Invasive Breast Cancer Flashcards
Invansive breast carcinoma:
- Clinical Presentation
- **Mammographic **findings
-
Clinical presentation
- Palpable mass
- Dimpling of the skin
- Retraction of the nipple
-
Mammographic findings
- Mass/density
- Calcifications
What is the distribution of breast carcinoma?
- 50% arise in upper outer quadrant
- 20% in subareolar central area
- 10% in each of the other quadrants
Invasive Breast Carcinoma:
Histological Types
-
Ductal
- Ductal NOS -Not otherwise specified
- Tubular
- Medullary
- Mucinous (Colloid)
- Adenoid cystic
- Hypersecretory
- Metaplastic
- Lobular
What are the molecular subtypes of breast carcinoma?
-
Identified 4 molecular subtypes:
- Luminal A
- Luminal B
- HER2 positive
- Basal-like
- These are associated with different clinical outcomes and different therapies
Invasive Ductal Carcinoma
- Incidence:
- Appearance:
- Associated with ….
- Molecular Subtypes:
- 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
**Invasive Lobar Carcinoma **(ILC)
- Age predilection:
- Incidence:
- Appearence:
- 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%
- What is the pattern of metastases for ILC?
- What does it stain negatively for?
- How is its prognosis compared to ductal NOS?
-
Distinctive pattern of metastases:
- CSF, serosal surfaces, GI, ovary, uterus, bone marrow
- E-cadherin negative
- Slightly better prognosis than ductal NOS
- What can be seen on mammography for ILC?
- What are the gross features of ILC?
-
Mammography (often negative)
- Asymmetric, ill defined
- Spiculated mass/density
-
Gross features
- Hard tumor
- Irregular borders
- No distinct margin, blends with surrounding tissue
What are the **microscopic features **of ILC?
- Small cells
- Single file pattern
- Targetoid growth pattern
- No gland formation
- Intracytoplasmic mucin vacuoles
- Signet ring cells
Medullary Carcinoma
- Age predilection:
- Increased incidence in ….
- Prognosis:
- Genetic expression:
- 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
Medullary Carcinoma:
- Mammographic findings
- Gross findings
-
Mammographic findings
- Oval circumscribed mass
- Can be mistaken for fibroadenoma
-
Gross findings
- Soft, fleshy
- Circumscribed border
- Lobulated, bulging cut surface
Meduallry Carcinoma: Microscopic criteria for diagnosis
- Syncytial growth pattern in 75% of tumor cells
- High nuclear grade
- Lymphoplasmacytic infiltrate
- Pushing (non-infiltrative) border
Tubular Carcinoma
- Median Age:
- Focality:
- Most common location:
- Prognosis:
- Median age: mid to late 40’s
- Multifocal in 10 - 56% of cases
- Periphery of the breast
-
Excellent prognosis
- Axillary metastasis
Tubular Carcinoma
- Mammographic findings
- Gross findings
-
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
What are the microscopic findings in tubular carcinoma?
- Single layer of epithelial cells lining glands
- No myoepithelial layer
- Glands scattered in desmoplastic stroma
Colloid (Mucinous) Carcinoma:
Clinical Features
- Usually postmenopausal
- Slow growing mass
- Good prognosis
- Axillary metastases:
- Incidence is slightly higher in women with BRCA1 mutation
Colloid (Mucinous) Carcinoma:
- Mammographic findings
- Gross
- Microscopic findings
-
Mammographic findings
- Well circumscribed and lobulated
-
Gross
- Circumscribed mass
- Soft, pale blue, gelatinous surface
-
Microscopic findings
- Tumor cells and nests in pools of mucin
What is inflammatory carcinoma of the breast?
- Clinical diagnosis: 6-9% of carcinomas
- Not a specific histological subtype
- Skin erythema, peau d’orange
- DDx: acute mastitis
Inflammatory carcinoma
- Gross features:
- Microscopic:
- Prognosis:
-
Gross features
- Diffuse induration of breast parenchyma
- Thickening of the skin
-
Microscopic: skin biopsy
- Lymphatic tumor emboli
-
Bad prognosis
- 10-year survival is 30%
What is the difference between grade and stage?
-
Stage (TNM)
- Tumor size
- Nodal status
- Metastasis
-
Grade (modified Bloom-Richardson)
- Architectural grade
- Nuclear grade
- Mitoses
Histological grade of invasive breast carcinoma correlates with _______
Histological grade of invasive breast carcinoma correlates with prognosis
What is the breast carcinoma grade system?
What is the prognosis for a large breast cancer tumor?
- Decreased survival
- Increased rate of nodal metastasis
- 0.6-1.0cm ⇒ 10%
- 1.1-1.5cm ⇒ 21%
- 1.6-2.0cm ⇒ 35%
How can axial node status affect the 10 year survival rate?
- Negative nodes: 70-80%
- 1 - 3 positive nodes: 30-40%
- > 10 positive nodes: 10-15%
_______ lymph node status is the most important prognostic factor for invasive carcinoma in the absence of distant metastases
Axillary lymph node status is the most important prognostic factor for invasive carcinoma in the absence of distant metastases
What are the prognostic markers for breast cancer (3)?
- Estrogen receptor
- Progesterone receptor
- HER2Neu FISH/IHC
When is oncotype a useful test for prognisticating breast cancer?
- Applicable only for patients with early carcinoma, small, node negative, ER+
- Expression of a set of genes predicts patient’s response to chemotherapy
What is the treatment for breast carcinoma?
-
Surgery
- Conservative; lumpectomy
- Mastectomy
- Radiation
-
Systemic treatment
- Chemotherapy
- Hormonal therapy
