Intro to Breast Cancer Flashcards
1
Q
How do the breast change during life?
- Pre-pregnancy
- Pregnancy
- Post-menopausal
A
- Pre-pregnancy
- Neonatal
- Pubertal
- Menstrual cycle
- Pregnancy
- Lactational change
- Postmenopausal
- Atrophy
2
Q
What can be done to diagnose a breast lesion?
A
- Self examination
-
Imaging
- Mammography
- Ultrasound
- MRI
-
Biopsy
- Fine needle aspiration
- Core needle biopsy
- Vacuum assisted or mammotome
- Excisional
3
Q
Screening vs. Diagnostic Mammograms (differences?):
A
-
Screening occurs in asymptomatic women
- 40-50 years: every year or every other year
- >50 years: yearly screening
- 1st degree relative with breast cancer: screening begins 10 years before the age at diagnosis in the 1st degree relative
- Diagnostic mammograms are used to evaluate a palpable lesion
4
Q
What are suspicious mammographic findings?
A
- Density
- These carcinomas are ½ the size of palpable ones
- Microcalcifications
- Picks up even smaller lesions
- May herald an in situ carcinoma
- Magnification or compression views may aid in the evaluation of mammographic abnormalities
5
Q
When is an ultrasound used to evaluate breast tissue?
A
- Often used in women younger than 35 years especially if the lesion is clinically benign
- Can differentiate solid from cystic masses
- Often used in conjunction with mammography
6
Q
What are the indications for a breast MRI?
A
- Pre-operative evaluation of extent of malignant disease/contralateralprocess
- Evaluate tumor response to neo-adjuvant chemotherapy
- Axillarylymph node positive for metastatic carcinoma with unknown primary
- Evaluate integrity silicone breast implant
- High risk screening
7
Q
What are different types of breast pathology specimens?
A
- FNA
- Core biopsy
- Excisional biopsy
- Excision / lumpectomy
- Mastectomy
- Lymph nodes:
- sentinel node
- axillary dissection
8
Q
What are the advantages/disadvantages of a fine needle aspirate (FNA)?
A
- Safe, accurate and well tolerated
- Requires subspecialty expertise for interpretation
- Cannot distinguish between in situ and invasive lesions
- Higher rate of false negative results
9
Q
How is a core needle biopsy obtained?
A
- 8, 11 or 14 gauge needles
- Several cores are usually obtained
- False negatives are usually due to sampling error
- Can be obtained using radiologic guidance if the mass is small, deep, mobile, vaguely palpable or multiple
10
Q
- What is a lumpectomy?
- What is used for orientation?
A
- Needle localization biopsy
- Oriented with clips
11
Q
- What is the “triple test”?
- How is it interpreted?
A
- Combination of physical examination, imaging studies and biopsy
-
If all three tests point to a benign diagnosis,
- it is likely that the process is benign
- can be followed without requiring surgical removal (95% sensitive)
-
If there is any discordance among the three tests,
- further studies are indicated
12
Q
Most common lesion best on age group:
- **15-25: **
- **25-35: **
- **35-50: **
- **Over 50: **
- Pregnant or lactating:
A
-
15-25
- Fibroadenoma
-
25-35
- Fibroadenoma (cyst or cancer possible but uncommon)
-
35-50
- Fibrocystic changes, cancer, cyst
-
Over 50
- Cancer until proved otherwise
-
Pregnant or Lactating
- Lactating adenoma, cyst, mastitis, cancer
13
Q
What are the inflammatory conditions of the breast?
A
- Acute mastitis
- Periductal mastitis
- Mammary duct ectasia
- Fat necrosis
- Other (lymphocytic mastopathy, granulomatous mastitis, plasma cell mastitis, galactocele)
14
Q
What are the benign** epithelial lesions** of the breast?
A
- Non-proliferative breast changes (fibrocystic changes)
- Proliferative breast disease without atypia
- Proliferative breast disease with atypia
15
Q
What are the different types of non-proliferative breast changes (Fibrocystic Changes)?
A
- Cysts
- Fibrosis
- Apocrine metaplasia
20
Q
What is ductal hyperplasia?
A
- Lumen filled by heterogeneous population of cells
- Different morphologies –myoepithelial and epithelial
- Irregular slit-like fenestrations, prominent at periphery
21
Q
Describe sclerosing adenosis:
A
- Enlarged lobule, circumscribed edge
- Preserved background lobular architecture
- Compressed and distorted acini
- Dense stroma, calcifications
23
Q
How does a complex sclerosing adenosis (radial scar) appear microscopically?
A
- Stellate lesion
- Central hyalinized stroma with entrapped glands
- Dilated ducts at periphery
25
Q
How does a papilloma appear microscopically?
A
- Branching fibrovascular cores within duct
- Epithelial hyperplasia often present
27
Q
What is the microscopic appearence of atypical hyperplasia?
A
- Resembles in situ carcinoma
- Lacks quantitative or qualitative features for this diagnosis
34
Q
Fibroadenoma
- Peak incidence:
- Clinical Presentation:
- Regression?
A
- Peak incidence: 3rd decade
- Less than 5% postmenopausal
- Solitary, well-circumscribed, movable, painless nodule
- Multiple - 15%
- Regression during menopause
35
Q
Phyllodes Tumor:
- Gross appearance:
- Peak Incidence:
- Palpable?
- Aggressive?
A
-
Large, fibroepithelial tumor
- Benign or malignant
- Most in 5th, 6th decade
- < 1% of breast tumors
- Latin women 3 -4x increased incidence
- Discrete palpable breast mass
- Rapid growth
36
Q
Phyllodes Tumor:
Benign features
A
- Circumscribed
- Not encapsulated
- Gray-tan cut surface
- Interlacing clefts
- Cysts
- Necrosis
- Hemorrhage
37
Q
What are microscopic findings of a benign phyllodes tumor?
A
- Leaf-like or epithelium lined clefts, cysts
- Increase in stromal cellularity
- Stromal overgrowth
