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Block 1 WK 6 > Pathology of the Breast > Flashcards

Pathology of the Breast Flashcards

1
Q

A large number of pivotal events in cancer treatment occurred with what type of cancer?

A

breast cancer

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2
Q

Breast cancer arises where?

A

in the epithelial

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3
Q

Is it easier to see cancer in the breast in pre or post menopausal women?

A

post

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4
Q

What can often been mistaken for cancer in the breast?

A

Fat necrosis

  • localized
  • unlateral
  • due to trauma
  • presents as a mass which can mimic a tumor
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5
Q 
What does this describe:
Localized
Unilateral
Due to trauma
Presents as a mass which can mimic a tumor
A

fat necrosis

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6
Q

What does this describe:
Present in over 50% of female breasts
May be a palpable mass(40% of all breast masses)
Certain types increase risk of invasive cancer
Mammographic microcalcifications

A

fibrocystic change

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7
Q

The anatomy of the breast can be compared to a tree why?

A

because it has branches an leaves (large ducts and lactiferous sinuses)

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8
Q

Why kinds of lesions can occur on the Lobular Unit or Terminal Duct?

A

cyst, sclerosing adenosis, small duct papilloma, hyperplasia, atypical hyperplasia, carcinoma

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9
Q

What kinds of lesion occur in the lobular stroma?

A

fibroadenoma, phyllodes tumor

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10
Q

What kinds of lesions occur in the nipple and areola?

A

Duct ectasia, recurrent subareola abcess, solitary ductal papilloma, pagets disease

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11
Q

What lesion occur on the interlobular stroma?

A

fat necrosis, lipoma, fibrous tumor, PASH, fibromatosis, Sarcoma

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12
Q

(blank) breast lesions can mimic the appearance of malignant lesions both on imaging studies as well as on biopsy.

A

Benign

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13
Q

What is the malignant phenotype?

A 
○ Self-sufficiency in growth signals
		○ Insensitivity to growth-inhibitory signals
		○ Evasion of apoptosis
		○ Limitless replicative potential
		○ Sustained angiogenesis
		○ Ability to invade and metastasize
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14
Q

What are the 3 modes of metastasis?

A

§ Lymphatic spread-regional lymph nodes usually affected first
§ Hematogenous spread-spread through the blood usually to the lung, liver, brain, bone marrow and adrenals.
§ Transcoelomic spread (seeding of body cavities)- spread into the peritoneal, pleura, pericardial and subarachnoid spaces.

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15
Q

Ductal carcinoma in situ threatens what?

A

Not life, but the breast

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16
Q

(blank) are providing useful prognostic and predictive biomarkers of this disease .

A

Molecular classifications

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17
Q 
What does this describe:
Most common 
Increased fibrous stroma and dilated ducts
Apocrine metaplasia
“lumpy” to palpation
A

Nonproliferative Fibrocystic ChangesCysts, fibrosis, and adenosis

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18
Q 
What does this describe:
Epithelial hyperplasia
Sclerosing adenosis
Radial scar
The presence of cytologic atypia significantly increases relative risk of developing invasive carcinoma
A

Proliferative Fibrocystic Change

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19
Q

What does this describe:
Risk of invasive carcinoma related to complexity of hyperplasia and atypia
Characterized by multilayered duct cell proliferation
Solid or papillary

A

epithelial hyperplasia

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20
Q

What does this describe:
Proliferation of small ductules and fibrosis
Gross: can be very firm
Lobular arrangement maintained
Mild increase in risk of invasive carcinoma

A

sclerosing adenosis

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21
Q

What type of adenosis mimics the appearance of invasive cancer of the breast?

A

sclerosing adenosis/ radial sclerosing

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22
Q

Is there a risk of developing carcinoma from cysts, fibrosis, apocrine metaplasia, mild hyperplasia?

A

No

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23
Q

Is there a risk of developing carcinoma from sclerosing adenosis, moderate/severe hyperplasia?

