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Patho II > The Breast > Flashcards

The Breast Flashcards

1
Q

What are the two major structures of the breast?

A

Ducts

Lobules

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2
Q

What are the two types of epithelial cells of the breast?

A

Luminal

Myoepithelial

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3
Q

What are the two types of stroma of the breast?

A

Interlobular

Intralobular

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4
Q

What structural changes occur in the breast during the 1st half of the menstrual cycle?

A

Lobules are relatively quiescent

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5
Q

What happens to the structure of the breast after ovulation?

A

Cell proliferation and the number of acini per lobule increases

INtralobular stroma becomes edematous

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6
Q

What happens to the structure of the breast during menstruation?

A

Regression of the lobules and the disappearance of edema

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7
Q

What happens to the breast pre-puberty?

A

Lactiferous ducts are formed at birth but lobules remain underdeveloped until puberty

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8
Q

What happens to breast during puberty?

A

Ovarian ESTROGEN and PROGESTERONE induces branching of the ductal system and development of lobules

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9
Q

What happens to the breast during pregnancy?

A

Progesterone and prolactin induce complete maturation of the breast at the time of the first full-term pregnancy

Permanent increase in number and size of lobules

Oxytocin induces myoepithelial proliferation and differentiation

Following lactation, total breast size decreases due to apoptosis of epithelium and lobule atrophy

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10
Q

What happens to the breast during aging and menopause?

A

Lobular and ductal atrophy occurs

Interlobular stroma decreases in fibrous connective tissue and increase in adipose tissue content

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11
Q

What are the three classifications of benign breast lesions?

A

Non-proliferative

Proliferation without atypia

Atypical hyperplasia

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12
Q

What is non-proliferation benign breast lesions associated with?

A

Simple breast cysts

NOT associated with an increased risk of breast cancer

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13
Q

What is a simple breast cyst?

A

Fluid-filled masses derived from teh terminal duct lobular unit

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14
Q

What is proliferation without atypia benign breast lesions associated with?

A

Fibroadenoma

Small increased risk of developing breast cancer

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15
Q

What is atypical hyperplasia benign breast lesions associated with?

A

Substantial increased risk of developing breast cancer

Multifocal lesions

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16
Q

What is a simple fibroadenoma?

A

Benign solid tumors containing glandular as well as fibrous tissue

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17
Q

What is the etiology of simple fibroadenoma?

A

Not known but likely a hormonal relationship

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18
Q

What is the classification of simple fibroadenomas?

A

Proliferation without atypia

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19
Q

What is a complex fibroadenoma?

A

Associated with a slightly increased risk of cancer when multicentric proliferative changes are present

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20
Q

What causes fibroadenomas?

A

Estrogen, progesterone, and lactation during pregnancy

Some have receptors on their surface and respond to human epidermal factor (EGH) and growth hormone

21
Q

What is the cause of calcified fibroadenomas seen in older patients?

A

Increased stromal growth

Necrosis

22
Q

What is the most common type of breast carcinoma?

A

Adenocarcinoma

23
Q

What are the two types of in situ breast carcinomas?

A

Ductal (DCIS) (aka introduction carcninoma)

Lobular

24
Q

What are the two types of invasive breast carcinomas?

A

Infiltrating ductal

Invasive lobular

25
Q

What is the human epidermal growth factor receptor 2 (HER2) oncogene?

A

Encodes for the HER2 receptors which belongs to the epidermal growth factor receptor (EGFR) family

26
Q

What does the HER2 receptor do?

A

Controls epithelial cell growth and differentiation

Maybe angiogenesis

27
Q

What percentage of human breast cancers have amplification/overexpression of HER2?

A

18-20%

28
Q

What are the three major genetic pathways of carcinogenesis?

A

ER +, HER2 -

HER2 +

ER -, HER2 -

29
Q

What major genetic pathway of carcinogenesis is the most common?

A

ER +, HER2 -

30
Q

What pathway is associated with HER2 + breast carcinogenesis?

A

Cancers arise through a pathway that is strongly associated with amplifications of the HER2 gene

31
Q

What pathway is associated with ER -, HER2 - genetic pathways of carcinogenesis?

A

Cancers arise through a distinct pathway that is independent of ER-mediated changes in gene expression and HER2 gene amplifications

32
Q

What are triple negative breast cancer cells negative for?

A

Progesterone
ER
HER2

33
Q

What are the dominant drivers of cell proliferation and survival in the majority of human breast cancers?

A

ER and/or HER2 signaling pathways

34
Q

What are the clinical implications of HER2-ER crosstalk?

A

Resistance can occur to broth endocrine and HER2 therapies

35
Q

What is Carcinoma in Situ/Ductal Carcinoma in Situ?

A

Malignant clonal proliferation of epithelial cells limited to ducts and lobules by the basement membrane

36
Q

What are the three main categories of CIS/DCIS?

A

HIgh grade
Low grade
Intermediate grade

37
Q

What is High grade CIS/DCIS?

A

Lesions lack estrogen and progesterone receptors

High proliferative rate

Overexpression of the HER2 oncogene

P53 mutations

Angiogenesis

38
Q

What is low grade CIS/DCIS?

A

Lesions are estrogen and progesterone receptor positive

Low proliferative rate

Rarely (if ever) show abnormalities of the HER2/new or p53

39
Q

What are intermediate grade CIS/DCIS?

A

Somewhere between low and high grade

40
Q

What are the three invasive (infiltrating) breast carcinomas?

A

ER positive, HER2 negative - low proliferation

ER positive, HER2 negative - high proliferation

HER2 positive

ER negative, HER2 negative

41
Q

What is ER positive, HER2 negative, low proliferation invasive breast carcinomas?

A

Respond well to hormonal treatment and long survival with metastatic disease is possible, despite the fact that incomplete responses to chemotherapy are the rule

42
Q

What is ER positive, HER2 negative, high proliferation invasive breast carcinomas?

A

10% of these carcinomas show a complete response to chemotherapy

43
Q

What is HER2 positive invasive breast carcinomas?

A

Second most common molecular subtype

44
Q

What is ER negative, HER2 negative invasive breast carcinomas?

A

Basal-like triple negative carcinoma

Third major molecular structure

45
Q

What mutations represent 80-90% of familial breast cancers?

A

BRCA1 and BRCA2

46
Q

What are BRCA1 and BRCA2 genes?

A

Genes that produce tumor suppressor proteins which help to repair damaged DNA

47
Q

What are the major risk factors for sporadic breast cancer?

A

Hormone Exposure!

Gender
Age at menarche and menopause
Reproductive history 
Breastfeeding
Exogenous estrogens
Radiation exposure
Exposure to chemicals with estrogen like effects
48
Q

How does hormonal exposure cause sporadic breast cancer?

A

By stimulating breast growth during puberty, menstrual cycles, and pregnancy thereby increasing the number of cells that can potentially give rise to a cancer

Patho II (16 decks)

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