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Reproductive > PATH: Breast > Flashcards

PATH: Breast Flashcards

1
Q

What are the common symptoms of breast cancer?

A

Lumpiness
Pain
Palpable mass
nipple discharge

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2
Q

What percentage of patients with breast cancer present with the “common” symptoms?

A

less than 10%

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3
Q

What is the most common presentation of a woman with breast cancer?

A

abnormal mammogram!

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4
Q

Can you diagnose a patient off of a mammogram finding?

A

NO! need to do biopsy to diagnose as cancer

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5
Q

What cell layer is characteristically missing from breast tumors?

A

the myoepithelium

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6
Q

What makes breast cancer tumors “rock hard”?

A

desmoplastic reaction (lots of intervening stroma)

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7
Q

What is the progression of normal breast tissue to invasive carcinoma?

A

normal–> hyperplasia –> atypical hyperplasia –> carcinoma in situ –> invasive carcinoma

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8
Q

What does breast hyperplasia look like?

A

semi-controlled proliferation of polymorphic cells with irregular spaces between (looks kind of like a glomerulus)

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9
Q

What does atypical hyperplasia look like when a less controlled monomorphic sub-population takes over?

A

produces more uniform “cookie-cutter” spaces

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10
Q

What is this cookie-cutter pattern in atypical hyperplasia called?

A

cribiform pattern

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11
Q

What does atypical hyperplasia caused by a more aggressive subpopulation look like?

A

solid pattern of cell proliferation

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12
Q

Is carcinoma in situ cancer?

A

YES (malignant transformation with cells capable of invasion and metastasis)

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13
Q

List the features MORE COMMONLY SEEN in carcinoma in situ in the breast.

A 
Necrosis
Periductal inflammation
Periductal fibrosis
Uniform hyperchromatic (darker) nuclei
Calcification
Mucin production
Loss of myoepithelial cell layer
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14
Q

What is a very common pattern of DCIS? Why is it called this?

A

comedonecrosis pattern (necrosis in the middle of ducts looks like the comedones of acne vulagris)

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15
Q

What is a more benign feature, cribiform or slit-like spaces?

A

slit-like spaces (DCIS from atypical hyperplasia will typically retain the cribiform pattern to some extent)

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16
Q

True or false: patients with DCIS have lumpectomy and chemotherapy as major treatment.

A

FALSE: lumpectomy and radiation commonly done (no chemotherapy for DCIS patients); mastectomy is releatively curative but offers no survival advantage over lumpectomy and radiation

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17
Q

What are some features of usual ductal hyperplasia?

A

heterogenous cell size, shape and orientation with poor porders (often have irregular, slit-like and PERIPHERAL lumens with stretched/twisted bridges)

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18
Q

What is the difference is subsequent breast cancer risk for usual ductal versus atypical ductal hyperplasia?

A

usual ductal hyperplasia doubles risk

Atypical ductal hyperplasia increases risk 5 fold

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19
Q

What are some features of atypical ductal hyperplasia?

A

small, uniform, evenly spaced cells with rounded nculei and well defined borders (will typically have regular lumens with “rigid bridges)

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20
Q

Where is p63 found in the breast?

A

prominent in myoepithelial cells

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21
Q

If you see a lack of p63 staining, what should you think of?

A

probably invasive!

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22
Q

What “score” is used to differentiate if a breast cancer is high grade or low grade?

A

Nottingham Score

  • Tubule formaiton
  • Nuclear pleomorphism
  • Number of mitoses
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23
Q

What type of mutation does a person with hereditary cancer syndromes have?

A

germline (ex. BRCA)

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24
Q

What is it called to have a germline mutation in p53?

A

Li-Fraumeni syndrome (early cancer in many organs)

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25
Q

What is it called to have a germline mutation in PTEN?

A

Cowden Syndrome (multi-organ cancers)

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26
Q

Where do the cells that cause BRCA-induced ovarian cancer come from?

A

fallopian tube

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27
Q

If a woman with BRCA mutations wants to preserve her fertility, what is recommended for her?

A

2X yearly screening for ovarian cancer with transvaginal ultrasound and serum CA-125

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28
Q

How common is “triple-negative” breast cancer?

A

15% of breast cancers

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29
Q

Who gets “triple-negative” breast cancer?

A

black women (2X more likely) and usually older, obese, and in patients who had more children at a younger age

30
Q

How common are “triple-negative” breast cancers among women with BRCA1 mutations?

A

common, 70%

31
Q

What are some characteristics of “triple-negative” breast cancer?

A

mostly basal-like morphology; look like basal cells; usually CK 5/6+

32
Q

Where is an uncommon place for “triple-negative” breast cancer to invade?

A

bone (more commonly brain, lung, liver and distant LNs)

33
Q

On what chromosome is HER2?

A

17

34
Q

HOw do you test for HER2-positivity?

A

FISH for HER2a dn centromere of chromosome 17

35
Q

True or false: the incidence of DCIS has rapidly declined since mammography screening become popular int he US.

A

FALSE: it has increased!

36
Q

What mutations are common in ER+ Her2- breast cancers (luminal)?

