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56 Cards in this Set

  • Front
  • Back
LCIS: epidemiology
mostly in premenopasual women
detected as incidental finding on biopsy
not detected on mammography
*not considered a cancer
LCIS: morphology
loss E-cadherin
(-) HER2/Neu overexpression
(+) mucin, signet-ring cells common
expands & fills acini of a lobule
rarely distorts surrounding architecture
DCIS: overview
account for 50% of CAs detected by mammography
myoepithelial cells preserved, but may be decreased in number
can spread through ducts, lobules: extensive lesions of entire sector of breast
if lobule involvement, acini usu. distorted, unfolded, look like small ducts
*considered a cancer
DCIS: 5 types
Comedocarcinoma
Cribriform DCIS
Solid DCIS
Papillary DCIS
Micropapillary DCIS
Comedocarcinoma: histology
solid sheets pleomorphic cells
high grade hyperchromatic nuclei
areas central necrosis
Periductal concentric fibrosis
chronic inflammation
Comedocarincoma: mammography
calcified necrotic cell membranes
cluster, linear, branch microcalcifications
Noncomedo carcinoma: histology
+ monomorphic population of cells
+ nuclear grades low to high.
+ Several morphologic variants
Noncomedo carcinoma: 4 types
Cribiform DCIS
Solid DCIS
Papillary DCIS
Micropapillary DCIS
Cribiform DCIS
noncomedo carcinoma
round, regular (“cookie cutter”) spaces
lumens filled with calcifying secretory material
Solid DCIS
noncomedo carcinoma
almost fills lobule involved
not associated with calcifications
Papillary DCIS
noncomedo carcinoma
Delicate fibrovascular cores extend into a duct
cores lined by monomorphic population of tall columnar cells.

Myoepithelial cells are absent
Micropapillary DICS
(-) fibrovascular core
bulbous protrusions
often arranged in complex intraductal patterns
calcifications assoc c/ central necrosis
Paget disease: presentation
unilateral erythematous eruption c/ scale crust

pruritus common, may be mistaken for eczema
Paget disease: morphology
malignant Paget cells extend from DCIS in ducts via lactiferous sinuses into nipple skin

do NOT cross basement membrane

tumor cells disrupt epithelial barrier, allowing ECF to seep out

poorly differentiated
ER (-)
overexpress HER2/neu
Peau d'orange
associated with invasive breast cancer

2° lymphatic involvement blocking local area of skin drainage

lymphedema, thickening of skin tethered to breast by Cooper ligaments
Invasive ductal carcinoma on mammography
radiodense mass
usu ½ size of palpable cancers
< 20% have nodal metastases
6 categories of invasive carcinomas
invasive ductal carcinoma, no special type

invasive lobular carcinoma

medullary, mucinous, tubular, papillary carcinomas
Invasive ductal carcinomas: histology
irregular borders
firm white borders c/ chalky elastotic stroma extending into surrounding adipose tissue
Inflammatory carcinoma
tumors present with swollen, erythematous breast

extensive infiltration --> obstruction of lymphatics

usu diffusely infiltrative, not form palpable mass

many pts have mets at diagnosis
Invasive ductal carcinoma, NST: morphology
see notes, p. 8
Invasive lobular carcinoma: morphology
hallmark: presence of dyscohesive, infiltrating tumor cells
oft in single file or loose clusters or sheets

(-) tubule formation
(+) signet-ring cells, (+) mucin
desmoplasia may be minimal or absent
Invasive lobular carcinoma: well-to-moderately well differentiated
well-to-moderately differentiated
- usu diploid,
- ER(+), assoc c/ LCIS,
- usu (-) HER2/neu overexpression

