Malignant Breast Pathology Flashcards

1
Q

What is the lifetime risk of breast carcinoma?

A

1 in 8

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2
Q

State at least 5 risk factors for breast carcinoma

A

Female gender, BRCA1 or BRCA2 mutations (up to 85% lifetime risk), hormone exposure (early menarche, late menopause, nulliparity, OCP, HRT), advancing age, FHx, Caucasian race, obesity, smoking, alcohol, radiation exposure

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3
Q

Define Paget’s disease of the nipple

A

Eczema of the nipple then areola, often associated with breast cancer

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4
Q

Between what ages are women offered 3-yearly mammography?

A

47-73

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5
Q

Define carcinoma in situ

A

Neoplastic epithelial proliferation limited to the ducts or lobules by basement membrane

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6
Q

How is lobular carcinoma in situ diagnosed?

A

Always an incidental finding on biopsy as cells lack microcalcifications or stromal reactions

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7
Q

What % of lobular carcinoma in situ is bilateral?

A

20-40%

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8
Q

Describe the histology of ductal carcinoma in situ

A

Ducts filled with atypical epithelial cells

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9
Q

How is ductal carcinoma in situ diagnosed?

A

Areas of microcalcification on mammography, confirmed by biopsy

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10
Q

Define invasive breast carcinoma

A

Malignant epithelial tumours which infiltrate within the breast and can metastasise to distant sites

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11
Q

State the four types of invasive breast carcinoma

A

Ductal, lobular, tubular, mucinous

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12
Q

Describe invasive ductal carcinoma

A

The most common invasive breast cancer, made of cells that cannot be classified into another group - large, pleiomorphic cells that move into the stroma

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13
Q

Describe the histology of invasive lobular carcinoma

A

Cells aligned in single file chains or strands

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14
Q

Describe invasive tubular carcinoma

A

Rarely palpable as <1cm in size. Well-formed tubules with low grade nuclei

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15
Q

What is the main feature of invasive mucinous carcinoma?

A

Cells produce abundant extracellular mucin which dissects into surrounding stroma

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16
Q

Name 3 receptors all invasive breast carcinomas are assessed for, and their prognostic indication

A

Oestrogen receptor (good), progesterone receptor (good), HER2 receptor (bad)

17
Q

What is tamoxifen?

A

Mixed agonist and antagonist of oestrogen at its receptor

18
Q

What is Herceptin (trastuzumab)?

A

Monoclonal immunoglobulin antibody to Her2

19
Q

What is the main side effect of Herceptin (trastuzumab)?

A

Direct toxic effect on myocardium

20
Q

Describe the histology of basal-like carcinoma

A

Sheets of markedly atypical cells with lymphocytic infiltrate that stain for CK5, CK6, and CK14

21
Q

Which BRCA gene mutation confers the greatest risk of male breast cancer?

A

BRCA2

22
Q

Why is the prognosis worse in male breast cancer?

A

Diagnosis usually made later (stage III or IV), lack of awareness may postpone seeking medical attention, lesions are less contained as they do not have to travel as far to infiltrate skin/ nipple/ muscle tissue