Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PT2B3 > L 77, 78 - Breast Path and Breast Cancer > Flashcards

L 77, 78 - Breast Path and Breast Cancer Flashcards

1
Q

what is the functional unit of the breast

A

Terminal Duct Lobules -

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

path of milk through the breast during lactation

how do you differentiate between lobules and ducts on histology

A

Acini –> Terminal Ducts – > subsegmental duct –> Lactiferous ducts –> Nipple

Lobules – small and numerous

Ducts – larger tube through which milk collects after generation in the lobules. Seen as larger diameter circles or tube cut longitudinally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

______-lobular stroma is hormone responsive; therefore explaining what symptoms?

A

□ Intralobular – responsive to hormones which explains breast tenderness in response to porgesterone

Interlobular stroma is not hormone responsive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are two cell layers of ducts and acinin

A

Epithelial (luminal) Layer + Myoepithelial layer (outer layer, squeezing function during milk ejection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Patient presents to clinic with complaints of breast pain; what is likelihood this is a cancer?

what should you ask to differentiate between breast pain etiologies?

A

Very few cancers present as breast pain (5%); likelihood increases if there is a mass (10%)

Ask if pain is cyclical vs non cyclical with menstruation

If cyclical: non pathologic
If non cyclical: no pathology; may be ruptured cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

____% of patients presenting with palpable mass have cancer

True/false: younger women are more at risk for malignancy

A

10-35%

False: likelihood of malignancy increases with age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Patient presents with galactorrhea; what is your ddx? what are odds its malignant

what if the discharge is serous/bloody?

A

Not associated with malignancy
Usually from prolactinoma, anovulatory syndromes or side effects of TCA, OCP, Methyldopa

serous/bloody– usually benign papilloma or cyst; but risk of malig does increase with age.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Most common bug associated with acute lactation mastitis;

other physical signs

A

S. Aureus

Signs: cracks and fissures along the nipple; route of entry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Fat Necrosis – usually associated with _____

what is seen on mammography?

A

a/w trauma

usually see calcifications/densities which are mistaken for malignancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Patient presents with painful recurrent sub areolar masses

what is it?
what’s seen on histo?
#1 risk factor?

A

Periductal Mastitis: recurrent subareolar abscess +squamous metaplasia

Histo: Squamous metaplasia and keratinization of nipple ducts

90% of pts are smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

patient presents with periareolar mass and skin retraction + thick white/green/brown nipple secretions

dx?

is this patient a smoker or non smoker?

A

Mammary Duct Ectasia:

Non smoker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the most common benign breast tumor??

what age group is susceptible?

abnormal growth of what cell type?

A

Fibroadenoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Phyllodes Tumor

characteristic cytology architecture?

is this malignant?

abnormal growth of what cell type?

A

“leaf-like architecture”

low grade malignancy that doesn’t metastasize, but recur locally

Intralobular stroma – therefore responsive to hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Patient presents with mass;
gross path is a “blue domed” lesion with apocrine histology

dx

what is the course?

A

Blue dome = cyst
Apocrine changes = fibrocystic

Entirely benign and very common

Fibrosis may be from ruptured cysts;

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

4 forms of proliferative breast disease without atypia

what is the relative risk of cancer ?
what is the absolute risk?

A

Epithelial Hyperplasia - mild, moderate, severe
Sclerosis Adenosis
Intraductal Papilloma
Gynocomastia

AR: 5-7%
RR: 1.5-2x (for moderate and severe hyperplasia, adenosis, and intraductal papilloma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Epithelial Hyperplasia

what is seen on histo?
what grades have increased RR

A

Histo: increased proliferation of epithelial cells (luminal and myoepi)

Only moderate and severe
forms have increased RR

Lumen fills with heterogenous, mixed population of luminal and myoepithelial cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

IntraDuctal Papilloma

differences in presentation beween young vs older women?

A

Older women: subareolar, solitary; “large duct papilloma”

younger women: peripheral, multiple;

18
Q

what drugs or conditions may cause gynocomastia?

A

Gynocomastia

Cirrhosis, Testicular Tumor, Klinefelters, Puberty, Old ag

Spironolactone, Digoxine, Cimetidinbe, Alcohol, Ketoconazole (Some drugs create awesome knockers)

19
Q

2 types of proliferative breast disease with atypia?

what is the relative risk?
what is the absoute risk?
is this for the ipsilateral breast, conralateral or both ?

A

Atypical Ductal Hyperplasia

Atypical Lobular Hyperplasia –

RR: 4-5x
AR: 13-17% of having BC over the next 15 years
Both Breasts

20
Q

Atypical Lobular Hyperplasia —

what is the associated mutation ?

A

E Cadherin mutation

21
Q

what is the term for breast cancer which is contained to the epithelial layer?

which is much more common

A

DCIS – much more common

LCIS – not even in FIRST AID

22
Q

what are the two forms subtypes of DCIS

A

Comedocarcinoma (Comedo DCIS)

Paget’s Disease of the Nipple

23
Q

DCIS – what is the RR and AR? is this for the ipsilateral, contralateral or both breasts?

