Female Genital and Breast 2 Flashcards
What is salpingitis and what causes it?
Inflammation of the fallopian tubes caused by ascending lower genital tract infection.
Name four complications of salpingitis.
- Reinfection is common
- Access through tubes –> peritoneal cavity –> peritonitis and PID.
- Abscesses
- Adhesions –> ectopic pregnancy or infertility.
What morphological changes are seen in salpingitis?
Acute phase: polys, edema, congestion of mucosal folds.
Chronic: monocytes like lymphocytes and plasma cells. Edema and congestion is MINIMAL. Later, tubes become filled with pus or transudate.
Which cancer arises in people who have never given birth (nulliparity) or have a prior family history of the disease?
surface epithelial-stromal cell ovarian tumor
What percentage of ovarian cancer cases are familial?
5-10%
Surface epithelial-stromal cell ovarian tumors that overexpress HER2/NEU are associated with…?
poor prognosis
What is a serous tumor of the ovary? How common are they?
A type of surface epithelial-stromal cell ovarian tumor. The most frequent of the ovarian tumors (60-70%). Can be benign (cystadenoma) or malignant (cystadenocarcinoma). They are round and can get really big (40cm)
Cystadenomas of the ovary often appear between the ages of ____ and ____ and ____% are bilateral.
Name one cellular characteristic.
between ages of 30 and 40, 25% are bilateral.
Characterized by a single layer of tall columnar epithelium that lines the cyst(s).
Name four characteristics of a cystadenocarcinoma of the ovary. What is the prognosis?
- Asymptomatic until they are huge.
- Lymphatic spread is common, distant mestastasis is NOT.
- Seeding to the surface of the pelvis, abdominal organs, bladder, diaphragm, paracolic gutter, or omentum.
- CA-125 is the marker.
poor prognosis - 5 yr. rate is 35% due to late detection
What is CA-125 used for?
cystadenocarcinoma of the ovary
How common is breast cancer?
Very, its the most common malignancy in women and mortality is second only to lung cancer.
One in every ___ (a number) American women are expected to develop breast cancer, 1/4 of whom will die of the disease.
1 in 8
Describe the pathogenesis of breast cancer.
Complex; diverse histopathology, molecular features, and overall patient outcomes.
Describe the possible steps in the development of breast cancer.
Normal –> atypical hyperplasia –> low/moderate grade DCIS (ductal carcinoma in-situ)
The low/moderate DCIS can become a low/moderate grade invasive carcinoma OR can become a high grade invasive carcinoma.
Alternatively, things can just go straight to high grade DCIS –> high grade carcinoma.
What is the strongest association with increased risk for breast cancer?
Family history in first degree relatives. Even worse if breast cancer in family is early or bilateral.
What is BRCA1?
A TSG involved in breast, ovarian, and maybe prostate and colon ca.
BRCA1 mutations are likely in ___ in 200 to 400 people in the U.S. Germline point mutations and deletions in BRCA1 confer a ____ to ____% lifetime risk for breast cancer, half the time occurring before ____ years of age. BRCA1 mutations are likely responsible for ____% of all inherited breast cancer (3% of all breast cancers).
1 in 2-400 in U.S. have a BRCA1 mutation. It confers a 60-85% risk of breast cancer, with more than half occurring before the age of 50.
Responsible for 20% of all inherited breast cancers
Somatic mutations in BRAC1 are infrequently _______ in sporadic breast cancers.
not frequently detected in sporadic cases
BRCA2 mutations are responsible for ____% of hereditary breast cancer cases (just like BRCA1!) and carriers have a ___ to ___% lifetime chance of developing breast cancer and are at increased risk for _______ cancer.
20% of hereditary cases
30-40% lifetime chance of developing breast cancer
increased risk for ovarian cancer
In what population are BRCA2 mutations common?
Ashkenazi Jewish women
Are men with BRCA2 mutations at an increased risk for breast cancer?
Yeah
Young women with Li-fraumeni syndrome will almost all develop ______ cancer. What is the mutation responsible for this disease?
breast cancer
p53 mutation
Germline (inherited) p53 mutations account for ___% of breast cancer among women under the age of 40.
1%
Most breast cancers are not associated with hereditary factors. Name six factors that play a role in the development of the disease and briefly describe each.
- Hormonal - nulliparious or 1st pregnancy after 35 –> 2-3x higher risk.
- Radiation
- Previous breast cancer –> 10x higher risk for cancer in the same or other breast.
- Fibrocystic change
- Genetic changes (somatic mutations) in proto-oncogenes like HER2/NEU or TSGs.
- Environmental factors
HER2/NEU is a member of the ________ growth factor receptor family, and it has been found in up to ____% of invasive breast cancers. Its overexpression is associated with a _______ prognosis.
epidermal GF receptor family, found in up to 30% of invasive breast cancers, associated with a poor prognosis
What is the most common form of in situ breast carcinoma?
Ductal carcinoma in situ (DCIS)
Where does DCIS arise from? Describe five other characteristics.
Arises from terminal ducts of lobular units.
- No BM penetration
- Fills, distorts, and unfolds lobules and involves ductlike spaces.
- Histology varies; tumor cell nuclei will have similar characteristics, which can range from bland to pleomorphic.
- Calcifications
- Minimal necrosis
Which subtype of DCIS is less likely to incite a desmoplastic response?
The non-comedo subtype (the term non-comedo means that there are not many dead cancer cells in the tumor.)
