Malignant Pathology

Question 1

What type of tumour is a malignant Phyllodes tumour?

Answer 1

Sarcoma

Question 2

What is the commonest sarcoma of the breast? What is usually the cause for this?

Answer 2

Angiosarcoma, usually resulting from radiotherapy

Question 3

Apart from sarcoma and carcinoma, which other type of malignant tumour can affect the breasts and/or lymph nodes?

Answer 3

Lymphoma

Question 4

Which types of tumour are most likely to metastasise to the breast?

Answer 4

Bronchial, ovarian serous and kidney clear cell carcinomas, malignant melanomas and leiomyosarcomas (e.g. uterine)

Question 5

What is the definition of a breast carcinoma?

Answer 5

A malignant tumour of breast epithelial cells

Question 6

Where do all breast carcinomas arise?

Answer 6

In the glandular epithelium of the TDLU

Question 7

What specific type of carcinoma is seen in the breast?

Answer 7

Adenocarcinoma

Question 8

What are the 4 ductal precursor lesions?

Answer 8

Epithelial hyperplasia of usual type, columnar cell change, atypical ductal hyperplasia, DCIS

Question 9

What is the name used to describe lobular precursor lesions? What are its two subtypes?

Answer 9

Lobular in-situ neoplasia: atypical lobular hyperplasia and lobular carcinoma in situ

Question 10

In situ carcinoma in the breast is confined within where?

Answer 10

The basement membrane of acini and ducts

Question 11

Do in-situ carcinomas of the breast always become invasive?

Answer 11

No, not all

Question 12

How is lobar in-situ neoplasia usually found?

Answer 12

Usually an incidental finding in breast tissue removed for fibrocystic change

Question 13

What is the difference between atypical lobular hyperplasia and lobular carcinoma in situ?

Answer 13

ALH = < 50% of the lobule is involved, LCIS = > 50% of the lobule is involved

Question 14

What happens to the incidence of lobar in situ neoplasia after the menopause? Why is this?

Answer 14

Incidence decreases due to less oestrogen acting on the ER receptors

Question 15

Is lobar in-situ neoplasia palpable? Is it visible grossly?

Answer 15

No and no

Question 16

Lobar in-situ neoplasia is often picked up on mammography - what will it show?

Answer 16

Calcifications

Question 17

What is seen in 15-20% of open diagnostic biopsies for lobar in-situ neoplasia compared to core biopsy?

Answer 17

A higher grade lesion

Question 18

Having lobar in-situ neoplasia gives a how many times increased risk of subsequent invasive carcinoma?

Answer 18

8

Question 19

What is the management if lobar in-situ neoplasia is discovered on core biospy?

Answer 19

Proceed to excision or vacuum biopsy to exclude a higher grade lesion

Question 20

What is the management if lobar in-situ neoplasia is discovered on vacuum or excision biopsy?

Answer 20

Follow up - mammography more frequently than standard screening

Question 21

Intra-ductal proliferation can develop from which benign condition?

Answer 21

Fibrocystic change

Question 22

By how much do each of the following increase the risk of breast cancer? A) Epithelial hyperplasia of usual type B) Atypical ductal hyperplasia C) DCIS

Answer 22

A) 2x B) 4x C) 10x

Question 23

Atypical ductal hyperplasia goes on to become what?

Answer 23

DCIS

Question 24

DCIS goes on to become what?

Answer 24

Invasive ductal carcinoma

Question 25

DCIS is characteristically unicentric - what does this mean?

Answer 25

It only affects a single duct system

Question 26

How does DCIS usually present?

Answer 26

Often asymptomatic and picked up on screening as calcification

Question 27

What is DCIS involving the nipple known as?

Answer 27

Paget's disease of the nipple

Question 28

What is Paget's disease of the nipple?

Answer 28

High grade DCIS which extends along the ducts to reach the epidermis of the nipple

Question 29

Is Paget's disease of the nipple carcinoma in situ or invasive carcinoma?

Answer 29

Carcinoma in situ

Question 30

How does Paget's disease of the nipple usually present?

Answer 30

Dry, red skin around the nipple and nipple discharge

Question 31

How likely is it that DCIS will become invasive carcinoma?

Answer 31

75%

Question 32

How is DCIS managed?

Answer 32

Diagnosis, excision with clear margins and adjuvant radiotherapy

Question 33

What is microinvasive carcinoma?

Answer 33

Rare, high grade DCIS with invasion of < 1mm

Question 34

When is invasive breast carcinoma said to have occurred?

Answer 34

When malignant epithelial cells breach the basement membrane

Question 35

80% of breast carcinomas are positive for which hormone receptor?

Answer 35

ER receptor

Question 36

What is the relationship between ER+ breast cancers and survival? Why?

Answer 36

ER+ breast cancers have a better survival rate because they have better response to anti-oestrogen therapy

Question 37

67% of breast carcinomas are positive for which hormone receptor?

Answer 37

PgR

Question 38

What is the relationship between PgR+ breast cancers and survival?

Answer 38

PgR+ breast cancers have a better survival rate

Question 39

14% of breast carcinomas are positive for which receptor?

Answer 39

HER2

Question 40

What is the relationship between HER2+ breast cancers and survival?

Answer 40

HER2+ breast cancers have a worse survival rate

Question 41

HER2 overexpression and amplification predicts the response to which treatment?

Answer 41

Herceptin (traztusamab)

Question 42

In terms of hormone receptors, name the groups which convey the best - worst prognosis?

Answer 42

1) ER+, PgR+, HER2 - 2) ER+, PgR-, HER2- 3) HER2+ 4) Triple negative

Question 43

Why is triple negative breast cancer so bad?

Answer 43

It won't respond to any hormonal treatments and will require chemotherapy

Question 44

What is the most common type of invasive breast carcinoma?

Answer 44

Ductal (NST)

Question 45

What type makes up 10-15% of invasive breast carcinomas, with various subtypes existing?

Answer 45

Lobular carcinoma

Question 46

Which type of invasive breast carcinoma represents around 2% of cases and is often detected on mammography as a spiculate mass?

Answer 46

Tubular carcinoma

Question 47

Breast carcinomas can spread by direct infiltration to where?

Answer 47

Skin, skeletal muscle and chest wall

Question 48

Breast carcinomas can spread via lymphatics to where?

Answer 48

Axillary and mammary nodes

Question 49

Breast carcinomas can spread haematogenously, most commonly to where?

Answer 49

Bone, lungs and liver

Question 50

Malignant calcifications found on imaging will often be described as what?

Answer 50

Pleomorphic and casting