Endo/Repro - Breast Pathologies

Question 1

Name the three portions of an individual unit of the breast system from the local of milk production to ejection.

Answer 1

Lobular unit >> Terminal ductule >> Lactiferous ducts

Question 2

The age-related changes in breast tissue are of a switch from abundant ______ ______ to ______.

Answer 2

The age-related changes in breast tissue are of a switch from abundant fibrous** **stroma** to **adipose.

Question 3

When does acute mastitis typically occur and due to what etiology?

Answer 3

Breastfeeding;

S. aureus

Question 4

Fat necrosis in the breast usually occurs due to _______.

Answer 4

Fat necrosis in the breast usually occurs due to trauma.

Question 5

Describe the histology and X-ray appearance of fat necrosis.

Histology:

Mammography:

Answer 5

Describe the histology and X-ray appearance of fat necrosis.

Histology: Foamy macrophages, lipid-filled cysts, fibrosis

Mammography: Eggshell calcifications

Question 6

Which women will undergo fibrocystic changes of the breast?

Answer 6

All women

Question 7

__________ breast change refers to the following: palpably irregular and painful breasts; discrete lumps, multiple nodules, cysts; microcalcifications.

Answer 7

Fibrocystic breast change refers to the following: palpably irregular and painful breasts; discrete lumps, multiple nodules, cysts; microcalcifications.

Question 8

What are the two major classifications of fibrocystic breast change?

Answer 8

Non-proliferative (no increased risk for breast cancer development)

Proliferative (+/- atypia) (increased risk for breast cancer development)

Question 9

What is the term for the transition stage in breast tissue between hyperplasia and low-grade ductal carcinoma in-situ?

Answer 9

Atypical ductal hyperplasia

Question 10

A __________ is a benign tumor of the breast showing evidence of both connective tissue and epithelial proliferation. They are freely moveable and can enlarge with pregnancy.

Answer 10

A fibroadenoma is a benign tumor of the breast showing evidence of both connective tissue and epithelial proliferation. They are freely moveable and can enlarge with pregnancy.

Question 11

What breath pathology is a benign polyclonal proliferation of myoepithelial and epithelial cells that grow within the ducts?

Answer 11

Intraductal papilloma

(80% of cases present as unilateral serous or bloody discharge)

Question 12

Name the four major growth patterns of breast ductal carcinomas in-situ.

Answer 12

Micropapillary (finger-like projections);

cribriform (sieve-like pattern);

solid (complete lumen obliteration);

comedo (central necrosis)

Question 13

What is the number one risk factor for development of breast cancer?

Answer 13

Family history

Question 14

The overal 5-year survival rate for breast cancer is ____%.

Answer 14

The overal 5-year survival rate for breast cancer is 90%.

Question 15

What is the most common breast cancer?

Answer 15

Infiltrating, ductal carcinoma

Question 16

How do invasive ductal carcinomas of the breast appear grossly?

Answer 16

Stellate,

white,

firm

Question 17

Identify the different subtypes of invasive ductal carcinoma described below:

— favorable prognosis; grows in well-differentiated tubules

— favorable prognosis; malignant clusters of cells floating in pool of extracellular mucin

— High mitotic rate, diffuse lymphoplasmacytic infiltrate, high-grade pleomorphic nuclei

Answer 17

Tubular

Mucinous

Medullary

Question 18

Medullary carcinoma of the breast is associated with mutation in what gene(s)?

Answer 18

BRCA1

Question 19

What is Paget’s disease of the nipple?

Answer 19

A form of breast cancer where cancer cells spread into the epidermis of the areola

Question 20

Lobular carcinoma in-situ is caused in part by a loss of ________, causing cells to have a loose organization.

Answer 20

Lobular carcinoma in-situ is caused in part by a loss of E-cadherin, causing cells to have a loose (and sometimes linear) organization.

Question 21

Invasive lobular carcinomas of the breast have an increased risk for metastasis to what organs?

