Malignant Neoplasms Flashcards
2 main pathways of breast carcinoma by ER status
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
IBC NST with medullary pattern
Behavior
Molecular
Ihc
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
IBC NST with choriocarcinomatous pattern
Morpho
IHC
2 cell types like choriocarcinoma
(+) hPL and B-hCG
(-) ER, PR
Microinvasive carcinoma
Criteria
</= 1 mm in any area even if multifocal
Usually adjacent to DCIS
Invasive lobular carcinoma
3 cell types
5 patterns
Stains
Mutation
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
Mucinous carcinoma
3 histologic patterns
Hormone status
Ihc
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
Associated with + neuroendocrine markers
Solid papillary tumor
Mucinous carcinoma (esp pure mucinous carcinoma type B)
Metaplastic carcinoma
5 main patterns
Hormone status
Ihc
Mutations
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
Invasive apocrine carcinoma
2 cell types
Hormone status
Stains
Type A- with abundant granular eosinophilic cytoplasm
Type B- abundant, finely vacuolated cytoplasm (like histiocyte)
Triple negative
PAS +
+ CK, AR, GCDFP15
- GATA3
Tall cell carcinoma with reverse polarity
Ihc
Hormone status
Molecular
+ HMWCK and LMWCK, calretinin
Triple negative
IDH R172 hotspot mutation (MC)
Acinic cell carcinoma
Hormone status
Ihc
Triple negative
+ ck7, e cadherin, ema
- GCDFP15
Adenoid cystic carcinoma
Hormone status
Ihc
Molecular
Triple negative
+ CD117, LMWCK, EMA, CEA in luminal
MYB-NFIB fusion
Secretory carcinoma
Hormone status
Ihc
Mutation
Triple negative
(+) GATA3, S100, CK, CD117, p63
- SOX10
ETV6-NTRK
Mucoepidermoid carcinoma
Hormone status
Ihc
Molecular
Triple negative
+ HMWCK, p63, EMA, CEA
CRTC1- MAML2
Polymorphous adenocarcinoma
Morpho
Ihc
Hormone status
Monotonous in a variety of patterns: large nests, tubules, trabeculae, cribriform, alveolar, single file
+ BCL2 (strong), weak CK7, CK5/6, focal GFAP
Triple negative
Li-Fraumeni syndrome 1 vs 2
LFS1: TP53- associated, greater risk for breast cancer
LFS2: CHECK2-associated, less risk for breast cancer
Other syndromes assoc with breast cancer risk
Peutz-jeghers
CDH1-associated diffuse gastric and lobular breast cancer syndrome
Ataxia-telangiectasia - ATM gene
Cowden syndrome (multiple hamartoma syndrome) - PTEN
Size of tumor that is clinically palpable?
Mammographically detectable?
2-3 cm
1 cm
TNBC molecular
Germline- BRCA1 mutation
Sporadic - silenced BRCA1 thru epigenetic mechanisms or TP53 mutations
Usual hormone status of tumors that are palpable and have paget disease.
HER2 +
ER -
Does LCIS cause PDB?
No. Pagetoid spread is seen in the ducts but involvement of skin does not oxcur
Most important prognostic factor
LN metastases
Fibroadenoma and phyloddes tumor arise from which stroma
Intralobular stroma!
(Interlobular stromal tumors give rise to same ST tumors elsewhere such as lipomas and angisarcomas and consist of only stromal cells)
Mutation in FA and PT
MED12