- gene expression profile similar to luminal A cancers
Invasive lobular carcinoma: poorly differentiated
usu aneuploid,
lack hormone receptors,
may overexpress HER2/neu
Invasive lobular carcinoma: metastasis
Weird metastatic pattern:
peritoneum, retroperitoneum, leptomeninges, GI tract, ovaries, uterus
Medullary carcinoma: morphology
- tumor soft, fleshy, well-circumscribed
- little desmoplasia
- much more yielding on palpation & cutting than typical BRCA
- poorly differentiated
Medullary carcinoma: histology
(1) solid, syncytium-like sheets of large cells
c/ vesicular, pleomorphic nuclei & prominent nucleoli
75% tumor mass
(2) frequent mitotic figures
(3) moderate to marked lymphoplasacytic infiltrate surr & w/in tumor
(4) pushing (noninfiltrative) boarder
Medullary carcinoma: gene profile
basal-like
(-) HER2/Neu overexpression
(-) ER, (-) PR
Mucinous (Colloid) Carcinoma: morphology
tumor soft, rubbery
consistency and appearance of gray-blue gelatin
borders are pushing or circumscribed
tumor cells arr. in clusters and small islands of cells w/in large lakes of mucin
LN mets uncommon
Tubular carcinoma: morphology
tumors: well-formed tubules – confounding c/ benign sclerosing lesions
myoepithelial cell layer absent, so tumor cells in direct contact c/ stroma
cribiform pattern may be seen
apocrine snouts typical
calcification w/in lumens
Tubular carcinomas are frequently associated with...
atypical lobular hyperplasia
low-grade DCIS
breast cancer with youngest median age of presentation
tubular carcinomas (late 40s)
Why is it important to recognize tubular carcinomas?
excellent prognosis

>10% have LN mets at time of diagnosis
diploid, ER(+), HER2/neu (-), well-dx’d
Most common sites of metastatic ductal carcinomas
bone, lung, liver, brain
Luminal A
ER(+), HER2/neu (-)

50-60% NST CAs

↑t/sc genes of normal luminal cells

usu well-to-moderately dx’d, slow growing

postmenopausal women
respond well to hormonal tx, but only small number responds to std chemotx
Luminal B
ER(+), PR (+), overexpresses HER2/neu (“triple positive”)

15-20% NST CAs

more likely to have LN mets

may respond to std chemotx
Normal breast-like molecular portrait
ER (+), HER2/neu (-), well-dx’d
gene expression

pattern similar to normal tissue

6-10% NST CAs
Basal-like molecular portrait
ER(-), PR(-), HER2/neu(-)
subgroup of "triple negative" CAs

myoepithelial cell marker (-), progenitor cells (-), putative SCs (-)

many CAs in BRCA1(+) women are this type

high grade, high proliferation rate, aggressive course:
- freq mets to viscera & brain, poor prognosis

15-20% have complete response to chemotx
HER2/Neu (+) molecular portrait
ER(-), overexpression HER2/neu
amplification of 17q21 that encodes HER2/neu & various adjacent genes
poorly dx’d, high proliferation rate, high freq brain mets
Does trastuzumab cross BBB?
NO - brain mets still possible
Stage 0 Breast Cancer
DCIS, LCIS
Stage I Breast Cancer
T: invasive carcinoma < 2 cm
N: no LN mets
M: no distant mets
Stage II breast cancer
T: invasive carcinoma > 2 cm
N: no LN mets
M: no distant mets

or

T: tumor < 5 cm
N: 1-3 (+) LN
M: no distant mets
Stage III breast cancer
any combination between stage II or stage IV
Stage IV breast cancer
T: any
N: any
M: (+) distant mets
What stage is inflammatory breast cancer w/o distant mets?
Stage III
Most common benign tumor of female breast

usual age of presentation

usual pattern of presentation
fibroadenoma

age: 20-40 y/o

freq multiple & bilateral
palpable mass (freely moveable) or mammographic density/calcifications
popcorn calcifications
large lobulated calcifications seen in fibroadenomas, esp. in postmenopausal women
What drug can cause fibroadenomas?
Cyclosporin A
Where in the breast do fibroadenomas arise?
intralobular stroma
Phyllodes tumors

age
location in breast
detection
50-60 y/o
intrastromal tumors
mostly detected as palpable masses
Phyllodes tumors: morphology
size: few cm to entire breast

larger lesions oft have bulbous protrusions b/c of nodules of proliferating stroma

protrusions may extend into cystic space – not an indication of malignancy
Pyllodes tumors: distinguish from fibroadenoma due to....
↑cellularity,
↑mitotic rate,
nuclear pleomorphism,
stromal overgrowth,
infiltrative borders
only breast tumor more common in males
myofibroblastoma
What bening breast stromal lesion may be part of FAP/Gardner syndrome?
Fibromatosis
Describe fibromatosis
- irregular, infiltrating mass
- can involve both skin & muscle
- locally aggressive, but does NOT metastasize
Example of malignant stromal tumor
angiosarcoma

often 2* radiation therapy (eg: Hodgkin tx)

often arises in skin over breast

high grade, poor prognosis