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56 Cards in this Set
- Front
- Back
LCIS: epidemiology
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mostly in premenopasual women
detected as incidental finding on biopsy not detected on mammography *not considered a cancer |
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LCIS: morphology
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loss E-cadherin
(-) HER2/Neu overexpression (+) mucin, signet-ring cells common expands & fills acini of a lobule rarely distorts surrounding architecture |
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DCIS: overview
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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 |
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DCIS: 5 types
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Comedocarcinoma
Cribriform DCIS Solid DCIS Papillary DCIS Micropapillary DCIS |
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Comedocarcinoma: histology
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solid sheets pleomorphic cells
high grade hyperchromatic nuclei areas central necrosis Periductal concentric fibrosis chronic inflammation |
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Comedocarincoma: mammography
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calcified necrotic cell membranes
cluster, linear, branch microcalcifications |
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Noncomedo carcinoma: histology
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+ monomorphic population of cells
+ nuclear grades low to high. + Several morphologic variants |
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Noncomedo carcinoma: 4 types
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Cribiform DCIS
Solid DCIS Papillary DCIS Micropapillary DCIS |
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Cribiform DCIS
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noncomedo carcinoma
round, regular (“cookie cutter”) spaces lumens filled with calcifying secretory material |
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Solid DCIS
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noncomedo carcinoma
almost fills lobule involved not associated with calcifications |
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Papillary DCIS
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noncomedo carcinoma
Delicate fibrovascular cores extend into a duct cores lined by monomorphic population of tall columnar cells. Myoepithelial cells are absent |
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Micropapillary DICS
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(-) fibrovascular core
bulbous protrusions often arranged in complex intraductal patterns calcifications assoc c/ central necrosis |
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Paget disease: presentation
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unilateral erythematous eruption c/ scale crust
pruritus common, may be mistaken for eczema |
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Paget disease: morphology
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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 |
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Peau d'orange
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associated with invasive breast cancer
2° lymphatic involvement blocking local area of skin drainage lymphedema, thickening of skin tethered to breast by Cooper ligaments |
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Invasive ductal carcinoma on mammography
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radiodense mass
usu ½ size of palpable cancers < 20% have nodal metastases |
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6 categories of invasive carcinomas
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invasive ductal carcinoma, no special type
invasive lobular carcinoma medullary, mucinous, tubular, papillary carcinomas |
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Invasive ductal carcinomas: histology
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irregular borders
firm white borders c/ chalky elastotic stroma extending into surrounding adipose tissue |
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Inflammatory carcinoma
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tumors present with swollen, erythematous breast
extensive infiltration --> obstruction of lymphatics usu diffusely infiltrative, not form palpable mass many pts have mets at diagnosis |
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Invasive ductal carcinoma, NST: morphology
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see notes, p. 8
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Invasive lobular carcinoma: morphology
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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 |
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Invasive lobular carcinoma: well-to-moderately well differentiated
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well-to-moderately differentiated
- usu diploid, - ER(+), assoc c/ LCIS, - usu (-) HER2/neu overexpression - gene expression profile similar to luminal A cancers |
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Invasive lobular carcinoma: poorly differentiated
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usu aneuploid,
lack hormone receptors, may overexpress HER2/neu |
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Invasive lobular carcinoma: metastasis
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Weird metastatic pattern:
peritoneum, retroperitoneum, leptomeninges, GI tract, ovaries, uterus |
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Medullary carcinoma: morphology
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- tumor soft, fleshy, well-circumscribed
- little desmoplasia - much more yielding on palpation & cutting than typical BRCA - poorly differentiated |
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Medullary carcinoma: histology
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(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 |
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Medullary carcinoma: gene profile
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basal-like
(-) HER2/Neu overexpression (-) ER, (-) PR |
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Mucinous (Colloid) Carcinoma: morphology
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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 |
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Tubular carcinoma: morphology
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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 |
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Tubular carcinomas are frequently associated with...
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atypical lobular hyperplasia
low-grade DCIS |
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breast cancer with youngest median age of presentation
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tubular carcinomas (late 40s)
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Why is it important to recognize tubular carcinomas?
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excellent prognosis
>10% have LN mets at time of diagnosis diploid, ER(+), HER2/neu (-), well-dx’d |
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Most common sites of metastatic ductal carcinomas
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bone, lung, liver, brain
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Luminal A
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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 |
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Luminal B
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ER(+), PR (+), overexpresses HER2/neu (“triple positive”)
15-20% NST CAs more likely to have LN mets may respond to std chemotx |
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Normal breast-like molecular portrait
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ER (+), HER2/neu (-), well-dx’d
gene expression pattern similar to normal tissue 6-10% NST CAs |
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Basal-like molecular portrait
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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 |
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HER2/Neu (+) molecular portrait
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ER(-), overexpression HER2/neu
amplification of 17q21 that encodes HER2/neu & various adjacent genes poorly dx’d, high proliferation rate, high freq brain mets |
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Does trastuzumab cross BBB?
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NO - brain mets still possible
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Stage 0 Breast Cancer
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DCIS, LCIS
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Stage I Breast Cancer
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T: invasive carcinoma < 2 cm
N: no LN mets M: no distant mets |
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Stage II breast cancer
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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 |
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Stage III breast cancer
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any combination between stage II or stage IV
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Stage IV breast cancer
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T: any
N: any M: (+) distant mets |
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What stage is inflammatory breast cancer w/o distant mets?
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Stage III
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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 |
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popcorn calcifications
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large lobulated calcifications seen in fibroadenomas, esp. in postmenopausal women
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What drug can cause fibroadenomas?
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Cyclosporin A
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Where in the breast do fibroadenomas arise?
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intralobular stroma
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Phyllodes tumors
age location in breast detection |
50-60 y/o
intrastromal tumors mostly detected as palpable masses |
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Phyllodes tumors: morphology
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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 |
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Pyllodes tumors: distinguish from fibroadenoma due to....
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↑cellularity,
↑mitotic rate, nuclear pleomorphism, stromal overgrowth, infiltrative borders |
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only breast tumor more common in males
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myofibroblastoma
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What bening breast stromal lesion may be part of FAP/Gardner syndrome?
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Fibromatosis
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Describe fibromatosis
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- irregular, infiltrating mass
- can involve both skin & muscle - locally aggressive, but does NOT metastasize |
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Example of malignant stromal tumor
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angiosarcoma
often 2* radiation therapy (eg: Hodgkin tx) often arises in skin over breast high grade, poor prognosis |