What is the relationship between cellular differentiation and receptors for estrogen and progesterone in a case of DCIS?
Better differentiation = more estrogen receptors (and less often progesterone receptors)
With early screening, DCIS only rarely presents as a _______ or _________ detectable mass. If detection is delayed, a ______ _______ or _______ ______ may develop.
With screening DCIS rarely presents as a palpable or radiologically detectable mass. If detection is delayed, a palpable mass or nipple discharge may develop.
What is the prognosis for DCIS?
Excellent - 97% long term survival after simple masectomy or lumpectomy
What proportion of women with untreated low-grade DCIS go on to develop an invasive carcinoma? When it does develop, where in relation to the DCIS does it occur? How is this treated?
1/3 –> invasive carconima
Invasive cancer will develop in the same breast and quadrant as the DCIS.
Treated with surgery, radiation, anti-estrogens.
What four cellular characteristics are seen in a comedo DCIS (high grade)?
- Large, pleomorphic epithelial cells
- Abundant cytoplasm
- Irregular nuclei with irregular and prominent nucleoli.
- Cells grow rapidly within ducts and show intraductal necrosis.
Describe the gross morphological changes seen in a comedo DCIS (high grade).
- Distended duct-like structure
- Contains white, necrotic material resembling comedos (clogged hair follicles).
- Dystrophic calcification.
- Desmoplastic response
Comedo DCIS may incite chronic __________, _________ and a _________ response (fibroblast proliferation and fibrosis) in a _________ distribution.
May incite chronic inflammation, neovascularization, and a desmoplastic response (fibroblast proliferation and subsequent fibrosis) in a peritubular distribution.
What are four differences between DCIS and LCIS (lobar carcinoma in situ)?
- LCIS cells are smaller and more monotonous than in DCIS with round, regular nuclei and small nucleoli.
- The cells don’t pack the terminal ducts to the same extent as DCIS.
- Intracellular mucin vacuoles (signet ring cells) are common.
- Doesn’t form masses, doesn’t calcify
LCIS is usually an ________ finding. It does not form ______ and is rarely associated with _______.
incidental finding, doesn’t form masses and is rarely associated with calcifications
What proportion of women with LCIS go on to develop invasive carcinoma? What is LCIS used as a marker for?
1/3 of women with LCIS will eventually develop invasive carcinoma.
LCIS is a marker of increased of developing breast cancer in either breast and a direct precursor of some cancers.
Why would a clinician call a ductal carcinoma an “invasive ductal carcinoma” rather than either LCIS or DCIS?
Because they aren’t able to classify it as DCIS or LCIS so its just called an invasive ductal carcinoma.
The majority of breast cancers fall into this category…..
invasive ductal carcinoma
Name two characteristics of invasive ductal carcinomas.
- Usually associated with DCIS
2. Produces a desmoplastic response, which replaces normal breast fat and forms a hard, palpable mass.
Breast cancer cells that invade outside of the duct-lobular units and extend into the stroma is characteristic of what type of breast cancer?
Invasive ductal carcinoma.
What morphological changes are seen in an invasive ductal carcinoma (4)?
- Tumor cells outside the duct-lobular units, extending into the stroma.
- Heterogeneous and ranges from well-developed tubule formation and low-grade nuclei to tumors consisting of sheets of anaplastic cells.
- Irregular margins.
- Lymph invasion (bad), vascular, nerve invasion.
What proportion of invasive ductal carcinomas express estrogen/progesterone receptors and what proportion overexpress HER2/NEU?
About 2/3 express estrogen or progesterone receptors
About 1/3 overexpressed HER2/NEU
What are the clinical manifestations of invasive ductal carcinoma (7)?
- Nodules
- Nipple retraction
- Discharge
- Breast inflammation
- Lymph node enlargement - may be first sign of disease.
- Paraneoplastic syndrome - hypercalcemia –> radiologically visible calcification is possible.
- Metastasis
Nodules of 2-3 cm dia usually involve regional lymph nodes in about ___% of the cases
Nodules around 1 cm dia had nodal metastasis in about ___% of the cases (importance of screening!)
2-3 cm = lymph node involvement in 50% of cases
1 cm = lymph node involvement in 15% of cases
What eight factors are involved in prognosticating breast cancers?
- Size
- Lymph node involvement
- Distant metastasis
- Grade
- Histologic type
- Rate of proliferation
- Aneuploidy
- Overexpression of HER2/NEU
If there is no axillary lymph node involvement in a person with breast cancer, the 5-year survival rate is ___%. This rate decreases to 50% if more than _____(a number) nodes are involved.
90% with no axillary node involvement.
more than a dozen nodes –> less than 50% survival rate
Is the sentinel lymph node important in predicting breast metastasis to the other nodes?
Yeah
Do breast cancers with more cellular differentiation have a better, or worse prognosis?
Differentiation = better prognosis
Specialized types of breast carcinomas have a _______ prognosis than carcinomas of no special type (“ductal carcinomas”).
better
What is herceptin?
Anti HER2/NEU antibody for treatment of breast cancers that express it.
What does “aneuploidy” mean when referring to the prognosis of breast cancer?
Carcinomas with an abnormal DNA content (aneuploidy) have a slightly worse prognosis as compared to carcinomas with a DNA content similar to normal cells.
Breast cancers with high proliferative rates are associated with _______ (poorer or better) outcomes.
poorer
In which quadrant of the breast are tumors most common?
Upper outer/lateral
