Pathology of Breast Flashcards
8 Major breast cancer risk factors
female, >50 yrs, geography, family hx, fibrocystic change, prior breast/gyn cancer, radiation, unopposed estrogen
2 main forms of breast carcinoma
insitu (CIS) and invasive
2 main forms of CIS
ductal and lobular
Key features of CIS
microscopic, CIS cells proliferate in position, lacks capacity to spread (contained by basement membrane), benign-acting
Which breast carcinoma acts like a benign carcinoma
DCIS
T/F DCIS is always curable if treated
T
____ is a non-obligate precursor of invasive breast carcinoma
DCIS
Screening for DCIS would reveal ____
cluster of calcifications –> product of calcified necrosis
Calcification of tissues due to local acid/base changes e.g. from necrosis
dystrophic
Malignant DCIS vs Normal DCIS
enlarged cells, high NC ratio, nucleoli, mitoses
Which is more common? DCIS v LCIS
DCIS = 80% vs LCIS = 20%
Key features of LCIS
microscopic, proliferate in position, BUT incidental finding –> no mass/calcification
T/F LCIS is screenable
F –> incidental finding
Malignant features of LCIS
lack of cohesion, signet ring cells
T/F LCIS is benign acting
T
T/F LCIS is easy to excise
F –> hard to identify a singular mass
Tx of LCIS
watch and weight + sometimes tamoxifen (Anti estrogen to prevent malignant transformation)
Clinical presentation of invasive breast cancer
Mass on mammogram
Key features of invasive breast cancer
no longer in situ, can spread past basement membrane, potentially lethal
Paget disease of nipple
clinical finding involving crusting and ulceration due to surface DCIS or migration of breast carcinoma to nipple epidermis (transformation of ductal to squamous epithelium) –> paget cells
Inflammatory breast carcinoma
reddened skin on breast, evolving rapidly, virulent form of breast cancer –> carcinoma in dermal lymphatics
Why does skin redden in inflammatory breast carcinoma
unknown –> but not due to actual inflammation
linear infiltration pattern
invasive lobular carcinoma –> no glands, etc; just a linear progression of cancer cells
Breast cancer stage classifying features
TNM = tumor stage, lymph node status, metastasis –> 0 - IV
3 predictive markers
these predict response to specific tx and consequently are suggestive of prognosis –> estrogen receptor, progesterone receptor, HER2/neu over expression amplification
HER2/neu predicts response to ___
herceptin
Predilection for breast cancer in men
klinefelter
What kind of cancer do men get in the breast?
ductal carcinoma only
Clinical manifestations of fibrocystic changes
cyclic pain, tenderness, palpable mass, abnormal mammogram, mass/calcifications
Progression of non-proliferative fibrocystic change
fibrosis –> cyst formation–> adenosis (increased acini/lobule) –> benign apocrine metaplasia
Increasing acini/terminal duct accompanied by fibrosis is called ____ which is a type of ____ fibrocystic change
sclerosis adenosis –> proliferative fibrocystic change
Usual duct hyperplasia is a type of ____ fibrocystic change
proliferative fibrocystic change
Atypical duct hyperplasia is a type of ____ fibrocystic change
borderline lesion –> proliferative fibrocystic change
Atypical lobular hyperplasia is a type of ____ fibrocystic change
borderline lesion –> proliferative fibrocystic change
T/F Mild usual ductal hyperplasia is associated with increased risk of breast cancer
F
T/F nonproliferative fibrocystic change is associated with mildly increased risk of breast cancer
F
T/F Moderate usual ductal hyperplasia is associated with mildly increased risk of breast cancer
T
T/F sclerosing adenosis is associated with reduced risk of breast cancer
F –> mildly increased
T/F Atypical ductal/lobular hyperplasia is associated with mildly increased risk of breast cancer
F —> moderately increased risk
T/F Atypical ductal/lobular hyperplasia with a family hx of breast cancer is associated with moderately increased risk of breast cancer
F –> highly increased risk
3 benign tumors of breast
2 fibroepithelial tumors = fibroadenoma and phyllodes tumor + 1 epithelial = intraductal papilloma
T/F fibroadenoma is always benign
T
T/F Phyllodes tumor is always benign
F –> almost always
Key features of fibroadenoma
most common benign breast tumor, reproductive years, solitary/multiple/bilateral, excision always curative
T/F fibroadenoma has no breast cancer risk
T
Key features of phyllodes tumor
not common, reproductive years, solitary
Histologic features of phyllodes tumor
invasive border, high cell density
Intraductal papilloma
large duct lesion can be associated with nipple discharge/bleeding
T/F intraductal papilloma has no breast cancer risk
T
2 common sources of breast inflammation
postpartum infection and traumatic fat necrosis
post partum infections of breast are often caused by ____ and ___ and result in ____ inflammation
s. aureus and strep –> acute suppurative inflammation
traumatic fat necrosis involves ____ inflammation
granulomatous
____ is caused by relative estrogen excess in men
gynecomastia –> not precancerous
T/F gynecomastia increases breast cancer risk in men
F
Male breasts have ___ but no ___
have ducts but no lobules
Histology of gynecomastia
myofibroblasts producing lots of collagen around ducts
