lobule

(they are confined within the boundaries of the duct/lobule)

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13
Q

SF of LCIS?

A

-Often multifocal or multicentric
-Can be bilateral

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14
Q

Which pathology is not considered malignancy + is not treated as a true cancer?

A

LCIS, it is considered as lobular neoplasia

(it serves as a marker for significant increased future risk of developing invasive ductal or lobular cancer)

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15
Q

How is LCIS diagnosed?

A

-M/c incidentally from a biopsy or surgical specimen
-There are no specific clinical symptoms or sonographic/mammo features

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16
Q

What is ductal carcinoma in situ (DCIS) also known as?

A

Intraductal carcinoma

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17
Q

What is the m/c non-invasive cancer?

A

DCIS

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18
Q

What is the average age someone would develop DCIS?

A

50 y/o

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19
Q

Where does DCIS occur?

A

-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

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20
Q

What are the S/S of DCIS?

A

-Asymptomatic in early stages
-Nipple discharge

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21
Q

DCIS is best detected on which imaging modality?

A

Mammography

22
Q

What is the earliest form of cancer that can be detected on imaging?

A

DCIS (best on mammograms)

23
Q

Appearance of DCIS on mammo?

A

-Suspicious calcifications
-M/c microcals can be found in groups (more than 5 clustered within 1cm) or following a linear/branching pattern

24
Q

SF of DCIS?

A

-M/c microcalcs
-Can be variable
-Distended duct
-Hypoechoic mass with microlobulations

25
Q

What is paget disease?

A

Uncommon cancer of the epidermis of the nipple (often due to underlying DCIS within a main subareolar duct)

26
Q

What are the 2 S/S of paget disease?

A

-Eczema crusting of nipple/areola, redness or ulceration
-Nipple discharge + itching

27
Q

How is paget disease diagnosed? Is u/s needed?

A

-Diagnosis via biopsy
-U/s typically not needed, unless looking for a subareolar mass

28
Q

What is invasive cancer?

A

-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)

29
Q

What is the m/c breast cancer?

A

IDC (invasive ductal carcinoma)

30
Q

What is invasive ductal carcinoma (IDC) also known as?

A

-Infiltrating ductal carcinoma
or
-Invasive ductal carcinoma of no special type

31
Q

IDC is m/c in which quadrant?

A

UOQ

(has a poor prognosis)

32
Q

What are the S/S of IDC?

A

-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)

33
Q

How does IDC appear on mammo?

A

-Asymmetric, irregular, radiodense mass with spiculated margins
-Clustered microcalcs (common)
-Thick + straight coopers ligaments

34
Q

SF of IDC?

A

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)

35
Q

What is the 2nd m/c invasive breast malignancy ?

A

ILC (invasive lobular carcinoma)

36
Q

ILC follows a ___ growth pattern?

A

Diffuse

(it has a higher rate of being multifocal, multicentric + bilateral than IDC)

37
Q

What are the S/S of ILC?

A

-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

38
Q

SF of ILC?

A

-Irregular, ill-defined, hypoechoic solid area
-Shadowing
-Architectural distortion
-NO CALCS

39
Q

Calcifications are common with malignancy, which 2 types of cancer does not have this SF?

A

ILC + medullary carcinoma

40
Q

Is mammo good at detecting ILC?

A

No, it can underestimate or miss it due to its diffuse nature

41
Q

Who m/c gets medullary carcinoma?

A

-Uncommon
-Younger women (<50 y/o)
-Strongly associated with BRCA1 gene mutation

42
Q

SF of medullary carcinoma?

A

-Well marginated/circumscribed
-Central necrosis (large lesions)
-M/c located in UOQ

43
Q

What are the S/S of medullary cancer?

A

A discrete, round, soft, mobile + palpable mass

(often confusing with benign clinical symptoms)

44
Q

Are calcs common with medullary carcinoma?

A

No!

45
Q

What is the D/D for medullary carcinoma?

A

Fibroadenoma, cyst, abscess

46
Q

Colloid carcinoma is a ___ carcinoma?

A

Mucinous

47
Q

Colloid carcinoma is m/c in who?

A

-Elderly women (although uncommon)
-It is slow growing

48
Q

What is the main SF of colloid carcinoma?

A

Round/oval/lobulated circumscribed mass

49
Q

Papillary carcinoma m/c occurs in who?

A

-Tend to occur in older women
-Higher incidence in men

(although this is rare cancer)

50
Q

Papillary carcinoma can occur from what?

A

-Malignant transformation of a large duct papilloma (central)
or
-Within a peripheral TDLU

(slow growing)

51
Q

What is the S/S of papillary carcinoma?

A

Bloody nipple discharge

52
Q

SF of papillary carcinoma?

A

Overlap of benign + malignant features

MIDS 227 (module 1 + 2) (14 decks)

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