Robbins

Question 1

Discharge associated with malignancy is most commonly due to

Answer 1

ductal carcinoma in situ (DCIS)

Question 2

most common benign masses in the breasts

Answer 2

fibroadenomas and cysts

Question 3

Approximately 50% of breast carcinomas are located in what quadrant of the breast?

Answer 3

upper outer

Question 4

Squamous metaplasia of lactiferous ducts is alsso known as (3)

Answer 4

recurrent subareolar abscess, periductal mastitis, and Zuska disease

Question 5

key feature of squamous metaplasia of lactiferouducts

Answer 5

keratinizing squamous metaplasia

Question 6

lesion most common in women with type 1 (insulin-dependent) diabetes or autoimmune thyroid disease and is hypothesized to have an autoimmune basis

Answer 6

lymphocytic mastopathy

Question 7

three principal nonproliferative morphologic changes in the breast

Answer 7

cystic change, fibrosis, and adenosis

Question 8

Microscopically, there is an increase in dense collagenous connective tissue associated with epithelial hyperplasia of the duct lining. Lobule formation is almost never observed.

Answer 8

gynecomastia

Question 9

Gynecomastia also rarely occurs as a part of this syndrome

Answer 9

Klinefelter syndrome (XXY karyotype)

Question 10

T/F Lesions characterized by proliferation of epithelial cells, without atypia, are associated with a small increase in the risk of subsequent carcinoma in either breast

Answer 10

True

Question 11

is a clonal proliferation having some, but not all, of the histologic features of carcinoma in situ

Answer 11

Atypical hyperplasia

Question 12

give the relative risk:
Non proliferative breast changes

Answer 12

1

Question 13

give the relative risk:
Proliferative disease without atypia

Answer 13

1.5 - 2

Question 14

give the relative risk:
Proliferative disease with atypia

Answer 14

4 -5

Question 15

give the relative risk:
Carcinoma in situ

Answer 15

8 - 10

Question 16

is the most common and deadly malignancy of women globally

Answer 16

breast carcinoma

Question 17

are defined as being positive for ER and negative for HER2

Answer 17

luminal cancers

Question 18

are defined as cancers overexpressing HER2 and can be either ER-positive or ER-negative

Answer 18

HER2 cancers

Question 19

are cancers that are negative for ER and HER2. These cancers are termed as such because they also fail to express progesterone receptor (PR), which is under the control of ER

Answer 19

tripple negative cancers

Question 20

> 4 relative risk factors for developing breast cancer (6)

Answer 20

-female gender
-increasing age
-strong family hx (>1 relative, young multiple CA)
-personal hx of breast cancer
-high breast density
-germline mutation with high penetration

Question 21

2.1 - 4 relative risk factors for developing breast cancer (3)

Answer 21

-germline mutation of moderate penetrance
-high dose radiation to chest at young age
-family history (1 1st degree relative)

Question 22

Based on gene expression profiling:
luminal

Answer 22

ER+ HER2-

Question 23

Based on gene expression profiling:
HER2-enriched

Answer 23

HER2+

Question 24

Based on gene expression profiling:
basal-like

Answer 24

ER- HER2-

Question 25

most common gene mutation associated with hereditary susceptibility to breast cancer

Answer 25

BRCA1

Question 26

mutation that confers a smaller risk for ovarian carcinoma (10% to 20%) but is associated more frequently with male breast cancer

Answer 26

BRCA2

Question 27

process in which a normal sister chromatid is used as a template for repairing the DNA break

Answer 27

homologous recombination

Question 28

dominant pathway of breast cancer development, constituting 50% to 65% of cases

Answer 28

ER positive pathway

Question 29

luminal subgroup with low growth fractions

Answer 29

Luminal A

Question 30

luminal subgroup with high levels of expression of genes associated with proliferation

Answer 30

luminal B

Question 31

luminal subgroup that does not respond well to cytotoxic chemotherapy

Answer 31

luminal A

Question 32

most common subtype of breast cancer in patients with germline TP53 mutations (Li-Fraumeni syndrome)

Answer 32

HER-2 positive breast cancers

Question 33

is a receptor tyrosine kinase that promotes cell proliferation and opposes apoptosis by stimulating the RAS- and PI3K-AKT signaling pathways.

