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Reproduction Week 3 > Lecture 29: Pathology of the Breast > Flashcards

Lecture 29: Pathology of the Breast Flashcards

1
Q

What are the 8 major risk factors of SPORADIC breast cancer (1st LO)?

A
  1. Gender (female)
  2. Age (greater than 50 yo)
  3. Geography (seen more in industrialized countries)
  4. Family history breast cancer
  5. Fibrocystic changes (some)
  6. Prior breast or GYN cancer
  7. Radiation
  8. Unopposed estrogens
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2
Q

What are the two main sub-types of breast carcinoma as defined by microscopic pattern (2nd LO)?

A
  1. In situ carcinoma

2. Invasive carcinoma

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3
Q

What is the major difference between in situ and invasive breast carcinoma? What does it imply about prognosis? (3rd LO)

A

In situ carcinoma is always benign-acting if treated
In invasive breast cancer, 40-50% of patients die
Carcinoma in situ got its name because it looks malignant in microscope even though it doesn’t invade

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4
Q

What are the types of in situ carcinoma?

A

One of two subtypes of breast carcinoma

i. in Situ Ductal Carcinoma (DCIS)
ii. in situ lobular carcinoma (LCIS)

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5
Q

What are the types of invasive carcinoma?

A

One of two subtypes of breast carcinoma

i. Invasive ductal carcinoma
ii. Paget Disease of Nipple
iii. “Inflammatory” breast carcinoma
iv. Invasive Lobular Carcinoma
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6
Q

What is TDLU?

A

Terminal Duct Lobular Unit
Basic unit of the breast
Duct that connects lobules and terminates in lobules
This is “the working end of the breast” and is where most breast cancer starts

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7
Q

If DCIS is benign, why call it carcinoma?

A

It has cell structure that suggest malignancy

  1. Enlarged cells
  2. High N:C ratio
  3. prominent nucleoli
  4. increased mitoses
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8
Q

What is the clinical significance of DCIS?

A
  1. benign-behaving if treated
  2. can evolve to invasive cancer (we cant tell which)
  3. Non-obligate precursor (but all DCIS is treated as if it would become malignant)

All invasive carcinoma goes through DCIS stage

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9
Q

What is a key histological feature of LCIS?

A

The lumen of the glands are OBLITERATED
Signet-ring cells (nucleus is pushed to side)
Lack of cohesion
Starts in the ACINI

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10
Q

What is the clinical significance of LCIS?

A
  1. Benign but 15-20% of patients can develop carcinoma
  2. Difficult to excise
  3. risk factor and/or precursor
  4. Usual treatment = watch and wait
    If you administer tamoxifen to women with LCIS, you decrease risk of invasive carcinoma
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11
Q

What is the clinical appearance of Paget disease of nipple? How would it look under the microscope? What does the diagnosis imply? (4th LO)

A

Paget Disease is a clinical manifestation of breast cancer characterized by
i. Nipple redness
ii. Nipple crusting
iii. Nipple ulceration
Diagnosis implies that there is underlying breast carcinoma (DCIS or invasive ductal carcinoma)
Under the microscope, paget cells have pseudo egg shaped appearance

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12
Q

What are paget cells?

A

Indicative of DCIS or invasive breast carcinoma

DUCTAL invasive carcinoma

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13
Q

What are the most important PROGNOSTIC and PREDICTIVE factors in invasive breast cancer? (5th LO)

A

Prognostic factors (TNM)
i. tumor size (T)
ii. presence/absence in lymph nodes (N)
iii. presence/absence of metastasis (M)
Stage 0 = best whiel Stage IV is worst
Predictive factors
i. estrogen receptor in tumor (therapeutic target)
-if estrogen receptor positive, can use Tamoxifen
ii. progesterone receptor in tumor (therapeutic target)
iii. HER-2/neu (human-epidermal growth factor receptor 2)
HER-2/neu positive means you can use HERCEPTIN as treatment

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14
Q

What are prognostic factors?

A

Tells something about the probability of death

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15
Q

What are predictive factors?

A

Tells something about the probability that a patients cancer will respond to specific therapies

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16
Q

Why is inflammatory breast cancer not an infectious disease? (6th LO)

A

Refers just to the redness of the skin, not the fact that there is infection
Cancer in the dermal lymphatics WITHOUT an inflammatory infiltrate
Why the skin reddens is a mystery (fat necrosis?)

17
Q

Which men are at greatest risk of carcinoma?

