Week 9: Malignant Neoplasms of the Breast

Question 1

Risk factors for Malignant Breast Masses

Answer 1

• Age
• Gender
• Family history
• Estrogen exposure
• Lifestye/dietary/environmental

Question 2

Responsible for up to 80-90% of single gene familial breast cancers

Answer 2

BRCA1 & BRCA2 germline mutations

Question 3

The most important familial factor conferring an
increased risk for male breast cancer is

Answer 3

BRCA2

Question 4

ID

Answer 4

Lobular Carcinoma In-Situ (LCIS)

Question 5

What is the medical treatment for Lobular Carcinoma In-Situ (LCIS)?

Answer 5

Tamoxifen

selective estrogen receptor modulator (SERM) that exerts its anti-cancer effects by competitively binding to estrogen receptors (ERs). Treats ER+ breast cancers

Question 6

What should be suveilled for ~10 years after treatment of Lobular Carcinoma In-Situ (LCIS) with Tamoxifen

Answer 6

Leiomyosarcoma

Question 7

ID

Answer 7

Ductal Carcinoma In-Situ (DCIS)

Tumor cells are confined to ducts without invasion through basement membrane into stroma

Question 8

Treatment for Ductal Carcinoma In-Situ (DCIS)

Answer 8

• Surgery
• Tamoxifen

Question 9

tumor cells from Ductal Carcinoma In-Situ (DCIS) in the breast extend into the lactiferous ducts and into the adjacent epidermis

Answer 9

Paget’s Disease

Question 10

ID

Answer 10

Paget’s Disease

Question 11

ID

Answer 11

Paget’s Disease

Question 12

ID

Answer 12

Paget Disease

Paget cells, which typically appear as large, pale-staining cells with prominent nuclei in the epidermis (yellow arrows)

Question 13

What breast(s) is at risk for Lobular Carcinoma In-Situ (LCIS)

Answer 13

More likely both breasts

Question 14

What breast(s) is at risk for Ductal Carcinoma In-Situ (DCIS)

Answer 14

More likely ipsilateral

Question 15

A clonal population of malignant cells capable of invading stroma. The cells can invade lymphatic and blood vessels and metastasize to distant sites, and loss of myoepithelial cells.

Answer 15

Invasive Breast Cancer

Question 16

68-year-old female with a large, fungating, fixed firm right breast mass

Answer 16

Invasive Breast Cancer

Question 17

ID

Answer 17

Invasive Ductal Carcinoma

Question 18

ID

Answer 18

Invasive Lobular Carcinoma

Question 19

Is Invasive Lobular Carcinoma ER+/-, E-cadherin +/-

Answer 19

ER + and E-cadherin -

Question 20

What are the prognostic factors for the TNM staging

Answer 20

T (tumor) - primary tumor feature like size, chest wall or skin invasion
N (node) - worsens as number of lymph nodes involved worsens
M (metastasis) - worsens with metastatic disease

Question 21

ID

Answer 21

Tubular Carcinoma

Estrogen Receptor (ER)/Progesterone Receptor (PR)+

Question 22

ID

Answer 22

Mucinous Carcinoma

Estrogen Receptor (ER)/Progesterone Receptor (PR)+

Question 23

ID

Answer 23

Carcinoma with Medullary Pattern

50% of BRCA-1 have this histology

Question 24

ID

Answer 24

Mastectomy

A - skin ellipse with nipple
B - Skin-sparing
C - nipple-sparing

Question 25

ID

Answer 25

Left - Estrogen Receptor (ER) + Right - Estrogen Receptor (ER) -

Question 26

ID

Answer 26

Left - HER2 + Right - HER2 -

Question 27

ID

Answer 27

Normal Breast Tissue

Question 28

ID

Answer 28

Ductal Carcinoma In-Situ (DCIS) ## Footnote comedo-type (making "donuts" with a central comedonecrosis plug (yellow circle) and apoptosis (blue to yellow circle); calicifications (yellow arrow); desmoplastic stroma (green ellipse)

Question 29

ID

Answer 29

Ductal Carcinoma In-Situ (DCIS) ## Footnote large central zones of necrosis and calcifications fills several ducts

Question 30

ID

Answer 30

Lobular Carcinoma In-Situ (LCIS)

Question 31

ID

Answer 31

Lobular Carcinoma In-Situ (LCIS) (cyan circle) next to Invasive Lobular Carcinoma (yellow ellipse)

Question 32

What mutation is responsible for loss of E-cadherin expression

Answer 32

CDH1 gene ## Footnote High risk for signet ring Diffuse Type Gastric Cancer (Adenocarcinoma)

Question 33

CDH1 germline mutations are at a high risk for what 2 cancers?

Answer 33

* (Signet Ring) Diffuse Type Gastric Cancer (Adenocarcinoma) * Invasive Lobular Carcinoma

Question 34

ID

Answer 34

Invasive Lobular Carcinoma ## Footnote HE stain shows spindle cell pattern (left) and IHC shows E-cadherin negative (right)

Question 35

ID

Answer 35

Inflammatory Breast Cancer (IBC) ## Footnote peau d'orange (left image) and erythema, induration (right)

Question 36

ID

Answer 36

Inflammatory Carcinoma ## Footnote plugging of lymphovascular spaces of the dermis with carcinoid cells (curved black arrows)