Breast

Front 1

proliferative breast disease increases ones risk of developing cancer by what?

Back 1

i.e. moderate/florid hyperplasia, sclerosing adenosis, radial scar increase risk of cancer 1.5 to 2x

Front 2

T/F aypical ducal hyperlasia has the same risk of develp\oping cancer as proliferative brease disease.

Back 2

False. The risk increases 5x where as proliferative disease increses 1.5 to 2x.

Front 3

What chromosomal abnormalities are seen in ADH/DCIS?

Back 3

16q-, 17p-, 1q+

Front 4

How do you differentiate microglandular adenosis from invasive cancer (tubular ca)?

Back 4

Both lack myoepithelial cells, but BM present in adenosis, but not TCA; therefore, a BM stain (laminin, type IV collagen, reticulin) would be positive in adenosis.

Front 5

What is the most important prognositic factor for ?breast cancer

Back 5

Lymph node status

Front 6

What are the most aggressive breast cancers?

Back 6

-Ductal
-Lobular
-Squamous
-Metaplastic
-Apocrine

Front 7

Name the low grade breast carcinomas.

Back 7

-Papillary
-Tubular
-Colloid
-Medullary
-Adenoid cystic
-Juvenile

Front 8

Mammary hypoplasia is associated with what congenital anomaly?

Back 8

Turners syndrome

Front 9

Penicillamine can cause what effect on breast?

Back 9

Juvenile hypertrophy

Front 10

What is the most commone infectious agent in acute mastitis?

Back 10

Staph aureus, a gram + bacteria with a thick rigid cell wall made of peptidoglycan

Hint 10

Note: all staph are catalase positive (which differentiates it from strep) and coagulase positive (which identify it as staph aureus)

Front 11

T/F sclerosing lymphoctyic lobulitis is associated with type 2 diabetes?

Back 11

False. It is associated with type 1 diabetes. Also associated with HLA DR3, 4, and 5

Front 12

T/F excess etrogen increases ones likelihood of developing fibrocystic change?

Back 12

True. FCC is more common in women 25-45. It is usually bilateral, but may be unilateral.Calcs may be present. Long term OCP may decrease incidence.

Front 13

What increase risk of breast cancer does non-proliferative fibrocystic change impart on someone?

Back 13

NONE.

Front 14

What are the three most common breast lesions in order of frequency?

Back 14

FCC, CA, FA

Front 15

50% of kidney transplants on this medication develope this breast lesion.

Back 15

Cyclosporin, FA

Front 16

What is the peak incidence of FA and what associated epithelial changes may also be seen?

Back 16

20-35 years. May see apocrine metaplasia, squamous metaplasia, UDH, ADH, ALH, CIS, atrophy, cancer

Front 17

List the top 5 cancers in women in order.

Back 17

1. Breast 26% (1:8 will get it)
2. Lung 15% (1:16 will get it)
3. Colorectal 10% (1:19)
4. Uterine 6% (1:41)
5. NHL 4% (1:53)

Front 18

List the top 5 causese of cancer death in women in order

Back 18

1. Lung 25% of all cancer deaths
2. Breast 15%
3. Colorectal 10%
4.Uterine 3%
%. NHL 3%

Front 19

The following are all genetic risk factors for cancer. What are the associated chromosomes involved in each?
1. BRCA1
2. BRCA2
3. Li-Fraumeni syndrome
4. Cowdens disease
5. Ataxia-telangiectasia

Back 19

1. 17q21
2. 13q12
3. P53. most common brain tumor is meduloblastoma
4. AD 10q22 PTEN (multiple hamartomas of skin, breast, thyroid, oral mucosa, and intestinal epithelium, polyps of GI tract)
5. 11

Front 20

What percent of all breast cancers are hereditary?

Back 20

5 to 10%

Front 21

What percent of all breast cancers are hereditary?

Back 21

5 to 10%

Front 22

With respect to hereditary cancers, what percent are attributed to BRCA mutations?

Back 22

BRCA1 51%
BRCA2 32%
Others 18%

Front 23

All of the following are risk factors for breast cancer except.
a. Smoking
b. Non-proliferative FCC
c. Proliferative FCC
d. Poor diet/lack of exercise
e. Early age of first child
f. Late menarch
g. Endometrial cancer
h. Cancer of opposite breast

Back 23

b. Non-proliferative FCC
e. Early age of first child (late age increaes risk)
f. Later menarch (early menarch inreases risk)

Front 24

What is the relative risk for developing breast cancer in LCIS?

Back 24

7-12x increase which is about 20-25% risk after 20 years.

Front 25

T/F people with LCIS have a higher likelyhood of developing lobular cancer than ductal cancer/

Back 25

False. The order of frequency in this setting is ductal nos, Lobular, then ductal variants

Front 26

How many mitosis are needed to classify a phylloides as maligant?

Back 26

1. Benign 0-4 mitosis per 10HPF with no atypia
2. Borderline 1-5 mits per 10HPF with cellularity between b9 and malignant
3. Malignant >5 mits per 10HPF with worrisome features or >10 mits per 10HPF w/o worrisome features

Front 27

T/F the risk factors for male beast cancer are the same as for femal breast cancer.

Back 27

True with exception of reproductive risk factors.

Front 28

What are some risk factors for gynecomastia?

Back 28

1. Hyperestrinism
-cirrhosis, drugs(heroine, anabolic steroids, amphetamines, digoxin, phenothiazines, resperine, neuroleptic drugs)
2. Kleinfelters
3. Leydig cell, Sertoli cell tumors
4. ETOH

Front 29

T/F both BRCA gene mutations occur in male breast cancer the same frequence as female breast cancer.

Back 29

False. You see BRCA2 mutations, but not BRCA1 mutations in male breast cancer.

Front 30

Alll but which of the following are seen in HGDCIS
a. c-erB-2 expression
b. p53 expression
c. high proliferation index
d. iincreased stroma/ vessels
e. er/pr positivity

Back 30

e. er/pr positivity

Front 31

What percentage of LCIS is bilateral?

Back 31

up to 70%of LCIS are bilateral. Risk of invasive cancer is 7 to10x the general population.

Front 32

How does LCIS differ morphologicallly from DCIS?

Back 32

DCIS is has larger more pleomophic and cohesive cells with increased mitosis and may have necorsis

Hint 32

LCIS has smaller more uniform nuclei (except in pleomorphic LCIS) and discohesiive cells with no mitosis and no necrosis (except in pleomorphic LCIS)

Front 33

Where does lobular cancer tend to spread?

Back 33

CSF
Ovary
Pleura
Peritoneum
Bone marrow

Front 34

T/F both the classic type and pleomorphic type tend to overexpress the HER-2/neu gene.

Back 34

False. The classic type usually doesn't ehereas the pleomorphic type usually does.

Front 35

Lymphovascualr invasion is seen in what percent of micropapillary carcinoma ofthe breast?

Back 35

33 to 67%

Front 36

!. What is Stewar Treves syndrome?
2. T/F it s associated with thorotrast and polyvinly chloride escposure.

Back 36

1. Lymphagiosarcoma as reuslt of chronic lymphedema. Used ot be more common with surgery radiation. Other causes may include filariasis and less commonly foreign bodies.
2. False. PVC are associated with angiosarcomas of the liver, not lymphangiosarcoma.

Front 37

pseudoangiomatous stromal hyperplasia stains with what

Back 37

+ for CD34, vimentin, er(beta)/pr, androgen receptor

- for CD31, factor VIII, keratin, Ulex

Hint 37

Note: Ddx is angiorsarcoma which unlike PASH is postive for CD31 and facot VIII