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Breast > Malignant Neoplasms > Flashcards

Malignant Neoplasms Flashcards

1
Q

2 main pathways of breast carcinoma by ER status

A

ER-positive: (+) ER, Her2 (-) diploid with chromosomal gains and losses and low to intermediate grade cancers
Precursors: FEA, ADH, LG DCIS

ER-negative: aneuploid with complex karyotypes, frequent tp53 mutations
Precursors: microglandular adenosis and HGDCIS

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2
Q

IBC NST with medullary pattern
Behavior
Molecular
Ihc

A

Majority are triple negative (basal-like)
Better outcome than other stage-matched HG cancers (might be due to TILS)
(+) CK5/6, EGFR, PD-L1
15% are BRCA1 mutation carriers

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3
Q

IBC NST with choriocarcinomatous pattern
Morpho
IHC

A

2 cell types like choriocarcinoma
(+) hPL and B-hCG
(-) ER, PR

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4
Q

Microinvasive carcinoma
Criteria

A

</= 1 mm in any area even if multifocal
Usually adjacent to DCIS

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5
Q

Invasive lobular carcinoma
3 cell types
5 patterns
Stains
Mutation

A

Classic, signet ring cell type, pleomorphic
Classic pattern (MC), alveolar, solid, tubulolobular, mucinous
(+) mucicarmine - intracytoplasmic mucin
(+) p120 (cytoplasmic), GATA3, ER, PR, AR, GCDFP15
(-) e cadherin, beta catenin
CDH1 and PIK3CA mutations

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6
Q

Mucinous carcinoma
3 histologic patterns
Hormone status
Ihc

A

Pure mucinous carcinoma- type A (paucicellular) and type B (more cellular, less mucin) - type B with more favorable
Prognosis and frequently has NEUROENDOCRINE differentiation

Mixed mucinous carcinoma- also has a second component that lacks the mucin (>10% of tumor)

Micropapillary mucinous carcinoma - worst prognosis

Most are ER/PR + and HER2 -
+ WT1, EMA, variable Neuroendocrine expression

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7
Q

Associated with + neuroendocrine markers

A

Solid papillary tumor
Mucinous carcinoma (esp pure mucinous carcinoma type B)

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8
Q

Metaplastic carcinoma
5 main patterns
Hormone status
Ihc
Mutations

A

Low grade adenosquamous
Fibromatosis-like
Spindle cell
Squamous cell
MC with heterologous malignant differentiation
Triple negative
(+) p63, HMWCK, SOX10
(-) CK7, CD34
Tp53, PIK3CA, TERT promoter, PTEN, etc

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9
Q

Invasive apocrine carcinoma
2 cell types
Hormone status
Stains

A

Type A- with abundant granular eosinophilic cytoplasm
Type B- abundant, finely vacuolated cytoplasm (like histiocyte)
Triple negative
PAS +
+ CK, AR, GCDFP15
- GATA3

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10
Q

Tall cell carcinoma with reverse polarity
Ihc
Hormone status
Molecular

A

+ HMWCK and LMWCK, calretinin
Triple negative
IDH R172 hotspot mutation (MC)

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11
Q

Acinic cell carcinoma
Hormone status
Ihc

A

Triple negative
+ ck7, e cadherin, ema
- GCDFP15

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12
Q

Adenoid cystic carcinoma
Hormone status
Ihc
Molecular

A

Triple negative
+ CD117, LMWCK, EMA, CEA in luminal
MYB-NFIB fusion

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13
Q

Secretory carcinoma
Hormone status
Ihc
Mutation

A

Triple negative
(+) GATA3, S100, CK, CD117, p63
- SOX10
ETV6-NTRK

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14
Q

Mucoepidermoid carcinoma
Hormone status
Ihc
Molecular

A

Triple negative
+ HMWCK, p63, EMA, CEA
CRTC1- MAML2

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15
Q

Polymorphous adenocarcinoma
Morpho
Ihc
Hormone status

A

Monotonous in a variety of patterns: large nests, tubules, trabeculae, cribriform, alveolar, single file
+ BCL2 (strong), weak CK7, CK5/6, focal GFAP
Triple negative

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16
Q

Li-Fraumeni syndrome 1 vs 2

A

LFS1: TP53- associated, greater risk for breast cancer
LFS2: CHECK2-associated, less risk for breast cancer

17
Q

Other syndromes assoc with breast cancer risk

A

Peutz-jeghers
CDH1-associated diffuse gastric and lobular breast cancer syndrome
Ataxia-telangiectasia - ATM gene
Cowden syndrome (multiple hamartoma syndrome) - PTEN

18
Q

Size of tumor that is clinically palpable?
Mammographically detectable?

A

2-3 cm
1 cm

19
Q

TNBC molecular

A

Germline- BRCA1 mutation
Sporadic - silenced BRCA1 thru epigenetic mechanisms or TP53 mutations

20
Q

Usual hormone status of tumors that are palpable and have paget disease.

A

HER2 +
ER -

21
Q

Does LCIS cause PDB?

A

No. Pagetoid spread is seen in the ducts but involvement of skin does not oxcur

22
Q

Most important prognostic factor

A

LN metastases

23
Q

Fibroadenoma and phyloddes tumor arise from which stroma

A

Intralobular stroma!

(Interlobular stromal tumors give rise to same ST tumors elsewhere such as lipomas and angisarcomas and consist of only stromal cells)

24
Q

Mutation in FA and PT

A

MED12

25
Q

In malignant phyllodes tumor, which component metastasizes?

A

Stromal component only

26
Q

PHYLLODES TUMOR VS METAPLASTIC CARCINOMA

A

PT: + CD34, Bcl2
MC: + HMWCK, p63

Breast (6 decks)

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