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Breast > Invasive Breast Cancer > Flashcards

Invasive Breast Cancer Flashcards

1
Q

Invansive breast carcinoma:

  • Clinical Presentation
  • **Mammographic **findings
A
  • Clinical presentation
    • Palpable mass
    • Dimpling of the skin
    • Retraction of the nipple
  • Mammographic findings
    • Mass/density
    • Calcifications
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2
Q

What is the distribution of breast carcinoma?

A
  • 50% arise in upper outer quadrant
  • 20% in subareolar central area
  • 10% in each of the other quadrants
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3
Q

Invasive Breast Carcinoma:

Histological Types

A
  • Ductal
    • Ductal NOS -Not otherwise specified
    • Tubular
    • Medullary
    • Mucinous (Colloid)
    • Adenoid cystic
    • Hypersecretory
    • Metaplastic
  • Lobular
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4
Q

What are the molecular subtypes of breast carcinoma?

A
  • Identified 4 molecular subtypes:
    • Luminal A
    • Luminal B
    • HER2 positive
    • Basal-like
  • These are associated with different clinical outcomes and different therapies
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5
Q

Invasive Ductal Carcinoma

  • Incidence:
  • Appearance:
  • Associated with ….
  • Molecular Subtypes:
A
  • Majority of carcinomas (70% -80%)
  • Usually firm, white masses with indistinct borders
    • Range from well to poorly differentiated
  • Usually associated with DCIS, and rarely LCIS
  • Molecular subtypes:
    • 2/3 express ER/PR
    • 1/3 overexpress Her2/Neu
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6
Q

**Invasive Lobar Carcinoma **(ILC)

  • Age predilection:
  • Incidence:
  • Appearence:
A
  • Relatively more common in postmenopausal women
  • Account for 20% of all breast cancers
  • Appearence:
    • Multicentric more often than other carcinomas
    • Bilateral 20%
    • Contralateral carcinoma:
      • Prior or concurrent: 6 - 47%
      • Subsequent: 10 - 15%
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7
Q
  • What is the pattern of metastases for ILC?
  • What does it stain negatively for?
  • How is its prognosis compared to ductal NOS?
A
  • Distinctive pattern of metastases:
    • CSF, serosal surfaces, GI, ovary, uterus, bone marrow
  • E-cadherin negative
  • Slightly better prognosis than ductal NOS
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8
Q
  • What can be seen on mammography for ILC?
  • What are the gross features of ILC?
A
  • Mammography (often negative)
    • Asymmetric, ill defined
    • Spiculated mass/density
  • Gross features
    • ​Hard tumor
    • Irregular borders
    • No distinct margin, blends with surrounding tissue
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9
Q

What are the **microscopic features **of ILC?

A
  • Small cells
  • Single file pattern
  • Targetoid growth pattern
  • No gland formation
  • Intracytoplasmic mucin vacuoles
  • Signet ring cells
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10
Q

Medullary Carcinoma

  • Age predilection:
  • Increased incidence in ….
  • Prognosis:
  • Genetic expression:
A
  • Younger age group
  • Rare subtype; less than 1%
  • Increased incidence in women with BRCA1 gene
  • Better prognosis than invasive ductal carcinoma NOS
    • Metastases infrequent
  • Genetic expression:
    • Do not overexpress Her2/Neu
    • Negative for ER/PR
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11
Q

Medullary Carcinoma:

  • Mammographic findings
  • Gross findings
A
  • Mammographic findings
    • Oval circumscribed mass
    • Can be mistaken for fibroadenoma
  • Gross findings
    • Soft, fleshy
    • Circumscribed border
    • Lobulated, bulging cut surface
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12
Q

Meduallry Carcinoma: Microscopic criteria for diagnosis

A
  • Syncytial growth pattern in 75% of tumor cells
  • High nuclear grade
  • Lymphoplasmacytic infiltrate
  • Pushing (non-infiltrative) border
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13
Q

Tubular Carcinoma

  • Median Age:
  • Focality:
  • Most common location:
  • Prognosis:
A
  • Median age: mid to late 40’s
  • Multifocal in 10 - 56% of cases
  • Periphery of the breast
  • Excellent prognosis
    • Axillary metastasis <10%
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14
Q

Tubular Carcinoma

  • Mammographic findings
  • Gross findings
A
  • Mammographic findings
    • Small stellate lesion in an asymptomatic woman
  • Gross findings
    • Ill-defined stellate mass
    • Gray-white, firm
    • 80 –90% are 1 cm or smaller in size
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15
Q

What are the microscopic findings in tubular carcinoma?

A
  • Single layer of epithelial cells lining glands
  • No myoepithelial layer
  • Glands scattered in desmoplastic stroma
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16
Q

Colloid (Mucinous) Carcinoma:

Clinical Features

A
  • Usually postmenopausal
  • Slow growing mass
  • Good prognosis
  • Axillary metastases: <20%
  • Incidence is slightly higher in women with BRCA1 mutation
17
Q

Colloid (Mucinous) Carcinoma:

  • Mammographic findings
  • Gross
  • Microscopic findings
A
  • Mammographic findings
    • Well circumscribed and lobulated
  • Gross
    • Circumscribed mass
    • Soft, pale blue, gelatinous surface
  • Microscopic findings
    • Tumor cells and nests in pools of mucin
18
Q

What is inflammatory carcinoma of the breast?

A
  • Clinical diagnosis: 6-9% of carcinomas
  • Not a specific histological subtype
  • Skin erythema, peau d’orange
  • DDx: acute mastitis
19
Q

Inflammatory carcinoma

  • Gross features:
  • Microscopic:
  • Prognosis:
A
  • Gross features
    • ​Diffuse induration of breast parenchyma
    • Thickening of the skin
  • Microscopic: skin biopsy
    • Lymphatic tumor emboli
  • Bad prognosis
    • 10-year survival is 30%
20
Q

What is the difference between grade and stage?

A
  • Stage (TNM)
    • Tumor size
    • Nodal status
    • Metastasis
  • Grade (modified Bloom-Richardson)
    • Architectural grade
    • Nuclear grade
    • Mitoses
21
Q

Histological grade of invasive breast carcinoma correlates with _______

A

Histological grade of invasive breast carcinoma correlates with prognosis

22
Q

What is the breast carcinoma grade system?

A
23
Q

What is the prognosis for a large breast cancer tumor?

A
  • Decreased survival
  • Increased rate of nodal metastasis
    • <0.5cm ⇒ 3%
    • 0.6-1.0cm ⇒ 10%
    • 1.1-1.5cm ⇒ 21%
    • 1.6-2.0cm ⇒ 35%
24
Q

How can axial node status affect the 10 year survival rate?

A
  • Negative nodes: 70-80%
  • 1 - 3 positive nodes: 30-40%
  • > 10 positive nodes: 10-15%
25
Q

_______ lymph node status is the most important prognostic factor for invasive carcinoma in the absence of distant metastases

A

Axillary lymph node status is the most important prognostic factor for invasive carcinoma in the absence of distant metastases

26
Q

What are the prognostic markers for breast cancer (3)?

A
  1. Estrogen receptor
  2. Progesterone receptor
  3. HER2Neu FISH/IHC
27
Q

When is oncotype a useful test for prognisticating breast cancer?

A
  • Applicable only for patients with early carcinoma, small, node negative, ER+
  • Expression of a set of genes predicts patient’s response to chemotherapy
28
Q

What is the treatment for breast carcinoma?

A
  • Surgery
    • Conservative; lumpectomy
    • Mastectomy
  • Radiation
  • Systemic treatment
    • Chemotherapy
    • Hormonal therapy

Breast (5 decks)

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