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70 Cards in this Set
- Front
- Back
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the msot common benign breast tumor is what |
fibroadenoma, its made of fibrous and glandular tissue that is MOBILE
seen in girls <30 hormone sensitive |
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your 24 yo female has a BL mobile soft mass, what is it liekly to bee
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fibroadenoma
made of fibrous tissue and glandular tissue, most common benign tumor hormone sensitive |
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whaty does a fibroadenoma look like at gross
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fibrous tissue adn glandular tissue
lined by epithelium and surrounded by stroma KNOW THE PIC |
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ok so you have this young girls with a mobile soft mass that you think is an fibroadenoma but then she tells you it changes size with her cycle, and she even noticed changes with lactation. how does this cahnge your thinking
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it doesnt, adenomas are responsive to estrogens
**the change in size, infarct, adn inflmammtion that can mimic carcinoma |
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why might you think a fibroadenoma is cancer
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they can change in size, infarct, and have inflammation. all of these things mimic carcinoma
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ok ao obviously a fibroadenoma is from fibrous and glandular tissue. what tissue does a phyllodes tumor arise from
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intralobular stroma
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what features distinguish a fibroadenoma from a phyllodes
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Fibroadeno
<30 yo made from glandular and fibrous tissue Phyllodes older ppl arises from intralobular stroma LOTS of cells, increased mitosis, pleomorphism, stromal overgrowth, infiltrative borders |
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whats the tx and outcome of a phyllodes tumor
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low grade is common and mets is RATE
the high grade with LOTS of cellularity, mitosis, etc can have distant mets |
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whats a name for the really cellular high grade phyllodes
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cystocarcoma phyllodes
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what is the malignant stromal tumor
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angiosarcoma- complication of radiation, presents as mass
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angiosarcoma is what
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a STROMAL malignant tumor that is a complication of radiation
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large duct papilloma
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usually a solitary lesion, HUGE cause of bloody/serous nipple discharge in women <40
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what commonly causes serous/blood nipple discharge
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large duct papilloma
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what epithelial cancer of the breast is associated with increased cancer
1 single large duct papilloma or 2. multiple small duct papilloma |
multiple small
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besides multiple small duct papillomas what are hte other 2 intraductal papillomas that are at increased risk of cancer
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nipple adenoma
florid papillomatosis |
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whats the chance a woman who lives to 90 will get breast cancer
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1 in 8
**HUGE increase in incidence over last several years bc of better screen- mammography |
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what are hte 6 major risks for breast cancer
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1. female- most important risk factor
2. age- older is more liekly CA 3. young menstruation 4. old menopause 5. fisrt degree relative w/breast CA 6. breast biopsy w/atypical hyperplasia 7. white |
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a white woman smokes and had early menstruation and had a kid at 16
what are the RISKS of breast CA what is protective |
1. woman
2. white 3. early menstruation Protective- had a kid young SMOKING DOES NOT AFFECT breast CA risk |
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avg age of breast CA
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61
**if you are older you are at increased risk. when a young person gets breast CA its usually pretty bad |
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a breast biopsy is only an increased risk of cancer if...
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the previous biopsy showed atypical hyperplasia
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besides
age, race, age of period, age of menopause, age of first kid and fisrt degree relatives. what are some more minor risks of breast cancer |
high breast density
radiation cancer in other breast OR endometrium germline BRCA- note these mutations are NOT part of the most common 6 more common in whites, US and europe moderate/heavy drinking obese |
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will OTC cause increased risk of breast CA
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no
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whats the deal with obesity and breast CA
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fat when young is decreased risk
fat when old is increased risk |
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if your woman is high risk of breast Ca what do you do
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BL prophylactiv masectomy- common when one breast is already cancer
tamoxifen to prevent **any tx needs to consider that its BOTH breasts at risk |
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what are the 4 more common single gene mutations associated with hereditary breast cancer
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1. BRCA1
2. BRCA 2 **these two are the most common of the single mutations but as a whole only account for 3% of all breast cancers 3. p53 4. CHEC 2 |
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what is BRCA 1/2 assocaited with
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hereditary breast cancer bc of a single mutation. low incidence of gene mutation but super high association with breast CA. other CA assocated are male breast cacncer and ovarian ca. young onset of breast CA. BOTH are tumor suppressors
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the MAJOR risks for sporadic breast cacner are realted to what
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1. hormonal exposure- most CA is in postmenopaausal women and overexpress ER (this si good prognostic)
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ER- invasive carcinoma. tell me about it
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worse prognosis, high grade
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what are hte 2 divisions of breast cancer
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1. in situ- DCIS and LCIS
2. invasive |
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what are the 2 types of insitu breast cancer, what is more common
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1. Ductal Carcinoma in situ (DCIS)- more common
2. Lobular- BL |
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what are the specific types of invasive carcinoma
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1. NST- "no specific type" most common
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all breast carcinomes are thought to arise from what
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terminal duct lobular unit
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why is there an increase in the number of causes of DCIS
what is DCIS |
more commonly seen now with mammography
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what does DCIS look like on mammo
what is DCIS |
calcifications on mammo
DCIS is cancerous cells in the ducts/lubules of breast, limited by in tact BM. it doesnt invade blood, lymph nad no mets |
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what does comedocarcinoma look like
what about on mammo |
central necrosis
on mammo its MICROCALCIFICATIONS |
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does DCIS progress to invasice cancer
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yep
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whats the most common tx for DCIS
what are the 3 risk factors for recurre3nce |
tx- surgical excision w/radiation
risk: grade, size margin |
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how does paget disease present
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its a carcinoma in situ that extends to the skin. its scaly and oozy. UL.
usually there is an underlying palpable mass |
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is pagets a form of invasive cancer or DCIS
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DCIS
**hallmark is involvment of epidermis by malignant cells |
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w/o mammo how does invasive cacner present.
