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Breast Board > Malignant Breast Pathology > Flashcards

Malignant Breast Pathology Flashcards

1
Q

For women living to be age 85, the odds of developing breast cancer is estimated to be what?

A

1 in 8 women, 13% in postmenopausal women

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2
Q

Only __% of breast lumps are cancerous; __% are benign.

A

20%, 80%

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3
Q

More than ___% of breast cancers occur in women older than 50 years of age.

A

80%

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4
Q

Types of invasive carcinomas?

A 
Invasive ductal carcinoma
invasive lobular
special-types:
-tubular
-medullary
-colloid
-papillary
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5
Q

Types of non-invasive carcinomas?

A

Ductal carcinoma in situ (DCIS)= intraductal carcinoma

Lobular carcinoma in situ (LCIS)= lobular neoplasia

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6
Q

What percent of non-invasive cancers is DCIS?

A

85%

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7
Q

What is 60-70% of all breast cancers; 80-85% of all breast malignancies?

A

Invasive ductal carcinoma

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8
Q

Most breast cancers arise where?

A

Upper outer quadrant

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9
Q

Ductal carcinomas tend to arise within the _____ of the terminal duct lobular unit?

A

Extralobular terminal duct (ELTD)

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10
Q

Malignant epithelial cells are confined to the duct and do not extend past the basement membrane in what cancer?

A

Non-invasive in situ carcinoma

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11
Q

Tumor cells grow past the basement membrane of the duct wall into the surrounding tissues. Such cancers can gain access to lymphatic channels and blood vessels lying near the duct.

A

Invasive (infiltrating) carcinoma

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12
Q

In non-invasive carcinoma, cancer cells have not gained access to the blood vessels or lymphatic channels which means what?

A

There is no risk for metastasis

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13
Q

Tumors of ductal epithelial origin (adenocarcinoma) are what?

A

DCIS, invasive ductal NOS, tubular, medullary, colloid, papillary, inflammatory, Pagets

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14
Q

NOS stand for what?

A

not otherwise specified

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15
Q

Tumors of lobular origin are what?

A

LCIS, invasive lobular

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16
Q

Tumors of stroll tissue are what?

A

Phyllodes tumor, sarcomas, lymphoma

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17
Q

Common metastasis to the breast are what?

A

Melanoma, lymphoma, lung, gastric

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18
Q

What is the earliest identifiable form of breast cancer?

A

DCIS

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19
Q

This is a well-differentiated form of DCIS and includes cribriform, micro papillary, and solid types?

A

Low nuclear grade (non-comedo type)

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20
Q

This is a poorly-differentiated, more aggressive form of DCIS?

A

High nuclear grade (comedy type)

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21
Q

Clinical features of DCIS?

A

Usually asymptomatic, occasionally a palpable mass, possible bloody nipple discharge

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22
Q

What is the earliest mammographic sign of breast cancer?

A

Microcalcs

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23
Q

Mammographic sensitivity for DCIS is ___% with calcifications being the most common diagnostic clue.

A

70-80%

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24
Q

Other forms of DCIS?

A

Intracystic papillary carcinoma and Paget’s disease of the nipple

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25
Q

Most papillary carcinomas are what?

A

non-invasive

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26
Q

Uncommon presentation of breast cancer that involves the epidermal layer of the nipple and is usually associated with underlying DCIS?

A

Paget’s disease

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27
Q

Clinical features of this include erythema, ulceration, and eczema-like crusting of the nipple as well as nipple discharge and itching?

A

Paget’s disease

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28
Q

Is not considered a true cancer and is referred to as lobular neoplasia?

A

Lobular carcinoma in situ (LCIS)

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29
Q

Typically not detected by mammo or sono because of the absence of microcalcs or formation of a discrete mass?

A

LCIS

typically an incidental finding microscopically from a breast biopsy preformed for other reasons

30
Q

The worst prognosis for all breast cancers?

A

IDC NOS

31
Q

Common secondary features with invasive cancers are reactive fibrosis that can cause thickening, straightening, and retraction of Coopers ligaments that lead to what?

A

Skin dimpling or nipple retraction

32
Q

Tumor extension through the retromammary fat and deep fascia will cause what?

A

Focal fixation of the breast to the muscle layer

33
Q

The second most common invasive breast malignancy is what?

A

Invasive lobular carcinoma (ILC)

34
Q

What cancer is frequently missed by physical examination and mammography?

A

ILC

35
Q

In what percent of cases will patients develop a second primary ILC in the same or opposite breast within 20 yrs?

A

30-50%

36
Q

Histologically, this cancer can be confused with sclerosing adenoids and radial scars.

A

Tubular carcinoma

37
Q

For tubular carcinoma, this tumor is typically small (<1cm) and slow growing. Excellent prognosis and very low incidence of axillary metastasis.

