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Repro-Endo > Pathology of the Breast > Flashcards

Pathology of the Breast Flashcards

0
Q

2 major divisions of carcinoma by location?

A

Carcinoma in situ (CIS)

Invasive carcinoma

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1
Q

What are 8 major risk factors for sporadic breast cancer?

A 
Sex = female.
Age > 50.
Geography?
Family Hx of breast cancer.
Fibrocystic changes (some of them).
Prior breast or Gyn cancer.
Radiation (e.g. lymphoma Tx).
Unopposed estrogen.
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2
Q

2 forms of carcinoma in situ (CIS)? Which is more commonly diagnosed?

A 
Ductal CIS (DCIS) - more commonly diagnosed.
Lobular CIS (LCIS).
Note we're not really sure of LCIS incidence/prevalence because it's harder to diagnose.
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3
Q

Can DCIS progress to invasive carcinoma?

How curable is DCIS?

A

Yes, but not all of it does.

DCIS is “always” curable when treated.

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4
Q

How is DCIS usually picked up?

A

Focal cluster of calcifications on mammogram.

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5
Q

What’s the histology term for what DCIS-associated calcifications look like?

A

Calcified necrosis / dystrophic calcification.

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6
Q

Why is DCIS even called carcinoma if it’s not invasive?

A

Histologically, the cells have malignant-looking features: Large cells, high N:C ratio, open chromatin, nucleoli, increased mitoses.
(also the ducts can look ugly: cribriform, comedo-necrosis, etc.)

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7
Q

What do you do when you see DCIS? Why?

A

“Treat it.” - apparently this usually involves lumpectomy +/- radiation +/- tamoxifen (not in lecture).
We don’t currently know which DCIS will progress and which ones won’t.

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8
Q

How is LCIS usually picked up?

A

As an incidental finding on a biopsy done for other reasons.

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9
Q

What are the histological features of LCIS?

A

Lack of cohesion, and mucin-filled “signet-ring” cells.

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10
Q

What do you do when you find LCIS?

A

Usually watch and wait +/- anti-estrogen (such as tamoxifen).

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11
Q

What’s a common clinical presentation for invasive carcinoma on mammogram?

A

Stellate mass.

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12
Q

10 year survival for all invasive breast cancer?

A

45-50%

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13
Q

What are the 2 ways invasive breast cancer spreads to distant sites?

A

Hematogenously.

Through lymphatics.

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14
Q

What are 2 location-based categories of invasive carcinoma of the breast?

A

Ductal and lobular. They’re categorized for the associated CIS, which will always be there.

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15
Q

What is Paget Disease of the Nipple?

A

Crusting and ulceration of nipple (due to squamous metaplasia of duct cells there).
Indicative of invasive carcinoma or CIS.

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16
Q

What structures are being invaded in inflammatory breast carcinoma?

A

Dermal lymphatics.

It’s really virulent.

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17
Q

Histologic buzzwords for invasive lobular carcinoma?

A

Linear infiltration.

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18
Q

What are the 4 keys tasks of a pathologist with regard to breast cancer?

A

Diagnose
Stage
Identify predictive markers
Get molecular profile

19
Q

What’s the shorthand notation for breast cancer stage?

A 
TNM
T: Tumor size (Tis - T3)
N: Lymph nodes (N0 - N3)
M: Metastasis (M0, M1, Mx)
Stage: 0 - IV
20
Q

What are 3 markers always tested for in invasive breast cancer?

A 
Estrogen receptor (ER)
Progesterone receptor (PR)
HER2/neu overexpression
21
Q

How positive do tumors have to be for ER, PR, HER2/neu in order to merit specific treatment?

A

If they’re at all positive, specific treatment is indicate.

22
Q

What drug is used for HER2/neu positive cancers?

A

Herceptin

23
Q

What’s one molecular profiling assay that’s commonly used? What is its utility?

A

Oncotype DX

For node-negative tumors with low-risk profile, can treat with just lumpectomy + tamoxifen instead of using chemo.

24
Q

What type of breast carcinoma do men get?

A

Ductal. Male breast tissue does not have lobules.

25
Q

What’s 1 predisposing factor for breast cancer in males?

A

Klinefelter syndrome (XXY).

26
Q

How does staging, prognosis, and treatment differ between male and female breast cancer?

A

It doesn’t.

27
Q

4 clinical manifestations of fibrocystic breast changes?

A

Cyclic pain / tenderness.
Palpable mass.
Abnormal mammogram.
Mass or calcifications.

28
Q

What are the 2 major categories of fibrocystic changes?

A

Proliferative and non-proliferative.

29
Q

4 non-proliferative fibrocystic changes?

A

Fibrosis
Cysts
Adenosis
Apocrine metaplasia

30
Q

4 proliferative fibrocystic changes?

A

Sclerosing adenosis
Usual ductal hyperplasia
Atypical ductal hyperplasia
Atypical lobular hyperplasia

31
Q

Which two proliferative fibrocystic changes are called “borderline” lesions?

A

Atypical ductal hyperplasia

Atypical lobular hyperplasia

32
Q

What fibrocystic changes pose no additional cancer risk?

A

All the non-proliferative changes.

Mild usual ductal hyperplasia.

33
Q

Which fibrocystic changes are associated with moderate increased risk for breast cancer?

A

Sclerosing adenosis.

Moderate to “florid” usual ductal hyperplasia.

34
Q

Which fibrocystic changes are associated with a moderate to high risk of breast cancer? What increases the risk?

A

Atypical ductal and lobular hyperplasia.

Family Hx of breast cancer further increase this risk.

35
Q

3 benign tumors of the breast?

A

Stroma: Fibroadenoma and phyllodes tumor.
Epithelial: Intraductal papilloma.

36
Q

What’s the most common benign tumor of the breast? Prognosis?

A

Fibroadenoma. 100% curable and never malignant.

37
Q

What’s the deal with phyllodes tumor? What does it look like? Treatment? Prognosis?

A

Is (usually) benign, but has an invasive border.
Almost always can be cured by excision.
Has a mortality rate of 6%. (doesn’t sound that benign to me…)

38
Q

How does an intraductal papilloma usually present?

A

Nipple discharge / bleeding.

39
Q

Intraductal papilloma prognosis?

A

Completely benign.

40
Q

2 common inflammatory breast conditions?

A

Post-partum infection.

Traumatic fat necrosis.

41
Q

2 most common organisms causing breast abscess and cellulitis?

A

Staph. aureus

Streptococci

42
Q

How can traumatic fat necrosis present?

A

As a hard mass that forms after trauma.

43
Q

What kind of inflammation do you see in histology of traumatic fat necrosis?

A

Granulomatous inflammation.

44
Q

2 processes in gynecomastia?

A

Duct epithelia proliferate.

Myofibroblasts lay down collagen.

45
Q

What part of gynecomastia is irreversible?

A

The collagen deposition.

Repro-Endo (60 decks)

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