Malignant Breast Pathology Flashcards
For women living to be age 85, the odds of developing breast cancer is estimated to be what?
1 in 8 women, 13% in postmenopausal women
Only __% of breast lumps are cancerous; __% are benign.
20%, 80%
More than ___% of breast cancers occur in women older than 50 years of age.
80%
Types of invasive carcinomas?
Invasive ductal carcinoma invasive lobular special-types: -tubular -medullary -colloid -papillary
Types of non-invasive carcinomas?
Ductal carcinoma in situ (DCIS)= intraductal carcinoma
Lobular carcinoma in situ (LCIS)= lobular neoplasia
What percent of non-invasive cancers is DCIS?
85%
What is 60-70% of all breast cancers; 80-85% of all breast malignancies?
Invasive ductal carcinoma
Most breast cancers arise where?
Upper outer quadrant
Ductal carcinomas tend to arise within the _____ of the terminal duct lobular unit?
Extralobular terminal duct (ELTD)
Malignant epithelial cells are confined to the duct and do not extend past the basement membrane in what cancer?
Non-invasive in situ carcinoma
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.
Invasive (infiltrating) carcinoma
In non-invasive carcinoma, cancer cells have not gained access to the blood vessels or lymphatic channels which means what?
There is no risk for metastasis
Tumors of ductal epithelial origin (adenocarcinoma) are what?
DCIS, invasive ductal NOS, tubular, medullary, colloid, papillary, inflammatory, Pagets
NOS stand for what?
not otherwise specified
Tumors of lobular origin are what?
LCIS, invasive lobular
Tumors of stroll tissue are what?
Phyllodes tumor, sarcomas, lymphoma
Common metastasis to the breast are what?
Melanoma, lymphoma, lung, gastric
What is the earliest identifiable form of breast cancer?
DCIS
This is a well-differentiated form of DCIS and includes cribriform, micro papillary, and solid types?
Low nuclear grade (non-comedo type)
This is a poorly-differentiated, more aggressive form of DCIS?
High nuclear grade (comedy type)
Clinical features of DCIS?
Usually asymptomatic, occasionally a palpable mass, possible bloody nipple discharge
What is the earliest mammographic sign of breast cancer?
Microcalcs
Mammographic sensitivity for DCIS is ___% with calcifications being the most common diagnostic clue.
70-80%
Other forms of DCIS?
Intracystic papillary carcinoma and Paget’s disease of the nipple
Most papillary carcinomas are what?
non-invasive
Uncommon presentation of breast cancer that involves the epidermal layer of the nipple and is usually associated with underlying DCIS?
Paget’s disease
Clinical features of this include erythema, ulceration, and eczema-like crusting of the nipple as well as nipple discharge and itching?
Paget’s disease
Is not considered a true cancer and is referred to as lobular neoplasia?
Lobular carcinoma in situ (LCIS)
Typically not detected by mammo or sono because of the absence of microcalcs or formation of a discrete mass?
LCIS
typically an incidental finding microscopically from a breast biopsy preformed for other reasons
The worst prognosis for all breast cancers?
IDC NOS
Common secondary features with invasive cancers are reactive fibrosis that can cause thickening, straightening, and retraction of Coopers ligaments that lead to what?
Skin dimpling or nipple retraction
Tumor extension through the retromammary fat and deep fascia will cause what?
Focal fixation of the breast to the muscle layer
The second most common invasive breast malignancy is what?
Invasive lobular carcinoma (ILC)
What cancer is frequently missed by physical examination and mammography?
ILC
In what percent of cases will patients develop a second primary ILC in the same or opposite breast within 20 yrs?
30-50%
Histologically, this cancer can be confused with sclerosing adenoids and radial scars.
Tubular carcinoma
For tubular carcinoma, this tumor is typically small (<1cm) and slow growing. Excellent prognosis and very low incidence of axillary metastasis.
Pure tumor
Highly cellular subtype of invasive ductal carcinoma that tends to develop earlier that most other breast cancers?
Medullary carcinoma
Represents 11% of breast cancers in women under age 35 yrs?
Medullary carcinoma
Characteristically is well circumscribed with an expansile growth pattern and can undergo central necrosis?
Medullary carcinoma
Usually grows slowly, rarely undergoes central necrosis and is more likely to occur in older women. Has pure and mixed variants.
Colloid (mucinous) carcioma
Typically a well-circumscribed, lobulated mass that is relatively soft and gelatinous. Low rate of metastases and a good prognosis.
Pure colloid tumor
Mixed variants of this contain less mucin, are often larger, and more infiltrative than pure tumors?
Colloid (mucinous) carcinoma
This carcinoma is rare and occurs most often in older women. Slow growth rate and better prognosis than IDC NOS.
papillary carcinoma
Frond-like epithelial tumor within large duct; lacks myoepithelial cells; can arise within pre-existing papilloma.
Central lesion of papillary carcinoma
Arises within TDLU from areas of florid duct hyperplasia/papillomatosis.
Peripheral lesion of papillary carcinoma
What differentiates invasive lesions from in situ?
Stromal or vascular invasion
Features of an intracystic papillary carcinoma?
- 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
Uncommon fibroepithelial mass that is usually benign but can undergo malignant transformation and potentially metastasize.
Phyllodes tumor
This tumor is the most common breast sarcoma and recurrence is possible if excision is incomplete
Phyllodes tumor
Considered to be the malignant counterpart of a fibroadenoma and develop more often between ages 45-50yrs old?
Phyllodes tumor
The stromal component of a phyllodes tumor can undergo malignant transformation in ___% of cases?
25%
For phyllodes tumor, hematogenous metastasis occur mainly to where and is rare to where?
Common: lung, pleura, bone, liver
Rare: lymph nodes
What rarely presents as a primary breast cancer?
Lymphoma <0.5%
The most common lymphoma affecting the breast is?
Non-Hodgkins lymphoma
Refers to the presence of additional tumors within one breast quadrant or within the same ductal system as the primary tumor?
Multifocality carcinoma
Refers to the presence of multiple tumors in different quadrants of the breast or tumors separated by a distance of >5cm?
Multicentricity carcinoma
IDC NOS is multifocal in ___% of cases?
25-50%
What is effective in the evaluation of multifocal, multicentric, and bilateral disease, as well as lymph node assessment in cancer patients?
Contrast-enhanced MRI
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?
Inflammatory (diffuse) carcinoma
Rare and accounts for 1% of all breast cancers?
inflammatory carcinoma
What are the components of the TNM classification system?
Tumor size (T)
Involvement of regional lymph nodes (N)
The presence or absence of distant metastasis (M)
Cancer can spread from or to the breast by?
lymphatic channels, bloodstream, and direct extension
When these nodes are positive, tumor cells have gained access to the bloodstream.
Level III subclavicular nodes
Sonographically, internal mammary (parasternal) nodes are usually only seen when?
Enlarged by metastasis and when there is medially located cancer
The most common sites of hematogenous metastasis to distant sites?
Bone (most common), lung, brain, and liver
Metastasic disease to the breast is rare and can arise from:
A contralateral breast cancer (most common)
Extrammary primary
Hematological malignancies
In males, ____ cancer is the most common primary to metastasize to the breast.
Prostate
What can be difficult to distinguish from scar or fat necrosis?
Recurrent tumor
Approach to determining tumor recurrence?
- Serial mamma with clinical examination to monitor changes.
- Adjunctive sonography, especially with dense breasts.
- Supplemental contrast-enhanced MRI.
Often tumor recurrence does not appear until when?
2 or more years following conservative therapy
This cancer is strongly associated with LCIS and a positive family history of breast cancer.
Tubular carcinoma
