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Repro 2 Midterm > Dobson: Breast Pathology > Flashcards

Dobson: Breast Pathology Flashcards

1
Q

What are the 3 developmental disorders?

A
  • milk line remnants
  • accessory axillary breast tissue
  • congenital nipple inversion
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2
Q

Are inverted nipples supposed to alarm us?

A

-only if they weren’t there before

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3
Q

What % of breast cancers present with pain?

A

-only 10%

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4
Q

What do we think of with a bloody or serous discharge from the nipple?

A
  • intraductal papilloma

- especially if spontaneous and unilateral

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5
Q

What are the most common palpable lesions of the breast?

A
  • cysts
  • fibroadenomas
  • invasive carcinomas
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6
Q

When are benign lesions more common?

A

-in premenopausal women

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7
Q

When are malignant lesions more common?

A
  • post menopausal women

- remember, no always a palpable mass, only 1/3

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8
Q

What organism is responible for infectious acute mastitis?

A

-S. aureus

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9
Q

What cancer mimics acute mastitis?

A
  • inflammatory breast cancer

* should always be considered in women with an erythematous swollen breast

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10
Q

What is associated with fat necrosis of the breast?

A
  • breast trauma or prior surgery

- painless palpable mass

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11
Q

What are the genetics of the most common kind of breast cancer?

A
  • ER positive

- HER2 negative

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12
Q

What gene will be the most likely gene problem with breast cancer?

A

-BRCA1

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13
Q

What does BRCA1 mutation look like morphologically?

A
  • breast carcinomas
  • Medullary features
  • ER negative, HER2 negative
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14
Q

What are BRCA2 mutations more common in?

A

-Ovarian problems

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15
Q

What kind of lesions are most breast cancers?

A

-almost all breast malignancies are adenocarcinomas

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16
Q

What hormone is a promoter of breast cancers?

A
  • stimulates breast cancers
  • leads to accumulated DNA damage
  • damage may become fixed, repeated cycles increasd risk
  • prettty sure it’s estrogen
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17
Q

What proto oncogene encodes HER2?

A

-ERBB2

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18
Q

How would we treat HER2+ cancers?

A
  • strong membrane staining for antibody to HER2

- Herceptin (trastuzumab: binds and inhibits HER2

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19
Q

Carcinoma in situ

A
  • no extension beyond basement membrane
  • Myoepithelial cells preserved
  • confined to ducts
20
Q

How are DCIS detected?

A
  • mammography

- they don’t give any nipple discharge or anything like that

21
Q

LCIS

A
  • always an incidental finiding
  • loss of E-cadherin (ductal things are E cadherin positive)
  • bilateral in 20-40% of cases
  • risk factor for invasive lobular carcinoma
  • almost always expresses ER and PR, but no HER2
22
Q

Morphology of LCIS

A
  • uniform population of cells
  • mucin-positive signet ring cells**
  • no nipple involvement
  • necrosis and secretory activity are not seen
  • ER and PR, no HER2
23
Q

What cancer is the most common subtype with inherited BRCA2?

A
  • ER+, HER2-

- high and low proliferation subtypes

24
Q

How to tell between low and high proliferation luminal cancers?

A
  • Low: older women, mets to bone

- high: Ki67 staining, most common form associated with BRCA2 mutation

25
Q

What is Basal like cancers?

A

-ER-, HER2-

26
Q

What is the most common subtype in patients with TP53 germline mutations?

A

-HER2+ cancers

27
Q

What breast cancer is the most common subtype in BRCA1 germline mutations?

A
  • ER-, HER2-
  • “basal-like” cancers
  • LOF of TP53
28
Q

How do invasive carcinomas present on mammography?

A
  • calcifications without an associated density

- less than 1 cm in size

29
Q

What will invasive carcinoma look like if it invades the skin?

A

-dimpling

30
Q

Grade 1 on the Nottingham histologic score

A
  • tubular pattern
  • small round nuclei
  • low proliferative rate
31
Q

Grade 2

A
  • tubule, solid clusters or single infiltrating cells also present
  • greater degree of nuclear pleomorphism
32
Q

Grade 3

A
  • invade as ragged nests or solid sheets
  • enlarged irregular nuclei
  • high proliferative rate
33
Q

ER-positive, HER2- carcinoma

A

-all well differentiated carcinomas are in this group

34
Q

Her2+ carcinoma

A
  • poorly differentiated
  • most are apocrine carcinomas
  • 40% micropapillary carcinomas
  • there is DCIS in this one
35
Q

ER-, HER2- carcinomas

A
  • almost all poorly differentiated

- DCIS is generally limited or not present

36
Q

Paget disease of the breast?

A
  • that maplike area thing on the brest
  • abnormal PAS+ cells that light up with keratin markers
  • almost ALL have underlying cancer
37
Q

Lobular carcinoma

A
  • bilallelic loss of CHD1… gene that encodes E-cadherin
  • mets to peritoneum and retroperitoneum
  • leptomeninges
  • increased risk for gastric signet ring cell carcinoma
38
Q

MEdullary carcinoma

A
  • not associated with germline BRCA1 mutatuions
  • but hypermethylation of the BRCA1 promoter leading to downregulation of BRCA1 expression happens a lot
  • good prognosis
39
Q

Mucinous (colloid) carcinoma

A
  • soft or rubbery

- looks like pale gray-blue gelatin

40
Q

Inflammatory carcinoma

A
  • extensive invasion and proliferation within lymphatic channels
  • causes swelling that mimics non-neoplastic inflammatory lesions
  • high grade
  • higher incidence in african americans
  • very poor prognosis
41
Q

What is the buzzword for inflammatory carcinoma?

A

-Peau d’orange

42
Q

Male proliferative breast diseae- Gynecomastia

A
  • Button like subareolar enlargement enlargement

- from estrogen or androgen imbalance

43
Q

Fibrosis of what organ may be associated with male proliferative breast disease?

A

-The Liver!

44
Q

What is XXY genotype known as?

A
  • Klinefelter syndrome!

- increased risk for gynecomastia

45
Q

Is male breast cancer bad?

A
  • yes
  • usually high stage at presentation
  • BRCA2 association
46
Q

Fibroadenoma

A
  • Most common benign tumor of the female breast
  • most occur in 20’s and 30’s
  • palpable mass or mammographic density
  • males don’t really get these

Repro 2 Midterm (9 decks)

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