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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
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
fibroadenoma
26
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
phyllodes tumor
27
What term describes this behavior: | low probability of local recurrence; does not metastasize
benign
28
What term describes this behavior: | higher chance of local recurrence; low probability of metastasis
low grade malignant
29
What term describes this behavior: | most likely to recur locally and metastasize
high grade malignant
30
Where do metastases typically go?
to bone and lungs; axillary node mets rare
31
What is the typical treatment for BC
Typically wide local excision with adequate margins | Mastectomy unusual
32
What does this describe: Benign papillary neoplasm of subareolar location Usually less than 1 cm May have bloody discharge
intraductal papilloma
33
What are the epidemiology /risk factors?
``` 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
Does the risk of BC increase with early menarche and late menopause?
yes
35
Is BC more frequent in nulliparous or multiparous?
nulliparous
36
At what age do you have an increased risk of BC when you dont have a child until then.
30-35
37
At what age is their increased risk of BC with postmenopausal obesity?
40
38
Is the risk increased or decreased for BC with high dose of estrogens for menopausal symptoms?
increased risk
39
Is it worrisome to have a fibrocystic change with hyperplasia and atypia?
YES!
40
Do oral contraceptives increase BC risk?
no
41
If you have dense breasts, is that a risk factor of BC?
yes
42
Is a women more likely to get breast cancer in the US or Europe?
US
43
Is there a strong correlations between diet and BC?
no
44
Does drinking coffee increase your risk of BC?
no, it lowers it
45
Is there a decreased risk for BC if you exercise?
probably a small protective effect
46
T or F, the longer a women breastfeeds, the lower the risk of BC
True
47
T or F, environmental toxins and tobacco have been linked to breast cancer.
False
48
The recent trend is to refer to ductal carcinoma as | ....
“Breast Carcinoma-No Special Type”.
49
What are 3 noninvasive BC's? Are they benign?
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
What does this describe: 65-80% of all mammary carcinomas that are invasive Hard, firm nodule grossly
invasive ductal carcinoma
51
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
Invasive Ductal Carcinoma with Paget's Disease
52
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
Invasive Lobular Carcinoma
53
What are the four special types of breast cancer?
medullary colloid tubular inflammatory
54
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
Medullary carcinoma
55
What does this describe: Occurs in pure or mixed form Older women Pure form has better prognosis than mixed or infiltrating ductal carcinoma
Colloid Carcinoma
56
What does this describe: Well differentiated All tubules Better prognosis
tubular carcinoma
57
What are the clinical features of invasive carcinoma?
``` fixed position retraction of skin peau d' orange firm, hard nodule gritty texture if needle inserted ```
58
Lymphatic spread to the outer quadrants is through what?
the axillary nodes
59
Lymphatic spread to the inner quadrants is through what?
mammary nodes
60
A vascular spread is also known as a (blank)
node-negative breast cancers
61
What are the factors influencing prognosis?
size, margins, lymph node involvement, histologic type and grade, estrogen and progesterone receptors, Her-2/neu
62
What are the four types of molecular markers?
prognostic predictive immunocytochemistry molecular testing
63
What are the 6 common prognostic and predictive biomarkers?
``` Estrogen receptor Progesterone receptor P53 Ki-67 Her-2/neu EGFR ```
64
What are the five types-defined by gene expression profiling of breast cancer?
Luminal A, Luminal B, Basal, ERBB2+, censored
65
``` 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 ```
Luminal A
66
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
Luminal B
67
``` 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 ```
Normal Breast-like
68
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
Basal-like
69
``` What type of gene expression profile does this describe: Her2/neu positive ER negative Usually high grade High frequency of brain metastases ```
Her2/neu postive
70
How is the oncotype diagnosis test used?
to detect recurrence, check out your genes, determines benefit of chemo, scored continuously 1-100
71
When can an oncotype diagnosis test be used
When pnt is early stage (I or II), ER+ and node negative or postmenopausal, hormone receptor + and node +
72
What is HER2?
human epidermal growth factor receptor 2 ), which promotes the growth of cancer cells
73
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?
250
74
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?
recurrence Substantial benefit from chemotherapy intermediate benefit from chemotherapy minimal benefit from chemotherapy
75
The oncotype DX assay showed that the overall survival rate between the low risk and high risk group showed what?
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
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
gynecomastia
77
How often does male carcinoma occur?
Rare (1/100 as common as female CA) | Behavior is same as female disease given a similar type, grade, and stage
78
Certain benign lesions are completely innocuous; others, while not cancer, do what?
increase the risk of subsequent cancer.
79
The basis of our classification of breast cancer is still largely (blank)
morphological.
80
Invasive breast cancers spread either (blank)
lymphatically or hematogenously or via pleural cavity
81
Molecular classifications are providing useful prognostic and predictive (blank) of this disease .
biomarkers
82
(blank) for breast cancer has begun to decrease but we have a long way to go.
Age-adjusted mortality

Block 1 WK 6 (10 decks)

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