Lecture 33 - Diseases of Breast Flashcards
Which are more likely to be malignant, round or spiculated/irregular densities found on mammography?
Spiculated/irregular
BI-RADS scoring system for breast imaging is categorized 0-6.
0 –> basically inconclusive and needs further imaging or comparison to previous imaging
1 –> ______
2 –> _______
3 –> _______
4–> _______
5—> _______
6–> _______
1 –> no abnormal findings
2 –> Benign abnormal findings (non-cancerous calcifications/small round lesion)
3 –> potentially not benign, follow up in less than a year (usually 6 months)
4 –> Potentially malignant, biopsy likely recommended
5 –> Looks malignant, do the biopsy
6 –> Biopsy confirmed malignancy (imaging here is more to check progression and/or treatment efficacy)
Similar to colon cancer screening, patients with family hx of breast cancer should have an annual mammogram starting at an age _____years younger than when their family member was diagnosed or starting at age ______ (whichever is sooner).
Patients with known ______ mutations should have annual mammograms starting between ages 25-30.
10 years younger
40
BRCA
_______ is the antibiotic of choice for acute mastitis (most often caused by infection with ____ ____ following nipple trauma from breast feeding) because it is not harmful to the child –> this is important because one of the therapies for acute mastitis is to continue breast feeding.
Dicloxacillin
Stapg aureus
The biggest risk factor for Squamous Metaplasia of the lactiferous ducts is ______ (90% of patients) –> it is thought this causes a relative Vit___ deficiency that leads to the metaplasia. The squamous cells of the ducts produce _____, which can plug the ducts causing dilation, inflammation, and eventually rupture.
Smoking
Vit A
Keratin
A good indicator that abnormal breast tissue is not cancerous is the presence of a fair amount of _______ cells (they decrease in number as the lesion progresses to cancer).
Myoepithelial cells
2/3 of breast Fibroadenomas demonstrate mutations in ______ (gene).
MED 12
Benign Phyllodes tumors, like Fibroadenomas, typically demonstrate mutations in ______. Those that are malignant may also show mutations in _____.
MED 12
TERT
Of Fibroadenomas and Phyllodes tumors, which are common in women in their 3rd decade of life (20’s) and which are common in women in their 5th-6th decades of life (40’s-50’s)?
Fibroadenoma –> 3rd decade
Phyllodes –> 5th-6th decades
Black and Hispanic women have lesser risk of developing breast cancer overall, but if they do develop breast cancer before their 5th-6th decades of life, it is usually _____ negative OR ______ positive. It has a worse prognosis, but why?
Triple negative
HER2 positive
It has a worse prognosis bc many of the breast cancer therapies in use today rely on the receptors Triple negative breast cancer lacks (Estrogen, Progesterone, HER2). On the other hand, overexpression of HER2 (HER2 positive) causes out-of-control cell division, so these cancers will be more aggressive.
Increased breast density is a risk factor for breast cancer, but one of the reasons relates to imaging. How does breast density affect mammography?
Mammography is LESS effective in MORE dense breasts. MRI is recommended for these patients.
Patients with DCIS (Ductal Carcinoma in-situ) have an ____-_____ X greater risk of developing Invasive carcinoma.
8-10 X greater risk
What’s the difference histologically between Non-comedo DCIS and Comedo DCIS?
Comedo DCIS (think comedone –> black heads) have a central area of necrosis.
Paget’s disease of the nipple arises from DCIS that extend from the _____ ducts to the nipple. Because it mimics ______ (which type of cancer?), it’s important to test the malignant cells to determine if they are breast tissue cells.
Lactiferous ducts
Melanoma
Lobular Carcinoma in-situ (LCIS) is almost always found _______ (how?). The arrangement of cells in LCIS is discohesive because the cells lose expression of ____ ______, a cellular adhesion protein.
They almost always express ______ and _______ receptors. What does this typically mean for HER2 expression?
Incidentally
E Cadherin
Estrogen
Progesterone
This means HER2 overexpression is UNLIKELY (so these are typically less aggressive and have better prognosis)
Invasive ductal carcinoma is classified as Well differentiated, Moderately differentiated, and Poorly differentiated. What’s the difference?
The presence of prominent tubule formation decreases from Well to Poorly differentiated, and the tumor becomes more of a solid mass of cells with large nuclei.
Invasive Lobular Carcinoma, like Lobular Carcinoma in-situ (LCIS), shows loss of expression of _____ _______. These lesions tend to be poorly circumscribed and show a diffuse invasive pattern of cells in a “_____ _____” arrangement.
E Cadherin
“Single file”
Where has the cancer invaded when patients present with peau d’ orange appearance of the breast?
Into epidermal lymphatics, from which it can spread all over –> poor prognosis
BRCA1 is located on chromosome _____.
BRCA2 is located on chromosome _____.
Breast cancer in patients with mutations in which one, BRCA1 or BRCA2, tends to be Estrogen Receptor (ER) positive? –> remember this is good for treatment with something like Tamoxifen.
17q21
13q12.3
BRCA2
______% of double positive (ER+ and PR+) breast cancers respond to hormone therapy, while only _____% of Single positives respond.
_____ positive alone cancers are less likely to respond to CHEMO, whereas DOUBLE negative cancers are more likely to fail Hormone therapy but respond to CHEMO.
80%
40%
ER+ alone –> less responsive to chemo
Luminal Breast cancers are _____ positive / _____ negative and are the MOST common.
ER positive / HER2 negative
HER2 is an oncogene located on chromosome ______ (like BRCA1). Breast cancer with overexpression of HER2 is the most common subtype among patients with germline _____ (tumor suppressor gene lost in Li Fraumeni syndrome) mutations. _____ (aka trastuzimab) is a monoclonal AB used to treat HER2+ cancer, but not all HER2+ cancers are responsive.
17
p53
Herceptin
Mutations in ______ are highly associated with Triple Negative Breast Cancers (TNBC).
p53
Why do males ONLY develop Ductal carcinoma?
Keep in mind male breast cancer is usually associated with a ______ mutation, and they are typically _____ positive.
They don’t have lobules!
BRCA2
ER+
