Pathophysiology

Question 1

Two main classes of malignant breast lesions

Answer 1

• Non-invasive

- Invasive

Question 2

Two types of non-invasive lesions (2)

Answer 2

• Ductal carcinoma in situ (DCIS)

- Lobular carcinoma in situ

Question 3

Two types of invasive breast cancelesions (2)

Answer 3

• Ductal carcinoma

- Lobular carcinoma

Question 4

What type of carcinoma are most breast cancers?

Answer 4

Adenocarcinomas - glandular epithelial differentiation

Question 5

Define a non invasive carcinoma (3)

Answer 5

• Tumour confined to ducts/acinci of lobules
• No infiltration of basement membrane
• Pre malignancy

Question 6

Describe a ductal carcinoma in situ (3)

Answer 6

• Associated with fibrosis
• Not spread beyond basement membrane of ducts
• Originated in a duct

Question 7

What is paget’s disease of the nipple (4)

Answer 7

• Ductal carcinoma in situ
• Tumour originated in a duct
• Cancerous cell migrated down the duct
• Attached to epithelial skin on outside of nipple

Question 8

What is lobular carcinoma in situ? (3)

Answer 8

• Occurs in lobules
• Doesn’t affect ducts
• Difficult to detect

Question 9

What are the typical features of a lobular carcinoma in situ? (2)

Answer 9

• Multifocal

- Bilateral

Question 10

What is an invasive carcinoma? (2)

Answer 10

• Gone through basement membrane of tissue in origin

- Can metastisise spread to other tissues

Question 11

Types of invasive ductal carcinoma (5)

Answer 11

• Scirrhous carcinoma
• Medullary carcinoma
• Paget’s disease of the breast
• Mucinous carcinoma
• Anaplastic carcinoma

Question 12

Typical presentation of scirrhous carcinoma

Answer 12

Hard lump

Question 13

Mucinous carcinoma - features (3)

Answer 13

• Ill defined border
• No nipple inversion/skin tethering
• Better prognosis
• Mucin in cancer cells

Question 14

Tubular carcinoma features (2)

Answer 14

• Cells arranged as tubules

- Good prognosis

Question 15

Medullary carcinoma features

Answer 15

• Large well circumscribed

- Histology: lymphocytic infiltrate + macrophages

Question 16

What is the rare type of invasive ductal carcinoma?

Answer 16

Medullarly

Question 17

What lymph nodes do breast carcinomas typically spread to? (2)

Answer 17

• Axillarly

- Periclavicular

Question 18

3 ways breast carcinomas metastisise

Answer 18

• Local tissue
• Lymph nodes
• Via blood to distant sites

Question 19

What distant sites do breast carcinomas typically metastisise to? (2)

Answer 19

• Lung
• Bones
  Less commonly: liver + brain + adrenal glands

Question 20

Poor prognostic factors for spread?

Answer 20

• Young age/premenopause
• Large tumour size
• High grade
• Triple negative
• Positive lymph nodes

Question 21

Types of ductal carcinoma in situ - benign/not?

Answer 21

• Comedocarcinoma (benign)

- Lobular carcinoma

Question 22

Comedocarcinoma histological description (6)

Answer 22

• High grade malignant ductal epithelial cells
• Dark staining nuclei
• Mitotic figures
• Necrosis
• Central calcification
• Basement membrane intact

Question 23

Lobular carcinoma (2)

Answer 23

• Malignant cells in terminal duct lobules

- Not invaded through basement membrane

Question 24

Anaplastic carcinoma

Answer 24

Better prognosis

- T cell non-Hodgkin lymphoma

Question 25

Inflammatory carcinoma

Answer 25

• Malignant cells in lymhatic cells