Pathology 2 Flashcards
whats the difference between a fibroadenoma and a malignant phyllodes tumour
the stromal cmpocant in phyllodes is neoplastic
when does an angiosarcoma occur
usually post radiotherapy for breast cancer
where do lymphomas occur
breast and or lymph nodes
what are some of the commonest tumours that metastasis to the breasts
carcinoma - bronchial, ovarial serous, clear cell of the kidney
malignant melanoma
soft tissue tumours such as leimyosarcoma of the myometrium
what does breast carcinoma mean
malignant tumour of the breast epithelial cells
where does breast carcinoma arise and what is it
glandular epithelium of the terminal duct lobular unit (TDLU)
it is an adenocarcinoma but called a breast carcinoma
ductal precursor lesions and the stages to cancer
epithelial hyperplasia of the usual type - benign process
columnar cell change - calcifies
atypical ductal hyperplasia - some pre malignant potential
ductal in situ carcinoma
lobular precursor
atypical lobular hyperplasia leading to lobular in situ carcinoma
in situ carcinoma is confined within what
cytology
does it always become invasive
classification
basement membrane or acini and ducts
cytologically malignant but non invasive
doesn’t always progress and become invasive but it can
lobular or ductal
two types of lobular in situ
atypical lobular hyperplasia <50% of lobule involved
lobular carcinoma in situ >50% of lobule involved
intra lobular proliferation of characteristic cells
small intermediate sized nuclei solid proliferation intra cytoplasmic lumens/vacules ER positive E catherine negative - CDH1 gene deleted/mutated
what does the CDH1 gene do
cell adhesion gene which is in the cell membrane and holds everything together
features of lobular in city neoplasia
frequently multifocal and bilateral incidence decreases after menopause not palpable but visibly gross may calcify incidental finding usually
management of lobular in situ neo[plasia
LN on core biopsy - proceed to excision or vacuum biopsy
LN on vacuum or excision biopsy - follow up
intraductal columnar change
slightly dilated
regular columnar cells
in picket fence arrangement
often calcifies
intraductal atypical ductal hyperplasia
partial ductal involvement has some features of DCIS
DCIS
filled with neoplastic cells and has calcification
features of DCIS
arises in TDLU characteristically unicentric (single duct system)
DCIS cytology
where
may involve what
malignant epithelial cells
confined within the BM of the duct
may involve tubules (cancerisation) and nipple skin (pagets)
what is pagets
high grade DCIS extending along ducts to reach the epidermis of the nipple
still in situ - non invasive
classification types of DCIS
cytological grade
histological grade
presence of necrosis (comedy) - nearly always in high grade DCIS
what is micro invasive carcinoma
rare
DCIS high grade with invasion of <1mm
treat as high grade DCIS
management of DCIS
diagnosis
surgery
radio
chemo
invasive carcinoma is what
malignant epithelial cells which have breached the BM
infiltration of normal tissue r
risk of mets and death
risk factors for breast carcinoma (invasive)
age young age of menarche few children ] not breastfeeding late menopause hormones - OCP, HRT previous breast disease geography diet, alcohol, smoking genetics
what do NSAIDS do to the risk for breast carcinoma
lower risk
BRCA1 BRCA2 TP53 PTEN STK11/LKB1 ATM
breast/ovarian breast/ovarian Li frarumeni syndrome cow dens peutz-jeghers ataxia telengectasia
invasion of breast carcinoma local
lymph
blood
loca - stroma of breast, skin, muscles of chest wall
lymph - regional training LNs
blood - bone, liver, brain, lungs, abd viscera, female genital tract
histopathology of breast carcinoma from commonest to not so
ductal lobular mucinous medullary tubular cribriform papillary mixed
well differentiated
poorly differentiated
very similar to the parent tissue - low grade - good prognosis
very different - high grade - poor prognosis
grading of breast carcinoma
tubular differentiation
nuclear pleomorphism
mitotic activity
tumour staging
direct invasion of adjacent tissues - t0-t4
lymphatic spread - N0-N3
blood borne M0-M1
predictive and prognostic factors for invasive carcinoma
ER (oestrogen receptor)
HER 2
what does ER do
ER expression predicts response to anti oestrogen therapy such as oophorectomy, tamoxifen, aromatase inhibitors, GnRH antagonists
HER 2
human epidermal growth factor receptor 2
HER2 over expression and amplification seen in approx 15% - predicts respond to trastuzameb
prognostic indices
nottington
adjuvant online
PREDICT
