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Repro > Pathology 2 > Flashcards

Pathology 2 Flashcards

1
Q

whats the difference between a fibroadenoma and a malignant phyllodes tumour

A

the stromal cmpocant in phyllodes is neoplastic

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2
Q

when does an angiosarcoma occur

A

usually post radiotherapy for breast cancer

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3
Q

where do lymphomas occur

A

breast and or lymph nodes

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4
Q

what are some of the commonest tumours that metastasis to the breasts

A

carcinoma - bronchial, ovarial serous, clear cell of the kidney
malignant melanoma
soft tissue tumours such as leimyosarcoma of the myometrium

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5
Q

what does breast carcinoma mean

A

malignant tumour of the breast epithelial cells

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6
Q

where does breast carcinoma arise and what is it

A

glandular epithelium of the terminal duct lobular unit (TDLU)
it is an adenocarcinoma but called a breast carcinoma

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7
Q

ductal precursor lesions and the stages to cancer

A

epithelial hyperplasia of the usual type - benign process
columnar cell change - calcifies
atypical ductal hyperplasia - some pre malignant potential
ductal in situ carcinoma

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8
Q

lobular precursor

A

atypical lobular hyperplasia leading to lobular in situ carcinoma

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9
Q

in situ carcinoma is confined within what
cytology
does it always become invasive
classification

A

basement membrane or acini and ducts

cytologically malignant but non invasive

doesn’t always progress and become invasive but it can

lobular or ductal

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10
Q

two types of lobular in situ

A

atypical lobular hyperplasia <50% of lobule involved

lobular carcinoma in situ >50% of lobule involved

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11
Q

intra lobular proliferation of characteristic cells

A 
small intermediate sized nuclei
solid proliferation 
intra cytoplasmic lumens/vacules
ER positive
E catherine negative - CDH1 gene deleted/mutated
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12
Q

what does the CDH1 gene do

A

cell adhesion gene which is in the cell membrane and holds everything together

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13
Q

features of lobular in city neoplasia

A 
frequently multifocal and bilateral 
incidence decreases after menopause
not palpable but visibly gross
may calcify
incidental finding usually
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14
Q

management of lobular in situ neo[plasia

A

LN on core biopsy - proceed to excision or vacuum biopsy

LN on vacuum or excision biopsy - follow up

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15
Q

intraductal columnar change

A

slightly dilated
regular columnar cells
in picket fence arrangement
often calcifies

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16
Q

intraductal atypical ductal hyperplasia

A

partial ductal involvement has some features of DCIS

17
Q

DCIS

A

filled with neoplastic cells and has calcification

18
Q

features of DCIS

A 
arises in TDLU
characteristically unicentric (single duct system)
19
Q

DCIS cytology
where
may involve what

A

malignant epithelial cells
confined within the BM of the duct
may involve tubules (cancerisation) and nipple skin (pagets)

20
Q

what is pagets

A

high grade DCIS extending along ducts to reach the epidermis of the nipple
still in situ - non invasive

21
Q

classification types of DCIS

A

cytological grade
histological grade
presence of necrosis (comedy) - nearly always in high grade DCIS

22
Q

what is micro invasive carcinoma

A

rare
DCIS high grade with invasion of <1mm
treat as high grade DCIS

23
Q

management of DCIS

A

diagnosis
surgery
radio
chemo

24
Q

invasive carcinoma is what

A

malignant epithelial cells which have breached the BM
infiltration of normal tissue r
risk of mets and death

25
Q

risk factors for breast carcinoma (invasive)

A 
age 
young age of menarche 
few children ]
not breastfeeding 
late menopause 
hormones - OCP, HRT
previous breast disease
geography 
diet, alcohol, smoking
genetics
26
Q

what do NSAIDS do to the risk for breast carcinoma

A

lower risk

27
Q 
BRCA1
BRCA2
TP53
PTEN
STK11/LKB1
ATM
A 
breast/ovarian 
breast/ovarian
Li frarumeni syndrome
cow dens
peutz-jeghers
ataxia telengectasia
28
Q

invasion of breast carcinoma local
lymph
blood

A

loca - stroma of breast, skin, muscles of chest wall
lymph - regional training LNs
blood - bone, liver, brain, lungs, abd viscera, female genital tract

29
Q

histopathology of breast carcinoma from commonest to not so

A 
ductal 
lobular
mucinous
medullary 
tubular
cribriform 
papillary 
mixed
30
Q

well differentiated

poorly differentiated

A

very similar to the parent tissue - low grade - good prognosis

very different - high grade - poor prognosis

31
Q

grading of breast carcinoma

A

tubular differentiation
nuclear pleomorphism
mitotic activity

32
Q

tumour staging

A

direct invasion of adjacent tissues - t0-t4
lymphatic spread - N0-N3
blood borne M0-M1

33
Q

predictive and prognostic factors for invasive carcinoma

A

ER (oestrogen receptor)

HER 2

34
Q

what does ER do

A

ER expression predicts response to anti oestrogen therapy such as oophorectomy, tamoxifen, aromatase inhibitors, GnRH antagonists

35
Q

HER 2

A

human epidermal growth factor receptor 2

HER2 over expression and amplification seen in approx 15% - predicts respond to trastuzameb

36
Q

prognostic indices

A

nottington
adjuvant online
PREDICT

Repro (56 decks)

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