A

Slight increase

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24
Q

Is there a risk of developing carcinoma from proliferative change with cellular atypia

A

Considerable increase

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25
Q

What does this describe:
Most common benign tumor in female breast
Most common before age 30 but can occur at any age
Well circumscribed, soft, moveable, usually spherical
Characteristic microscopic features
Does not increase risk of future carcinoma

A

fibroadenoma

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26
Q

What does this describe:
Grossly and microscopically similar to fibroadenomas but have a more cellular stroma
Average age is 45 years
Average size is 4-5 cm; range is 1-20 cm
Histologically classified as benign, low grade malignant (borderline), and high grade malignant

A

phyllodes tumor

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27
Q

What term describes this behavior:

low probability of local recurrence; does not metastasize

A

benign

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28
Q

What term describes this behavior:

higher chance of local recurrence; low probability of metastasis

A

low grade malignant

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29
Q

What term describes this behavior:

most likely to recur locally and metastasize

A

high grade malignant

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30
Q

Where do metastases typically go?

A

to bone and lungs; axillary node mets rare

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31
Q

What is the typical treatment for BC

A

Typically wide local excision with adequate margins

Mastectomy unusual

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32
Q

What does this describe:
Benign papillary neoplasm of subareolar location
Usually less than 1 cm
May have bloody discharge

A

intraductal papilloma

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33
Q

What are the epidemiology /risk factors?

A 
rare before 25
peak incidence at 75-80
white women highest rates of b.c
magnitude of risk is proportional- number of close relatives with bc and age of occurence
12% genetic component
34
Q

Does the risk of BC increase with early menarche and late menopause?

A

yes

35
Q

Is BC more frequent in nulliparous or multiparous?

A

nulliparous

36
Q

At what age do you have an increased risk of BC when you dont have a child until then.

A

30-35

37
Q

At what age is their increased risk of BC with postmenopausal obesity?

A

40

38
Q

Is the risk increased or decreased for BC with high dose of estrogens for menopausal symptoms?

A

increased risk

39
Q

Is it worrisome to have a fibrocystic change with hyperplasia and atypia?

A

YES!

40
Q

Do oral contraceptives increase BC risk?

A

no

41
Q

If you have dense breasts, is that a risk factor of BC?

A

yes

42
Q

Is a women more likely to get breast cancer in the US or Europe?

A

US

43
Q

Is there a strong correlations between diet and BC?

A

no

44
Q

Does drinking coffee increase your risk of BC?

A

no, it lowers it

45
Q

Is there a decreased risk for BC if you exercise?

A

probably a small protective effect

46
Q

T or F, the longer a women breastfeeds, the lower the risk of BC

A

True

47
Q

T or F, environmental toxins and tobacco have been linked to breast cancer.

A

False

48
Q

The recent trend is to refer to ductal carcinoma as

….

A

“Breast Carcinoma-No Special Type”.

49
Q

What are 3 noninvasive BC’s?

Are they benign?

A

Intraductal carcinoma
Intraductal carcinoma with Paget’s disease
Lobular carcinoma in situ-frequently multifocal and bilateral

No, malignant and monoclonal, just surrounded by basement membrane

50
Q

What does this describe:
65-80% of all mammary carcinomas that are invasive
Hard, firm nodule grossly

A

invasive ductal carcinoma

51
Q

What does this describe:
A ductal carcinoma (invasive or noninvasive) which arises in the main excretory ducts and extends intraepithelially to the nipple and areola
“Paget cell”
Areola skin inflamed, fissured, oozing

A

Invasive Ductal Carcinoma with Paget’s Disease

52
Q

What does this describe?
About 5% of invasive breast cancer
20% bilateral
Tend to be multicentric
small cells
infiltrate in rows of single cells or concentric rings around ducts
Loss of e-cadherin in both invasive and LCIS

A

Invasive Lobular Carcinoma

53
Q

What are the four special types of breast cancer?

A

medullary
colloid
tubular
inflammatory

54
Q

What does this describe:
1-5% of invasive breast cancer
Grossly fleshly
Microscopically composed of large, pleomorphic, vesicular syncytial cells with a lymphocytic infiltrate
Better prognosis than infiltrating ductal carcinoma

A

Medullary carcinoma

55
Q

What does this describe:
Occurs in pure or mixed form
Older women
Pure form has better prognosis than mixed or infiltrating ductal carcinoma

A

Colloid Carcinoma

56
Q

What does this describe:
Well differentiated
All tubules
Better prognosis

A

tubular carcinoma

57
Q

What are the clinical features of invasive carcinoma?

