MALIGNANT NEOPLASMS I

Question 1

carcinoma in-situ? 2 types

Answer 1

• Ductal carcinoma in-situ (DCIS)

* Lobular carcinoma in-situ (LCIS)

Question 2

invasive carcinoma? 3 types

Answer 2

• Ductal carcinoma (79%)
• Lobular carcinoma (10%)
• Special types (medullary, colloid, tubular,
metaplastic, etc.) (11%)

Question 3

more common in which breast? left or right?

upper outer quadrant?
remaining quadrants?
central/subareolar area?

Answer 3

left (110:100)

50%
10%
20%

Question 4

***major risk factors?

Answer 4

age
genetic predisposition
hormones
proliferative breast disease
CA of contralateral breast or endometrium
environmental influences 
radiation exposure at young age

Question 5

estrogen excess?

Answer 5

increased duration of reproductive life

nulliparity

first child after 30 y/o

postmenopausal obesity

Question 6

major genetic risk factor?

Answer 6

BRCA-1

BRCA-2

Question 7

• 17q21
• Tumor supressor gene, 2% of all breast cancers
• Poorly differentiated w/ medullary features
• Often triple negative
• Other cancers: ovarian, male breast, prostate, pancreas, fallopian tube

Answer 7

BRCA-1

Question 8

• 13q12-13
• Tumor suppressor gene, 1% of all breast cancers
• Poorly differentiated
• Tend to be ER-positive
• Other cancers: ovarian, male breast, prostate, pancreas, stomach, melanoma, gallbladder, bile duct, pharynx

Answer 8

BRCA-2

Question 9

• Most commonly detected as mammographic calcifications
• Non-invasive: malignant cells confined by basement membrane of duct or lobule
• Can spread throughout duct system
• Often multifocal (ipsilateral and contralateral)
• No metastatic potential
• 8-10x risk of invasive cancer

Answer 9

In-situ Carcinoma

Question 10

• 20-25% of breast CA
• Increasing incidence due to mammography
• Malignant cells limited to ducts and lobules by basement membrane
• Histologic subtypes: solid, cribriform, comedo, micropapillary, papillary
• Microinvasion- invasion into stroma <1 mm

Answer 10

Ductal Carcinoma In-situ

Question 11

• Proliferation of small, uniform, loosely cohesive cells which fill & distend at least 50% of acini in a single lobule
• Frequently incidental, multifocal and bilateral
• Invasive CA develops in 25-30% of women with
LCIS followed over 20 years (9x risk)
• Either breast at increased risk! • Loss of E-cadherin (cell adhesion protein)

Answer 11

Lobular Carcinoma In-situ

Question 12

• Most common type of breast CA
• Gross lesion:
  Yellow-white, firm, stellate  
  mass
• Cuts with a gritty sensation
(desmoplasia/calcs)
• Histology: 
  Infiltrating malignant cells     
  arranged in nests, cords, 
  tubules, and single cells
• Dense fibrous stroma

Answer 12

Invasive Ductal Carcinoma

Question 13

Grading system (Scarff-Bloom-Richardson) for invasive ductal carcinoma is based on?

differentiation scale

Answer 13

• Degree of tubular formation
• Nuclear grade ranging from Grade 1 - small, uniform
nuclei to Grade 3 - enlarged, pleomorphic nuclei
• Mitotic counts per 10 hpf

well differentiated
3-5, grade 1
mod differentiated
6-7, grade 2
poorly differentiated
8-9, grade 3

Question 14

• 5-10% of invasive breast CA
• Frequently bilateral and multicentric
• Gross lesion:
   Poorly circumscribed, firm  
   mass
• Histology:
   Small, uniform cells   
   infiltrating in strands, cords, 
   and as single cells within 
   fibrous stroma

Answer 14

Invasive Lobular Carcinoma