A

Germline BRCA2 mutations (1q gain and 16q loss), PIK3CA mutations
(leads to atypical ductal lyperplasia before DCIS)

37
Q

What mutations are common in Her2 positive cancers?

A

Germline TP53 mutations
HER2 amplification
(leads to atypical apocrine adenosis before DCIS)

38
Q

What mutations are common in ER-, HER3- breast cancers (basal-like)?

A

Germline BRCA1 mutaitons
TP53 mutation
BRCA1 inactivation

39
Q

What is stage 1 breast cancer?

A

invasive carcinoma <2cm

No mets or only micromets

40
Q

What is stage 2 breast cancer?

A

invasive carcinoma >5cm invasive with 1-3 postive LNs

invasive carcinoma > 2cm but less than or equal to 5cm with 0-3 positive lymph nodes

41
Q

What is stage 3 breast cancer?

A

invasive carcinoma >5cm (Negative or positive LNs)
Any size invasive carcinoma (>/= 4 positive LNs)
invasive carcinoma with skin or chest wall involvement or inflammatory carcinoma (negative or positive LNs)

42
Q

What is stage 4 breast cancer?

A

any size invasive carcinoma with negative or positive LNs

43
Q

In what type of breast cancer is “indian filing” or infiltrating single file characteristic?

A

lobular breast cancer

44
Q

What is the most common type of breast cancer to present as an occult primary?

A

lobular breast cancer

45
Q

What is the histological hallmark of lobular breast cancer?

A

presence of discohesive infiltrating tumor cells (often including signet-ring cells containing intracytoplasmic droplets)

46
Q

Do you commonly see tubule formation with lobular breast cancer?

A

NO

47
Q

What are masses of lobular breast cancer like?

A

hard irregular masses (but can be diffuse pattern with minimal desmoplasia that is difficult to palpate or detect)

48
Q

What is a benign epithelial neoplasm growing within a dilated duct (composed or multiple branching fibrovascular cores)?

A

papilloma

49
Q

Where are large duct papillomas usually found?

A

lactiferous sinuses of nipple (usually solitary)

50
Q

Where are small duct papillomas usually found?

A

deeper in the ductal system (usually multiple)

51
Q

What is the characteristic symptom of a papilloma?

A

80% have nipple discharge (that can be bloody if stalk undergoes torsion)

52
Q

What is the word for a breast stromal neoplasm that is commonly multiple and bilateral in 20-40 year old women?

A

fibroadenomas

53
Q

What is the microscopic characteristic of fibroadenomas?

A

slit-like spaces that are compressed by normal looking stroma

54
Q

How do fibroadenomas differ between old women and younger girls?

A

in older women, the stroma becomes densely hyalinized and the epithelium becomes atropic

55
Q

Why do fibroadenomas get bigger durign pregnancy?

A

because the epithelial component is hormonally responsive

56
Q

Are fibroadenomas ALWAYS benign?

A

NO- very small chance of malignancy

57
Q

What is a breast stromal neoplasm?

A

Phyllodes tumor

58
Q

Who gets Phyllodes tumors?

A

rare, more likely in Latinas (50-60 yo)

59
Q

What causes a Phyllodes tumor to have a higher tumor grade and more aggressive behavior?

A

gains of chromosome 1q, increased chromosomal aberrations and overexpression of HOXb13

60
Q

When viewed in 2D, what does a phyllodes tumor look like?

A

leaves

61
Q

Do Phyllodes tumor usually metastasize?

A

no they metastasize rarely, but the do invade locally

62
Q

What distinguishes a Phyllodes tumor from a fibroadenoma?

A

higher cellularity, higher mitotic rate, nuclear pleomorphism, stromal overgrowth and infiltrative borders

63
Q

What is the “only” sarcoma that occurs in the breast?

A

angiosarcoma (SUPER UNCOMMON)

64
Q

Who gets angiosarcomas?

A

women who had radiation to breast skin 5-10 years prior

65
Q

What is sclerosing adenosis?

A

something that looks like adenocarcinoma but is not

66
Q

What are some characteristics of sclerosing adenosis?

A

increased acini number compressed/distorted in certral portion of the lesion (arranged in swirling pattern and the outer border is well-circumscribed)
Stromal fibrosis that compresses lumens to create appearance of solid cords or double strands of cells

67
Q

What is fibrocystic changes of the breats?

A

benign, non-proliferative cysts with assoicated fibrosis (that makes breasts lumpy and bumpy on palpation)

68
Q

What do unopened cysts of fibrocystic change contain?

A

semi-translucent fluid of a brown or blue color

called “blue-dome cysts”

69
Q

Are fibrocystic changes associated with an increased risk of breast cancer?

A

NO

70
Q

What are the most common causes of fat necrosis?

A

breast trauma or prior surgery

71
Q

What is the pathogenesis of fat necrosis?

A

Hemorrhagic –> central areas of liqueactive necrosis with neutrophils and macrophages–> proliferating fibroblasts and chronic inflammatory cells surround area–> giant cells, calcificaiton and hemosiderin–> scar tissue or fibrous tissue walls off lesion

Reproductive (21 decks)

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