Answer 33

HER2

Question 34

all breast carcinomas arise from cells in the

Answer 34

terminal duct lobular unit

Question 35

T/F many of the molecular changes found in invasive breast carcinomas also are found in breast carcinoma in situ

Answer 35

True

Question 36

dcis morphology that may occasionally produce a vague nodularity, but more often is detected as clustered or linear and branching areas of calcification

Answer 36

comedo

Question 37

major risk factors for recurrence in dcis are (3)

Answer 37

high nuclear grade and necrosis extent of disease positive surgical margins

Question 38

The observed loss of cellular adhesion in LCIS is usually due to dysfunction of this protein

Answer 38

E-cadherin

Question 39

Gene for e-cadherin

Answer 39

CDH1

Question 40

DCIS is usually ER __ HER2__

Answer 40

ER- HER2+

Question 41

LCIS is usually ER____ HER2____

Answer 41

ER+ Her2-

Question 42

Paget disease does not occur in this in-situ lesion

Answer 42

LCIS

Question 43

breast carcinoma subtype with biallelic loss of expression of CDH1

Answer 43

Lobular carcinoma

Question 44

over half of BRCA1-associated carcinomas have this subtype appearance

Answer 44

carcinomas with medullary pattern

Question 45

hyper/hypo methylation of BRCA1 promoter leads to downregulation of BRCA1 expression

Answer 45

hyper

Question 46

Some special histologic types of cancer almost always fall within the luminal (ER-positive/HER2-negative) group namely (4)

Answer 46

lobular, mucinous, tubular, papillary

Question 47

Two special histologic types frequently overexpress HER2 namely (2)

Answer 47

apocrine and micropapillary

Question 48

TNBC (ER-negative, HER2-negative) often corresponds to one of several special histologic types (2)

Answer 48

carcinoma with medullary features and metaplastic carcinoma

Question 49

prognostic/predictive/both? Factors related to tumor biology are usually

Answer 49

both prognostic and predictive

Question 50

prognostic/predictive/both? factors related to tumor extent are

Answer 50

prognostic

Question 51

most important prognostic factor for invasive carcinoma in the absence of distant metastases

Answer 51

Lymphnode metastases

Question 52

breast cancer complication of infiltration of the skin and ulceration

Answer 52

carcinoma en cuirasse

Question 53

Breast CAP T staging: pT1mi PT1a pT1b pT1c pT2 pT3 pT4a pT4b pT4c

Answer 53

pT1mi 0.1 0.5 1 2 5cm pT4a invasion of chest wall pT4b ulceration/edema of skin pT4c both a and b

Question 54

T/F invasion of pectoralis muscle is staged in CAP as pT4a

Answer 54

false, pT4a is invasion of chest wall (intercostal muscles or deeper) which is rarely included in mastectomy specimens

Question 55

The most important familial factor conferring an increased risk for male breast cancer is germline mutation of the

Answer 55

BRCA2 tumor suppressor gene

Question 56

More than 90% of breast cancers in males are of what molecular subtype?

Answer 56

luminal ER+ HER2-

Question 57

T/F prognosis in male breast cancer is similar to that of women when matched for stage.

Answer 57

T

Question 58

two types of stroma in the breast

Answer 58

intralobular and interlobular

Question 59

two breast specific tumors that arise from cells of the intralobular stroma

Answer 59

fibroadenoma and phyllodes tumor

Question 60

Both fibroadenoma and phyllodes tumor are driven by somatic mutations in

Answer 60

MED12

Question 61

most common benign tumor of the female breast

Answer 61

Fibroadenoma

Question 62

half of women receiving this after renal transplantation developed multiple, bilateral fibroadenomas that regress after cessation of treatment

Answer 62

cyclosporin A

Question 63

features of complex fibroadenoma (4)

Answer 63

cysts larger than 0.3 cm, sclerosing adenosis, epithelial calcifications, or papillary apocrine change

Question 64

phyllodes tumors that display malignant behavior are more likely to have mutations in additional genes, such as

Answer 64

TERT

Question 65

Features of malignant phyllodes (5)

Answer 65

-Stromal overgrowth (4x field without epithelium) -Increased mitoses (≥10 per 10 HPFs) -Increased stromal cellularity (Often diffuse) -Infiltrative borders -Malignant heterologous elements (except well-differentiated liposarcoma, as it has a low metastatic risk)

Question 66

Malignant Tumor of Interlobular Stroma that arises as a complication of therapy

Answer 66

angiosarcoma

Question 67

Young women with this type of lymphoma may present with massive bilateral breast involvement, often while pregnant or lactating

Answer 67

Burkitt