Answer 21

Ovaries;

the GI tract

Question 22

Using the double-TNM rule, what system is used for grading a breast cancer?

What system is used for staging a breast cancer?

Answer 22

Tubules, nuclei, mitoses;

tumor size, nodal involvement, metastases

Question 23

What immunohistochemistry is assessed in a prognostic breast panel?

Answer 23

ER, PR, HER-2;

Ki-67

Question 24

What are the three major pathways of breast cancer development?

Answer 24

Luminal;

HER-2–enriched;

basal-like

Question 25

**_Invasive breast cancer molecular subtypes_** ~45% are \_\_\_\_\_\_\_\_\_\_\_. ~20% are \_\_\_\_\_\_\_\_\_\_\_. ~20% are \_\_\_\_\_\_\_\_\_\_\_. ~20% are \_\_\_\_\_\_\_\_\_\_\_.

Answer 25

**_Invasive breast cancer molecular subtypes_** ~45% are **_Luminal A_**. ~20% are **_Luminal B_**. ~20% are **_Her-2_**. ~20% are **_basal-like_**.

Question 26

The _________ molecular subtype of invasive breast cancer is hormone-driven.

Answer 26

The **_luminal_** molecular subtype of invasive breast cancer is hormone-driven.

Question 27

The _________ molecular subtype of invasive breast cancer is driven by *p53* and *BRCA*.

Answer 27

The **_basal-like_** molecular subtype of invasive breast cancer is driven by *p53* and *BRCA*.

Question 28

A breast cancer develops from a comedo DCIS to a highly aggressive, triple-negative malignancy. What is the subtype?

Answer 28

Basal-like

Question 29

Identify any of the following breast cancer subtypes which are _not_ hormone-driven: ## Footnote **Luminal** **HER-2--enriched** **Basal-like**

Answer 29

**HER-2--enriched** **Basal-like** (only luminal is ER+)

Question 30

**True/False**. Gynecomastia commonly involves a palpable abnormality due to proliferation of ducts and stroma.

Answer 30

True.

Question 31

How is breast ductal carcinoma in-situ detected?

Answer 31

Microcalcifications; mass effect, nipple discharge, Paget's disease

Question 32

Why do breast ductal carcinomas in-situ often present with microcalcifications?

Answer 32

**Duct occlusion** by calcium oxalate deposition or cellular debris

Question 33

How is breast ductal carcinoma in-situ diagnosed?

Answer 33

Stereotactic guided biopsy

Question 34

Which form(s) of breast ductal carcinoma in-situ is(are) high-grade? **Micropapillary, cribriform, solid, comedo**

Answer 34

Comedo _only_

Question 35

How are breast ductal carcinomas in-situ treated?

Answer 35

Breast-conserving therapy + radiation

Question 36

**True/False**. Breast DCIS can present with multiple foci in the same breast quadrant.

Answer 36

True.

Question 37

**True/False**. Breast cancers are typically split into the following phenotypes: ER+, HER-2+, triple-negative.

Answer 37

**True**. (Genomically: luminal, Her-2--enriched, basal-like)

Question 38

What drug(s) is(are) specific to luminal breast cancer (ER+)?

Answer 38

Tamoxifen

Question 39

What drug(s) is(are) specific to HER-2--enriched breast cancer (HER-2+)?

Answer 39

**Trastuzumab** (Herceptin) | (doxorubicin also blocks HER-2)

Question 40

What is the main treatment for basal-like breast cancer (triple negative)?

Answer 40

Chemotherapy

Question 41

Place the following breast cancer subtypes in order of decreasing difficulty in treatment *(i.e. with the most lethal at the top and the least lethal at the bottom)*: **ER+** (luminal) **HER-2** (HER-2--enriched) **Triple-negative** (basal-like)

Answer 41

Place the following breast cancer subtypes in order of decreasing difficulty in treatment: **Triple-negative** (basal-like) \>\> **HER-2** (HER-2--enriched) \> **ER+** (luminal)