T/F: DCIS is a direct precursor of invasive breast cancer

T/F: majority is found bilaterally

A

RR: 8-10x
AR: 25-30% of BC if 15 years
Breasts at risk: Ipsilateral only

True: DCIS is the direct precursor

False: DCIS in found bilaterally in only 10-20% of cases

24
Q

what s comedocarcinoma –

characteristic path?

A

High grade DCIS which is more likely to progress.

area has central necrosis

25
Q

what is paget’s disease of the nipple?
clinical appearance?
characterisitc pathology?

A

DCIS extends into the lactiferous ducts and extends into the nipple epidermis

Clinical: Eczematous/crusting patches on the nipple

Histo: Paget’s Cells – large cells in epidermis with clear halo (abundant pale cytoplasm)

26
Q

Mutlifocal and bilateral lesions found on mammography – bx reveals carcinoma contained to the epithelium. what is the dx?

A

LCIS === MULTIFOCAL AND BILATERAL

27
Q

LCIS –
AR, RR
is this for the ipsilateral, contralateral or both breasts?’

T/F: LCIS is a direct precursor to invasive carcinoma?

associated mutation

T/F — if DCIS does becomes invasive, it will always be invasive ductal carcinoma?

A

RR: 8-10x
AR: 25-30% of BC if 15 years
BOTH BREASTS

NOT A PRECURSOR, but A MAKER OF INCREASED RISK BILATERALLY of INVASIVE CARCINOMA

Mutation: E Cadherin

False – if a DCIS has bi-allelic mutations to E cadherin, it will become invasive lobular carcinoma

28
Q

what is the most common form of Invasive breast cancer?

Is this usually bilateral or unilateral?

A

Invasive Ductal Carcinoma – 80-85% of all breast cancers

Unilateral –

29
Q

how does an invasive ductal carcinoma appear clinicaly?

Radiographically?
Gross path?
histologically?

A

Clinically – “rock hard mass”

Radiograph – spiculated mass

Gross: firm, fibrotic center

histo: fibrotic center; ducts and lobules invading surrounding breast tissue; lots of desmoplasia;

30
Q

Pathognomonic histology for invasive lobular carcinoma

how does lobular invasive present?

what is the prognosis comapred to DCIS?

A

“Indian File” – orderly row of cells due to loss of E cadherin expression

BILATERAL AND MULTIFOCAL

Prognosis: same as DCIS

31
Q

three other forms of invasive breast cancer that have favorable prognosis… what age groups are most likely to get each?

A

Medullary carcinoma – usually in younger patients

Colloid (mucinous carcinoma) – old lady

Tubular carcinoma – most favorable prognosis

32
Q

two invasive carcinoma forms that have poor prognosis ?

A

Invasive Micropapillary Carcinoma

Metaplastic Carcinoma

33
Q

what is Inflammatory breast carcinoma and what are the characteristic findings?

A

Dermal lymphatic invasion by breast carcinoma
neoplasitc cells block lymphatic drainage

Skin erythema + Peau d’ orange (orange peel skin)

34
Q

what are important ancillary tests run on breast cancer findings; what is their signifiance ?

what is the marker for proliferation?

A

Hormone Receptor IHC:
Positive findings = Positive Prognostic and Positive Predictive findings

Her2/Neu (C-erb-2): weakly unfavorably prognostic, but positive predictive (Trastuzumab)

Ki-67: Marker for proliferation rate

35
Q

Luminal A invasive breast cancer:

postive/negative for what anxcillary tests:

A 
ER+/PR+/HER2- 
Proliferative low (low Ki-67) 
Low histological grade 
Older men and women
Long survival
36
Q

Luminal B invasive breast cancer:

A

ER+/PR+/HER2-
Medium to high prolifeation (more Ki-67)
Some associated with BRCA2
Behavior: Intermediate

37
Q

HER2+ invasive carcinoma

A

May be PR or ER +
Who: young, non white women with P53 mutations
Respond to herceptin

38
Q

Triple Negative –

A

ER-/PR-/HER2 -
Extremely High proliferation
Who; young AA and Hispanic women; BRCA1
Prognosis – Dramatic response to chemo; quickly relapse
If BRCA positive – bilateral mastectomy

39
Q

Luminal A invasive breast cancer:
whats the ancillary test profile?
prognosis ?

A 
ER+/PR+/HER2- 
Proliferative low (low Ki-67) 
Low histological grade 
Older men and women
Long survival
40
Q

Luminal B invasive breast cancer:
whats the ancillary test profile?
prognosis?

A

ER+/PR+/HER2-
Medium to high prolifeation (more Ki-67)
Some associated with BRCA2
Behavior: Intermediate

41
Q

HER2+ invasive carcinoma
whats the ancillary test profile?
Prognosis?

A

May be PR or ER +
Who: young, non white women with P53 mutations
Respond to herceptin

42
Q

Triple Negative –
whats the ancillary test profile
Prognosis?

A

ER-/PR-/HER2 -
Extremely High proliferation
Who; young AA and Hispanic women; BRCA1
Prognosis – Dramatic response to chemo; quickly relapse
If BRCA positive – bilateral mastectomy

PT2B3 (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions