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64 Cards in this Set

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What is the relative risk of cancer in breasts with usual ductal hyperplasia?
1.5-2x
What is the relative risk of cancer in sclerosing adenosis, radial scar, peripheral papillomas, complex sclerosing lesions?
1.5-2x
What is the relative risk of cancer in atypical ductal hyperplasia?
4-5X
If ADH is seen on core biopsy, what percentage has DCIS on excision?
15%
If FEA is seen on core biopsy, what percentage has a worse lesion on excision?
15-30%
What % of women get breast cancer?
1/8 = 12.5%
What is the most common type of cancer in women?
Breast
What is the leading cause of cancer death in women age 35-54?
Breast cancer
What chromosomes are BRCA1 and BRCA2 on?
BRCA1 = 17
BRCA2 = 13
What % of breast cancers are hereditary?
5-10%
What is the risk (% and relative risk) of developing breast cancer in the ipsilateral breast with DCIS?
95%, 8-10 fold increased relative risk
Where does the E-cadherin gene map?
16q22
What is the risk (% and relative risk) of developing cancer in the setting of LCIS in either breast?
20-25%, 8-10X
In the setting of invasive lobular carcinoma, what is the risk (%) of contralateral carcinoma?
10-15%
What percentage of invasive lobular carcinoma is associated with LCIS?
40-60%
In staging breast cancer, what is:
- pNo (ITC)
- pN1mi
- pN1
- pNo (ITC): <0.2 mm
- pN1mi: 0.2-2mm
- pN1: >2mm
Compared to female breast cancer, what is the incidence of male breast cancer?
Male breast cancer is 1% of female breast cancer
Elston grading:
- Tubule formation cut-offs
- Nuclear pleomorphism
- Mitoses
* Based on 10 hpf (field diameter 0.44 mm)
* based on 10 hpf (field diameter 0.59 mm)
- Tubule formation cut-offs
* 1 point = >75%
* 2 points = 10-75%
* 3 points = <10%

- Nuclear pleomorphism
* 1 point = minimal nuclear variation in size and shape
* 2 points = moderate variation in size and shape
* 3 points = marked pleomorphism

- Mitoses
* 10 hpf (field diameter 0.44 mm)
-- 1 point = 0-5
-- 2 points = 6-10
-- 3 points = >10

* 10 hpf (field diameter 0.59)
-- 1 point = 0-9
-- 2 points = 10-19
-- 3 points = >20
In Elston grading what are the number of points for:
- Grade 1
- Grade 2
- Grade 3
- Grade 1: 3-5
- Grade 2: 6-7
- Grade 8-9
In embryogenesis in what week does the milk line (a.k.a. mammary ridge) form?
5th week of gestation
Peripheral papilloma is characterized by what relative risk for developing cancer?
1.5-2x
Fibrocystic change is associated with what relative risk for cancer?
1. Same as general population
What is Stewart-Treves syndrome?
post-mastectomy lymphangiosarcoma of the arm
What is the incidence of post-radiation angiosarcoma?
0.2-1%
What is the relative risk of developing cancer in the setting of solitary intraductal papilloma arising from large ducts?
The relative risk is 1. Same as general population.
What is the relative risk of developing cancer in the setting of multiple intraductal papillomas/peripheral papillomas arising in terminal duct lobular units?
1.5-2X
What is the relative risk of developing contralateral breast cancer in the setting of ADH?

What about ADH arising from a papilloma?
ADH: Relative risk of 4-5 in contralateral breast

ADH arising from papilloma: No increased risk of contralateral breast cancer
With regard to risk for cancer, how is ADH more like LCIS than DCIS?
DCIS confers ipsilateral risk while ADH and LCIS confer bilateral risk.
What are the good prognosis breast cancers? (3)
Tubular, mucinous, medullary
This invasive breast carcinoma is well circumscribed, has greater than 75% syncytial growth pattern, and is associated with marked lymphoplasmacytic infiltrate.
Medullary carcinoma
What's the typical expression of medullary carcinoma:
ER
PR
Her2/Neu
ER: negative
PR: negative
Her2/Neu: negative
Is medullary carcinoma associated with BRCA1 or BRCA2?
BRCA1
What % of invasive lobular carcinoma is bilateral?
10-20%
What percent of invasive ductal carcinoma is bilateral?
5%
What IHC is specific for Paget's disease?
Her2/Neu
This lesion is a benign infiltrating neoplasm characterized by tubular structures with "comma-shaped" appearance which can recur if incompletely excised.
Syringomatous adenoma
This carcinoma has mucinous and neuroendocrine differentiation.
Solid papillary carcinoma
IHC pattern in microglandular adenosis:
p63
S100
AE1/3
ER
PR
Her2
p53
GCDFP
p63: negative (lacks myoepithelial cells)
S100: positive
AE1/3: positive
ER: negative
PR: negative
Her2: negative
p53: negative
GCDFP: negative
The Van Nuys Prognostic index scores DCIS based on what 3 categories?
1. Size:
- 1 pt = <15.0 mm
- 2 pt = 16-40 mm
- 3 pt = >40 mm

2. Nuclear grade
- 1 pt = low grade
- 2 pt = intermediate grade
- 3 pt = high grade

3. Distance from margin
- 1 pt = >10 mm
- 2 pt = 1-9 mm
- 3 pt = <1 mm

Score:
Low risk of recurrence = 3-4
Intermediate risk of recurrence = 5-6
High risk of recurrence = 7-9
Phylloes tumor is more common in what ethnic groups?
Asians and Latinos (especially from Central and South America)
Increased or decreased risk of breast cancer:
old age
increased
Increased or decreased risk of breast cancer:
being from the USA or Western countries
increased
Increased or decreased risk of breast cancer:
early menarche (<12 yrs)
increased
Increased or decreased risk of breast cancer:
late menopause (after 54)
increased
Increased or decreased risk of breast cancer:
nulliparity
increased
Increased or decreased risk of breast cancer:
maternal age at first birth >30
increased
Increased or decreased risk of breast cancer:
high breast density
increased
Increased or decreased risk of breast cancer:
hormone replacement therapy
increased
Increased or decreased risk of breast cancer:
OCP
increased
Increased or decreased risk of breast cancer:
obesity in post-menopausal women
increased
Increased or decreased risk of breast cancer:
alcohol consumption
increased
Increased or decreased risk of breast cancer:
geographic location in Africa or Asia
decreased
Increased or decreased risk of breast cancer:
early first pregnancy
decreased
Increased or decreased risk of breast cancer:
breast-feeding for prolonged duration
decreased
Increased or decreased risk of breast cancer:
obesity in pre-menopausal women
decreased
Increased or decreased risk of breast cancer:
increased physical activity
decreased
Increased or decreased risk of breast cancer:
tamoxifen
decreased
What mutations are associated with familial breast carcinoma? (6)
BRCA1, BRCA2, PTEN, ATM, p53, STK11 (aka LKB1)
Where does p53 map? What is the eponym for the familial p53 mutation?
17q13.1; Li-Fraumeni syndrome
Where does PTEN map and what is the eponym for the familial PTEN mutation?
10q23.3; Cowden's syndrome
Where does ATM map?
11q22-23
Where does STK11/LKB1 map and what is the name of the familial syndrome involving this gene?
19q13.3; Peutz-Jeghers
Is BRCA1 germ line mutation associated with male breast cancer?
No. But BRCA2 is.
Is BRCA2 germ line mutation associated with male breast cancer?
Yes. But BRCA1 is not.