Infiltrating carcinoma

Question 1

Types

Answer 1

• Invasive carcinoma, no special type (NST; invasive ductal carcinoma)
• Invasive lobular carcinoma
• Medullary carcinomas
• Mucinous (colloid) carcinomas
• Inflammatory

Question 2

Most common type

Answer 2

Invasive (ductal) carcinoma (No special type)

Question 3

Tumors that present with a swollen, erythematous breast due to extensive lymphatic invasion and destruction

• Diagnosis
• Clinical presentation
• Usual grade
• Prognosis

Answer 3

• Diagnosis
  
  • Inflammatory carcinoma
• Clinical presentation
  
  • Peau d’orange
• Usual grade
  
  • High grade
• Prognosis
  
  • Overall prognosis is poor

Question 4

Basically defined as in situ disease + absence of intact myoepithelial layer with haphazardly disposed cells with desmoplasia

• Diagnosis
• Histologic scoring and its component
• Grading

Answer 4

• Diagnosis
  
  • Invasive (ductal) carcinoma (No special type)
• Histologic scoring and its component
  
  • Nottingham histologic score
    
    • Tubule formation
    • Nuclear polymorphism
    • Mitotic figures
• Grading
  
  • Sum of Nottingham score (Elstone score)

Question 5

Most common breast cancer to present as occult primary

• Diagnosis
• Degree of desmoplasia
• Histopath and IHC features

Answer 5

• Diagnosis
  
  • Invasive lobular carcinoma
• Degree of desmoplasia
  
  • Little
• Histopath and IHC features
  
  • E-cadherin loss
  • Discohesive infiltrating tumor cells in a single file (Indian file)
  • Signet ring cell carcinoma
• Memory aid:*
• Nakasuot ng signet ring ung mga Indian

Question 6

Slow-growing well-differentiated ER-positive tumors

• Diagnosis
• Predisposed population
• Histopath finding

Answer 6

• Diagnosis
  
  • Mucinous (colloid) carcinomas
• Predisposed population
  
  • Elderly
• Histopath finding
  
  • Malignant cells grow in clusters within large
    mucin lakes

Question 7

Typically present after age 60 years as rapidly growing, well-circumscribed masses and usually ER and HER 2 ⊝

• Diagnosis
• Morphology
• Frequent phenotype among

Answer 7

• Diagnosis
  
  • Medullary carcinomas
• Morphology
  
  • Solid sheets of large cells with vesicular pleomorphic nuclei and prominent nucleoli, multiple mitoses, and a lymphoplasmacytic infiltrate
• _​_Frequent phenotype among
  
  • BRCA 1

Keywords:

• Lyphocytic and plasmacytic infiltrate
• Pleomorphic nuclei
• Prominent nucleoli

Question 8

Skin biopsy findings reveal permeation of dermal lymphatics with tumor

• Type
• Rate of metastasis
• Stage
• Treatment

Answer 8

• Type
  
  • Inflammatory
• Rate of metastasis
  
  • High
    
    • Axillary LN mets – 75%
    • Distant mets – 25%
• Stage
  
  • IIIB
• Treatment
  
  • Neoadjuvant chemo with Adriamycin based regimen
  • MRM
  • Adjuvant chemo + RT + hormone therapy