Robbins Flashcards
Discharge associated with malignancy is most commonly due to
ductal carcinoma in situ (DCIS)
most common benign masses in the breasts
fibroadenomas and cysts
Approximately 50% of breast carcinomas are located in what quadrant of the breast?
upper outer
Squamous metaplasia of lactiferous ducts is alsso known as (3)
recurrent subareolar abscess, periductal mastitis, and Zuska disease
key feature of squamous metaplasia of lactiferouducts
keratinizing squamous metaplasia
lesion most common in women with type 1 (insulin-dependent) diabetes or autoimmune thyroid disease and is hypothesized to have an autoimmune basis
lymphocytic mastopathy
three principal nonproliferative morphologic changes in the breast
cystic change, fibrosis, and adenosis
Microscopically, there is an increase in dense collagenous connective tissue associated with epithelial hyperplasia of the duct lining. Lobule formation is almost never observed.
gynecomastia
Gynecomastia also rarely occurs as a part of this syndrome
Klinefelter syndrome (XXY karyotype)
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
True
is a clonal proliferation having some, but not all, of the histologic features of carcinoma in situ
Atypical hyperplasia
give the relative risk:
Non proliferative breast changes
1
give the relative risk:
Proliferative disease without atypia
1.5 - 2
give the relative risk:
Proliferative disease with atypia
4 -5
give the relative risk:
Carcinoma in situ
8 - 10
is the most common and deadly malignancy of women globally
breast carcinoma
are defined as being positive for ER and negative for HER2
luminal cancers
are defined as cancers overexpressing HER2 and can be either ER-positive or ER-negative
HER2 cancers
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
tripple negative cancers
> 4 relative risk factors for developing breast cancer (6)
-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
2.1 - 4 relative risk factors for developing breast cancer (3)
-germline mutation of moderate penetrance
-high dose radiation to chest at young age
-family history (1 1st degree relative)
Based on gene expression profiling:
luminal
ER+ HER2-
Based on gene expression profiling:
HER2-enriched
HER2+
Based on gene expression profiling:
basal-like
ER- HER2-
most common gene mutation associated with hereditary susceptibility to breast cancer
BRCA1
mutation that confers a smaller risk for ovarian carcinoma (10% to 20%) but is associated more frequently with male breast cancer
BRCA2
process in which a normal sister chromatid is used as a template for repairing the DNA break
homologous recombination
dominant pathway of breast cancer development, constituting 50% to 65% of cases
ER positive pathway
luminal subgroup with low growth fractions
Luminal A
luminal subgroup with high levels of expression of genes associated with proliferation
luminal B
luminal subgroup that does not respond well to cytotoxic chemotherapy
luminal A
most common subtype of breast cancer in patients with germline TP53 mutations (Li-Fraumeni syndrome)
HER-2 positive breast cancers
is a receptor tyrosine kinase that promotes cell proliferation and opposes apoptosis by stimulating the RAS- and PI3K-AKT signaling pathways.
HER2
all breast carcinomas arise from cells in the
terminal duct lobular unit
T/F many of the molecular changes found in invasive breast carcinomas also are found in breast carcinoma in situ
True
dcis morphology that may occasionally produce a vague nodularity, but more often is detected as clustered or linear and branching areas of calcification
comedo
major risk factors for recurrence in dcis are (3)
high nuclear grade and necrosis
extent of disease
positive surgical margins
The observed loss of cellular adhesion in LCIS is usually due to dysfunction of this protein
E-cadherin
Gene for e-cadherin
CDH1
DCIS is usually ER __ HER2__
ER- HER2+
LCIS is usually ER____ HER2____
ER+ Her2-
Paget disease does not occur in this in-situ lesion
LCIS
breast carcinoma subtype with biallelic loss of expression of CDH1
Lobular carcinoma
over half of BRCA1-associated carcinomas have this subtype appearance
carcinomas with medullary pattern
hyper/hypo methylation of BRCA1 promoter leads to downregulation of BRCA1 expression
hyper
Some special histologic types of cancer almost always fall within the luminal (ER-positive/HER2-negative) group namely (4)
lobular, mucinous, tubular, papillary
Two special histologic types frequently overexpress HER2 namely (2)
apocrine and micropapillary
TNBC (ER-negative, HER2-negative) often corresponds to one of several special histologic types (2)
carcinoma with medullary features and metaplastic carcinoma
prognostic/predictive/both?
Factors related to tumor biology are usually
both prognostic and predictive
prognostic/predictive/both?
factors related to tumor extent are
prognostic
most important prognostic factor for invasive carcinoma in the absence of distant metastases
Lymphnode metastases
breast cancer complication of infiltration of the skin and ulceration
carcinoma en cuirasse
Breast CAP T staging:
pT1mi
PT1a
pT1b
pT1c
pT2
pT3
pT4a
pT4b
pT4c
pT1mi </=0.1 cm
PT1a >0.1 </=0.5
pT1b >0.5 </= 1cm
pT1c >1 </=2 cm
pT2 >2 </=5
pT3 >5cm
pT4a invasion of chest wall
pT4b ulceration/edema of skin
pT4c both a and b
T/F invasion of pectoralis muscle is staged in CAP as pT4a
false, pT4a is invasion of chest wall (intercostal muscles or deeper) which is rarely included in mastectomy specimens
The most important familial factor conferring an increased risk for male breast cancer is germline mutation of the
BRCA2 tumor suppressor gene
More than 90% of breast cancers in males are of what molecular subtype?
luminal ER+ HER2-
T/F prognosis in male breast cancer is similar to that of women when matched for stage.
T
two types of stroma in the breast
intralobular and interlobular
two breast specific tumors that arise from cells of the intralobular stroma
fibroadenoma and phyllodes tumor
Both fibroadenoma and phyllodes tumor are driven by somatic mutations in
MED12
most common benign tumor of the female breast
Fibroadenoma
half of women receiving this after renal transplantation developed multiple, bilateral fibroadenomas that regress after cessation of treatment
cyclosporin A
features of complex fibroadenoma (4)
cysts larger than 0.3 cm, sclerosing adenosis, epithelial calcifications, or papillary apocrine change
phyllodes tumors that display malignant behavior are more likely to have mutations in additional genes, such as
TERT
Features of malignant phyllodes (5)
-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)
Malignant Tumor of Interlobular Stroma that arises as a complication of therapy
angiosarcoma
Young women with this type of lymphoma may present with massive bilateral breast involvement, often while pregnant or lactating
Burkitt