A

Pure tumor

38
Q

Highly cellular subtype of invasive ductal carcinoma that tends to develop earlier that most other breast cancers?

A

Medullary carcinoma

39
Q

Represents 11% of breast cancers in women under age 35 yrs?

A

Medullary carcinoma

40
Q

Characteristically is well circumscribed with an expansile growth pattern and can undergo central necrosis?

A

Medullary carcinoma

41
Q

Usually grows slowly, rarely undergoes central necrosis and is more likely to occur in older women. Has pure and mixed variants.

A

Colloid (mucinous) carcioma

42
Q

Typically a well-circumscribed, lobulated mass that is relatively soft and gelatinous. Low rate of metastases and a good prognosis.

A

Pure colloid tumor

43
Q

Mixed variants of this contain less mucin, are often larger, and more infiltrative than pure tumors?

A

Colloid (mucinous) carcinoma

44
Q

This carcinoma is rare and occurs most often in older women. Slow growth rate and better prognosis than IDC NOS.

A

papillary carcinoma

45
Q

Frond-like epithelial tumor within large duct; lacks myoepithelial cells; can arise within pre-existing papilloma.

A

Central lesion of papillary carcinoma

46
Q

Arises within TDLU from areas of florid duct hyperplasia/papillomatosis.

A

Peripheral lesion of papillary carcinoma

47
Q

What differentiates invasive lesions from in situ?

A

Stromal or vascular invasion

48
Q

Features of an intracystic papillary carcinoma?

A
  • Intracystic mural nodule with duct extension past cyst wall
  • Solid nodular component may show microlobulation or irregular shape
  • Complex cyst with thick isoechoic separations
  • Doppler flow within solid component
49
Q

Uncommon fibroepithelial mass that is usually benign but can undergo malignant transformation and potentially metastasize.

A

Phyllodes tumor

50
Q

This tumor is the most common breast sarcoma and recurrence is possible if excision is incomplete

A

Phyllodes tumor

51
Q

Considered to be the malignant counterpart of a fibroadenoma and develop more often between ages 45-50yrs old?

A

Phyllodes tumor

52
Q

The stromal component of a phyllodes tumor can undergo malignant transformation in ___% of cases?

A

25%

53
Q

For phyllodes tumor, hematogenous metastasis occur mainly to where and is rare to where?

A

Common: lung, pleura, bone, liver
Rare: lymph nodes

54
Q

What rarely presents as a primary breast cancer?

A

Lymphoma <0.5%

55
Q

The most common lymphoma affecting the breast is?

A

Non-Hodgkins lymphoma

56
Q

Refers to the presence of additional tumors within one breast quadrant or within the same ductal system as the primary tumor?

A

Multifocality carcinoma

57
Q

Refers to the presence of multiple tumors in different quadrants of the breast or tumors separated by a distance of >5cm?

A

Multicentricity carcinoma

58
Q

IDC NOS is multifocal in ___% of cases?

A

25-50%

59
Q

What is effective in the evaluation of multifocal, multicentric, and bilateral disease, as well as lymph node assessment in cancer patients?

A

Contrast-enhanced MRI

60
Q

Not a histologic subtype, but describes breast changes that occur when tumor cells from a highly aggressive cancer invade and block lymphatic channels of the skin?

A

Inflammatory (diffuse) carcinoma

61
Q

Rare and accounts for 1% of all breast cancers?

A

inflammatory carcinoma

62
Q

What are the components of the TNM classification system?

A

Tumor size (T)
Involvement of regional lymph nodes (N)
The presence or absence of distant metastasis (M)

63
Q

Cancer can spread from or to the breast by?

A

lymphatic channels, bloodstream, and direct extension

64
Q

When these nodes are positive, tumor cells have gained access to the bloodstream.

A

Level III subclavicular nodes

65
Q

Sonographically, internal mammary (parasternal) nodes are usually only seen when?

A

Enlarged by metastasis and when there is medially located cancer

66
Q

The most common sites of hematogenous metastasis to distant sites?

A

Bone (most common), lung, brain, and liver

67
Q

Metastasic disease to the breast is rare and can arise from:

A

A contralateral breast cancer (most common)
Extrammary primary
Hematological malignancies

68
Q

In males, ____ cancer is the most common primary to metastasize to the breast.

A

Prostate

69
Q

What can be difficult to distinguish from scar or fat necrosis?

A

Recurrent tumor

70
Q

Approach to determining tumor recurrence?

A
  • Serial mamma with clinical examination to monitor changes.
  • Adjunctive sonography, especially with dense breasts.
  • Supplemental contrast-enhanced MRI.
71
Q

Often tumor recurrence does not appear until when?

A

2 or more years following conservative therapy

72
Q

This cancer is strongly associated with LCIS and a positive family history of breast cancer.

A

Tubular carcinoma

Breast Board (9 decks)

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