Pathology: Breast Cancer – Flashcards
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What is the most important oncogene of breast cancer to know?
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Her2/neu
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What is the most common in situ carcinoma of the breast?
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ductal carcinoma in situ
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What is the most common invasive carcinoma of the breast?
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- no special type carcinoma ("ductal")
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Half of all mammographically detected malignancies are what?
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DCIS (seen as abnormal calcifications)
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What makes DCIS so complicated?
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- although it's non-invasive, it can "skip" throughout the ductal system, making complete excision difficult
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What are the five histologic types of DCIS?
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solid comedo cribiform papillary micropapillary
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Describe solid DCIS
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- ducts are distended - no crowding, well spread out
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Describe micropapillary DCIS
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- no fibrovascular core
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Describe cribiform DCIS
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- sieve-like - cookie-cutter
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Describe comedo DCIS
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- central area of necrosis - highly anaplastic tumor cells - associated with microinvasive carcinoma
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What does the E. Cadherin marker highlight?
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- myoepithelial cells - if they're present: DCIS - if they're absent: invasive cancer or lobular carcinoma
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How can you tell low grade DCIS from high grade?
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look at the nucleus Low: uniform nuclei High: pleomorphic, enlarged, hyperchromatic, mitotically active nuclei with a higher tendency to invade
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How does LCIS (lobular carcinoma in situ) appear histologically?
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- uniform, pleomorphic cells - benign looking - less common than DCIS
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WHat is Paget's disease of the breast?
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- a subset of DCIS - refers to intraepithelial involvement of tumor - almost always associated with underlying breast cancer (95% chance)
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How can you tell the difference between Paget's disease of the breast and malignant melanoma?
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Paget's disease will be mucin positive (pink histologically)
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How does Paget's disease of the breast appear grossly?
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- irregular hyper-pigmented areola - erythematic-crustous central area in the left nipple
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What is microinvasive ductal carcinoma?
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- somewhere between DCIS and invasive ductal carcinoma - defined as invasion of less than 1 mm
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What kind of DCIS is usually seen with microinvasive ductal carcinoma?
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comedo-type DCIS
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How does infiltrating/invasive ductal carcinoma appear grossly?
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- classic nipple retraction - peau d'orange skin - puckered mass with stony feel - grossly ill defined stellate masses
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Describe invasive lobular carcinoma
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- greater tendency to be bilateral - often multicentric - has a blander appearance than IDC
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How does invasive lobular carcinoma appear histologically?
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- single file tumor cells - targetoid configuration
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Which is more aggressive in terms of spread, invasive ductal or lobular carcinoma?
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lobular
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Describe medullary carcinoma
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- invasive - pushing border - arranged in syncytium (broad sheet) - disproportionately shows BRCA1 gene rearragements
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Who usually gets mucinous carcinoma of the breast?
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the elderly - invasive
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Describe tubular carcinoma
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- invasive - angulated, small duct-like structures with 90% coverage
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How is tubular carcinoma different from sclerosing adenosis?
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sclerosing adenosis would be surround by myoepithelial cells and tubular carcinoma would not be
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What things affect clinical course?
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- axillary node status - size of largest lymph node metastasis - locally advanced disease - tumor size - histologic subtype - tumor grade - estrogen/progesterone receptors - Her2neu status - lymphovascular invasion - perineural invasion - mitotic rate - tumor DNA index - angiogenesis
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How do you grade something based on glandular/tubal differentiation?
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1 point: if over 75% of tumor exhibits glandular/tubal differentiation 2 points: 10-75% differentiation 3 points: less than 10% differentiation
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WHat sorts of things are considered when determining the Bloom-RIchardson tumor grade?
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glandular/tubular differentiation (less = higher score) nuclear pleomorphism (more = higher score) mitotic count (more = higher score)
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How do the points translate into a grade for Bloom-Richardson tumor grading scale?
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3-5 points: Grade 1 6-7 points: Grade 2 8-9 points: Grade 3
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What is a sentinel lymph node?
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- inject dye to find the lymph node that is draining the tumor - extract the lymph node, look for signs of metastasis
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What issue is related to rupture of silicone implants?
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- granulomatous mastitis