A 
fixed position
retraction of skin
peau d' orange
firm, hard nodule 
gritty texture if needle inserted
58
Q

Lymphatic spread to the outer quadrants is through what?

A

the axillary nodes

59
Q

Lymphatic spread to the inner quadrants is through what?

A

mammary nodes

60
Q

A vascular spread is also known as a (blank)

A

node-negative breast cancers

61
Q

What are the factors influencing prognosis?

A

size, margins, lymph node involvement, histologic type and grade, estrogen and progesterone receptors, Her-2/neu

62
Q

What are the four types of molecular markers?

A

prognostic
predictive
immunocytochemistry
molecular testing

63
Q

What are the 6 common prognostic and predictive biomarkers?

A 
Estrogen receptor
Progesterone receptor
P53
Ki-67
Her-2/neu
EGFR
64
Q

What are the five types-defined by gene expression profiling of breast cancer?

A

Luminal A, Luminal B, Basal, ERBB2+, censored

65
Q 
What type of gene expression profile does this describe:
40-50% of ductal (NST)
Largest group
ER positive
Grade 1 or 2
Occur  mostly in postmenopausal women
Slow growing 
Respond to hormonal Rx
A

Luminal A

66
Q

What type of gene expression profile does this describe:
ER positive
Less well differentiated than Luminal A
May be Her2/neu positive
More likely to metastasize than Luminal A

A

Luminal B

67
Q 
What type of gene expression profile does this describe:
6-10% of Ductal CA
ER positive
Her2/neu negative
Debate on whether it is a specific type
A

Normal Breast-like

68
Q

What type of gene expression profile does this describe:
13-25% of Ductal CA
A subset of the triple negative breast carcinomas
Express myoepithelial markers
Many BRCA-1 tumors are basal like
Tend to be high grade and aggresive

A

Basal-like

69
Q 
What type of gene expression profile does this describe:
Her2/neu positive
ER negative
Usually high grade
High frequency of brain metastases
A

Her2/neu postive

70
Q

How is the oncotype diagnosis test used?

A

to detect recurrence, check out your genes, determines benefit of chemo, scored continuously 1-100

71
Q

When can an oncotype diagnosis test be used

A

When pnt is early stage (I or II), ER+ and node negative or postmenopausal, hormone receptor + and node +

72
Q

What is HER2?

A

human epidermal growth factor receptor 2 ), which promotes the growth of cancer cells

73
Q

The 16 genes presented in this slide were selected for the Oncotype DX assay based on the three clinical trials, which demonstrated a consistent statistical link between these genes and distant breast cancer recurrence and the most robust predictive power across the three studies. 16 were picked for the assay out of how many breast cancer related genes?

A

250

74
Q

The oncotype DX assay is scored Scored continuously from 1-100. The higher the score, the more likely there will be a (blank).
31 or greater means what?
19-30 means what?
Less than 18 means what?

A

recurrence
Substantial benefit from chemotherapy
intermediate benefit from chemotherapy
minimal benefit from chemotherapy

75
Q

The oncotype DX assay showed that the overall survival rate between the low risk and high risk group showed what?

A

10 years there is a significant difference in OS between the low-risk group (90%, survive longer) and the high-risk group (68% survive less long).

76
Q

What does this describe:
Unilateral or bilateral breast enlargement
Results from imbalance of estrogens and androgens
Occurs at puberty, Klinefelter’s syndrome, testicular neoplasms, drug side effects, cirrhosis

A

gynecomastia

77
Q

How often does male carcinoma occur?

A

Rare (1/100 as common as female CA)

Behavior is same as female disease given a similar type, grade, and stage

78
Q

Certain benign lesions are completely innocuous; others, while not cancer, do what?

A

increase the risk of subsequent cancer.

79
Q

The basis of our classification of breast cancer is still largely (blank)

A

morphological.

80
Q

Invasive breast cancers spread either (blank)

A

lymphatically or hematogenously or via pleural cavity

81
Q

Molecular classifications are providing useful prognostic and predictive (blank) of this disease .

A

biomarkers

82
Q

(blank) for breast cancer has begun to decrease but we have a long way to go.

A

Age-adjusted mortality

Block 1 WK 6 (10 decks)

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