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palpable mass
once its palpable about 1/2 of women have LN mets |
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if breast CA is palpable whats the likelyhood tehre are infected LN
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1/2
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what does invasive carcinoma look like on mammo
what is a microcalcification on mammo |
microcalcifications- DCIS
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tell me abotu little about the lobular carcinoma in situ
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no invasive
not common usually incidental finding- no calcifications, no mass often BL 1/4 get invasive |
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what does a breast with cancer look like
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palpable mass- common to have axillary mets if palpable
cause dimpling of skin- peau d orange, tightening of cooper ligamenst nipple retraction |
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whats inflammatory carcinoma refer to
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the way the cancer looks, the boob is red hot and inflammed looking
rare, aggressive, BAD. no usually assocaated with a mass |
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the 5 types of invasive breast cancers are...
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1. NST- no specific type
2. Invasive lobular- strands of cells in a classic picture, mets to weird places, BL 3. medullary carcinoma 4. colloid carcinoma 5. tubular- BEST prognosis NST is prbly the wort prog and is most common |
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whats the morph of NST invasive carcinoma
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firm mass with irregular border
calcificatinos (not linear as was seen in DCIS) |
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whats expressed in well differentiated and poorly differentiated NTS invasive carcinoma
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well differentiated: ER+, HER2Nu-. good :) lots of tubules are seen
poorly differnetiated: ER-, Her2Nu+. Bad |
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what are the 5 classes of NST invasicarcinoma
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Luminal A: most common, ER= HEr2 Nu-. good prognosis
Luminal B normal breast like basal like HER 2 + |
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GRADE OF DCIS corresponds to the grade of what later
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invasive tumor
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does medullary carcinoma have a better or worse prognosis than NST?
what are the 3 components of medullary carcinoma |
better :)
1. solid sheets of large cells, pleomorphic nuclei w/prominent nucleoli, mitosis 2. lymphoplasacytic infiltrate 3. pushing non infiltrative border |
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what type of invasive cancer is characterized by
Solid sheets of large cells, pleomorphic nuclei with prominent nucleoli, mitosis • Lymphoplasmacytic infiltrate • Pushing, non‐infiltrative border |
medullary, better prognosis than NTS
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invasive lobular carcinoma
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presents as palpable mass or density on mammo
hard to detect, diffuse infiltrative pattern mets to CSF, serosal surface, orary and uterus (not the normal axillary, bone, ling) |
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wht invasive cancer has the strands of cells affected
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invasive lobular
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tell me about tubular carcinoma
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great prognosis. seen in younger women (40's)
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whats invasive papillary carcinoma
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simliar presentation as NTS but better prognosis
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what are hte principal radio signs of breast cancer
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1. density
2. architectural distortion 3. calcifications 4. changes over time |
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breast cacner prodnosis is based on what 2 path findings
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1. axillary mets
2. type of primary carcinoma **need to know in order to choose appropriate treatment |
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what are the 2 tings the pathologist tells you that helps you determine tx for a pt w/invasive carcioma
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1. tpye of primary
2. mets to LN |
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6 MAJOR breast cacner prognostic markers
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1. in situ or invasive
2. distant mets (lung and bone is common) 3. AXILLARY METS!!! MOST IMPORTANT 4. TUMOR SIZE- 2 most important 4. locally advanced 6. inflammtory carcinoma |
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of the 6 major prognostic factors for breast cancer, what 2 are the MOST importnat
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1. axillar mets; MOST important
2. tumor size |
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whats the sentinel node, how is it used in breast cancer
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its the node that will MOST likely get the mets from a cancer. in breast ca we take the sentinal node (recall if you take them all you can get lymphedema and increased risk of angiosarcoma)
take the sentinal only, if clean assume ALL are clean,. if mets take more nodes |
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ok so the 6 major prognostic factors for breast cancer are:
invasive or insitu distant mets local axillary mets tumor size locally advanced inflammatory what arehte 6 MINOR prognostic factors |
1. histo subtype- tubular best, NST worst
2. GRADE: nuclear atypia, mitosis, tubule formation 3. ER PR + 4. HER 2 Nu 5. Lymph invasion 6. proliforative rate, DNA content |
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is the following a major or minor breast cacner prognostic factor
axillary mets lymph invasion distant mets tumor size HISTO subtype lnflammatory ER, PR +/- insitu or infasive HER2 NU locally advanced DNA content tumor grade proliforative rate |
axillary mets: major
lymph invasion: minor distant mets: major tumor size: major HISTO subtype: minor lnflammatory: major ER, PR +/-: minor insitu or infasive: major HER2 NU: minor locally advanced: major DNA content: minor tumor grade: minor proliforative rate: monor |
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tx for breast CA
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1. surgery w.post op radiation
2. chemo, hormone |
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who determiens the grade
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the pathologist
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whats gynecomastia
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male breast development
occurs bc estrogen is high. seen in: kleinfelters testicular neoplasm cirrhosis 2 components – Dense periductal, hyaline connective tissue – Micropapillary hyperplasia of ductal linings |
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What is the most cause of hyperestrinism
leading to gynecomastia? |
increased estrogen bc of
1. kleinfelters 2. test neoplasm 3. cirrhosis |
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How common is breast cancer in males as
compared to females? Is it associated with BRCA1 and 2 mutations? |
rare, same presentation as female. seen in super old men
ya, associated with mutation |
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where does breast CA met to
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1. axilla
2. bone: LYTIC lesion, recall prostate is a blastic lesion 3. lung |
