Malignant Breast Pathology Flashcards
Where do the majority of breast cancers occur? (hint: quadrants)
UOQ
What are the risk factors of breast CA?
- Increased age
- Female
- History of breast CA
- BRCA 1 and BRCA 2 genes
T or F? Breast CA is the leading cause of cancer in women?
FALSE: it’s the 2nd most common
What is non-invasive breast cancer termed?
Carcinoma in-situ
What are the two types of non-invasive carcinomas?
Lobular carcinoma in situ (LCIS)
Ductal carcinoma in situ (DCIS)
What is the most common non-invasive cancer?
DCIS - ductal carcinoma in situ
What is the difference between LCIS and DCIS?
LCIS is confined to the lobules or ducts within the lobules
DCIS is confined to within the DUCTS either in the lobules or surrounding lobules
Where are malignant cells located in DCIS?
Confined within the ducts and does not surround outside tissue
What is the earliest form of cancer that can be detected on ultrasound?
DCIS
SF of ductal carcinoma in situ (DCIS)?
- Microcalcifications
- Distension of ducts
- Hypoechoic mass
What is Paget disease?
Cancer of the epidermis of the nipple
What are patient symptoms of Paget disease?
- Nipple discharge
- Itching
- Eczema like crusting of nipple or redness
What does it mean when breast cancer is invasive?
It has spread to other tissues
What are two ways breast cancer can spread?
- Via blood
- Via lymphatics
What is the most common breast cancer?
Invasive ductal carcinoma (IDC)
Do invasive ductal carcinomas have a good prognosis?
NO
Which quadrant of the breast does IDC usually occur?
UOQ
SF of IDC?
- Hypoechoic
- Spiculated
- Irregular shaped
- Microcalcifications
- Shadowing
- Non-parallel
What is the second most invasive breast malignancy?
Invasive lobular carcinoma (ILC)
Why does ILC have higher rates of being multifocal, multicentric and bilateral than IDC?
Because it’s diffuse rather than focal
SF of invasive lobular carcinoma (ILC)?
- Hypoechoic
- Spiculated
- Irregular, ill-defined
- Shadowing
- NO calcifications
What are major differences in SF between IDC and ILC?
IDC - mass like and has calcifications and a symptom is bloody nipple discharge
ILC - diffuse and no calcifications and “shrinking” of the breast
What are the four types of special-type invasive ductal carcinomas?
- Papillary
- Medullary
- Tubular
- Colloid
Patient symptoms of Medullary carcinoma?
- Palpable
- Mobile
- Soft
- Grows rapidly
- UOQ
SF of medullary carcinoma?
- Hypoechoic
- Well-circumscribed
- Lobulations
- Round
- Vascularity
- Central necrosis
In what population is medullary carcinoma most common?
Before age 50
Colloid carcinoma is also known as?
Mucinous carcinoma
In what population is colloid carcinoma most common?
Elderly women
Is colloid carcinoma slow or fast growing?
SLOW growing
SF of colloid carcinoma?
- Iso-/hypoechoic
- Well-circumscribd
- Lobulated
- Homogenous or mildly heterogenous
What carcinoma has a higher incidence in men?
Papillary
In what population of women is papillary carcinoma most common?
Elderly women
What is the prominent patient symptom for papillary carcinoma?
Bloody nipple discharge
SF of papillary carcinoma?
- Overlap of benign and malignant characteristics
- Prominent vascularity or vascular stalk
Intra-cystic types of what cancer contain bloody fluid?
Papillary
Common size for tubular carcinoma?
<2cm - slow growing
Which carcinoma is also known as prominent reactive fibrosis?
Tubular carcinoma
What type of carcinoma occurs when highly invasive CA infiltrates the lymphatics of the skin?
Inflammatory carcinoma
What pathology shows signs of “orange peel appearance of the skin”?
Inflammatory carcinoma
What can inflammatory carcinoma mimic?
Mastitis
SF of inflammatory carcinoma?
- Edema/thickened skin
- Hypoechoic shadowing mass
- Spiculated
- Hypervascular SURROUNDING tissues
What are the 3 routes for METS of the breast?
- Blood
- Lymphatics
- Direct extension
Where is the first site of mets spread to with primary breast cancer?
Ipsi-lateral axillary lymph nodes - SLN
What lymph node is at most risk of metastases?
Sentinel node (SN)
What other organs are the most frequent for breast cancer to spread?
- Bone
- Liver
- Lung
- Brain
What is the most common metastases site FROM the breast?
Axillary lymph node - Sentinel Node
What is the most common and 2nd most common metastases site TO the breast?
- M/C = The contralateral breast
- 2nd M/C = melanoma
SF of suspicious lymph nodes?
- Node enlargement
- Loss of fatty hilum
- Rounded shape
- Hypoechoic or heterogenous
What is the normal size of a benign intra-mammary lymph node?
< or = 1cm
What is the most common male breast abnormality?
Gynecomastia
Cause of gynecomastia?
Abnormal estrogen to testosterone levels
Gynecomastia vs. pseudo-gynecomastia?
Gynecomastia = proliferation of ductal tissues
Pseudo-gynecomastia = Fatty deposits WITHOUT tissue proliferation
T or F? Pseudo-gynecomastia is a normal variant?
TRUE
SF of gynecomastia
- Hypoechoic
- Triangular area beneath areola
What is the most common primary breast cancer in men?
IDC
Where is primary breast cancer in men usually located?
Beneath the areloa
Male age of incidence of breast cancer?
Over 60 years
What is male breast cancer strongly associated with? (2)
- Klinefelter syndrome
- Genetics
Male patient symptoms of breast cancer?
- Bloody nipple discharge
- Nipple retraction or ulceration
- Hard and painless
- Palpable axillary nodes
SF of male breast cancer?
- Hypoechoic
- Complex
- Well-circumscribed
- Irregular, spiculated
- Vascular
Where do malignant breast masses most commonly originate from?
The ducts (TDLU)
What stage (0-3) is DCIS considered to be?
Stage 0
Paget disease is often initiated by underlying what?
DCIS within a main subareolar duct