A

Klinefelter syndrome

18
Q

What are the two main reasons that fibrocystic changes (FCC) are important? (7th LO)

A
  1. Fibrocystic changes (FCCs) can form a palpable mass or calcification on a mammogram that raise a concern for cancer and must be biopsied
  2. Some FCCs are markers for an elevated breast cancer risk
19
Q

What are most masses and calcifications detected on a screening mammogram caused by?

A

Caused by FCCs or benign conditions

NOT usually caused by cancer

20
Q

What are the non-proliferative and proliferative fibrocystic changes? (8th LO)

A
  1. Non-proliferative
    i. fibrosis
    ii. cysts
    iii. adenosis (increasing amount of acini…paradoxical placement)
    iv. apocrine metaplasia
  2. Proliferative
    i. Sclerosing adenosis
    ii. usual ductal hyperplasia (UDH)
    iii. atypical ductal or lubular hyperplasia )ADH or ALH)
21
Q

What is the breast cancer risk for the FCC categories? (8th LO)

A

Proliferative FCCs = cancer
Non-proliferative = does not lead to cancer
i. Slight risk (2x) = sclerosing adneosis, usual ductal hyperplasia (mild)
ii. Moderate (4-5x) = Atypical ductal/lobular hyperplasia (ADH or ALH)
iii. High (10x) = ADH or ALH with a family history of breast cancer

22
Q

What is the most common benign EPITHELIAL tumor of the breast? What is its usual clinical presentation? (9th LO)

A

Ductal Papilloma
Causes nipple discharge to be bloody
Arises from lactiferous ducts

23
Q

What are the two most common fibroepithelial (stromal) tumors of the breast and which is 100% benign and which one is usually benign? (10th LO)

A
  1. Fibroadenoma
    ALWAYS benign
  2. Phyllodes Tumor
    Usually benign (6% metastasize)
24
Q

What is significant about fibroadenoma (FA)?

A

It is a fibroepithelial (stromal) tumor and it is the most common STROMAL tumor
ALWAYS benign
Most common BENIGN (stromal and epithelial) tumor of the breast
Well demarcated and movable mass

25
Q

What is the clinco-pathologic correlation of fibroadenoma?

A

In the old days FA was excised simply to confirm the tumor was not cancer
Today, a core needle biopsy diagnosis of fibroadenoma usually eliminates the need for excisional biopsy

26
Q

What is significant about phyllodes tumor?

A

A stromal tumor
Can be metastatic (6%)
Differs from FA because it invades surrounding breast tissue, high stromal density, many more mitotic figures
Metastasizes into a sarcoma so you will not see it in a lymph node

27
Q

What is significant about ductal papilloma (aka Large Duct Papilloma, aka intraductal or solitary papilloma?

A

The most common benign EPITHELIAL tumor
Arises from lactiferous ducts
Causes nipple discharge to be bloody

28
Q

What are the two most common pathogens that cause breast infections? (11th LO)

A
  1. Staphylococcus aureuss

2. streptococci

29
Q

What is a common type of NON-infectious inflammation that presents as a mass in the breast? (12th LO)

A

Fat necrosis from trauma
Can produce a hard mass similar to canceer
Caused cellularly by phagocytic histiocytes
Can eventually lead to a hard mass

30
Q

What is the difference between signs and symptoms?

A

Symptoms are felt and experienced by patient

Signs can be observed or perceived by others

31
Q

What is the most common benign breast disease in MEN and what is the hormonal state that causes it? (13th LO)

A

Gynecomastia
Decreased androgen:estrogen balance
Hyperestirinism (relative increase in estrogen) can be caused by cirrhosis, testicular failure, exogenous estrogen, etc.

32
Q

Is gynecomastia considered a precursor to Klinefelter associated breast cancer?

A

No

33
Q

What are the key features of breast carcinoma in men?

A
  1. Uncommon (1%)
  2. Klinefelter Syndrome (XXY)
  3. Ductal carcinoma only
  4. Staging, treatment and outcome
34
Q

WHAT IS THE MOST COMMON BENIGN TUMOR OF THE FEMALE BREAST?

A

Fibroadenoma

35
Q

WHICH IS A COMPONENT OF BREAST CANCER STAGE?

A

PRESENCE OR ABSENCE OF LYMPH NODE METASTASIS (PART OF TNM)

36
Q
  1. WHICH IS A PREDICTIVE FACTOR IN BREAST CANCER ANALYSIS?
A

ESTROGEN RECEPTOR CONTENT

37
Q

Which of the following microscopic changes is a proliferative fibrocystic change?

A

Usual ductal hyperplasia

Reproduction Week 3 (8 decks)

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