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
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
3
Q
Invasive Breast Carcinoma:
Histological Types
A
-
Ductal
- Ductal NOS -Not otherwise specified
- Tubular
- Medullary
- Mucinous (Colloid)
- Adenoid cystic
- Hypersecretory
- Metaplastic
- Lobular
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
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
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%
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
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
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
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
12
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
13
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
14
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
15
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
16
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
23
Q
What is the breast carcinoma grade system?
A
