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78 Cards in this Set

  • Front
  • Back
Where do ALL Breast CA's arise from?
Terminal Duct Lobular Unit
What are the terms "ductal" & "lobular" carcinomas used to indicate?
Their histological growth pattern & cytological characteristics; they DO NOT imply the site of origin (all breast CA's arise from TDLU)
Which cancer type is more common, In situ Carcinoma or Invasive Carcinoma?
Invasive = 70-80%

In Situ = 15-30%
How does Ductal Carcinoma In Situ present clinically?
1. Mammographic calcifications
2. Mammographic density
3. vaguely palpable mass
4. nipple discharge
5. incidental findings in biopsy for other lesions
List the 5 growth patterns for Ductal Carcinoma In Situ
1. Comedo
2. Solid
3. Cribriform
4. Papillary
5. Micropapillary
List the 3 histologic features of Comedocarcinoma (DCIS)
1. Solid Sheets of high-grade malignant cells
2. Central Necrosis
3. Periductal Concentric Fibrosis
Comedo DCIS
-high grade malignant cells
-central necrosis
-periductal fibrosis
What Breast CA is seen here?
Comedo DCIS
-White = central necrosis
-Organge = high-grade malignant cells
-Black = concentric fibrosis
What Breast CA is seen here? Label the arrows.
Solid DCIS with microcalcifications
What Breast CA is shown here?
Cribriform DCIS
What Breast CA is seen here?
Solid DCIS
What Breast CA is seen here?
Papillary DCIS
-has fibrovascular core
What Breast CA is seen here?
Micropapillary DCIS
-does not have fibrovascular core
What Breast CA is seen here?
Describe "Paget's Disease"
is a form of DCIS that extends from nipple ducts into the contiguous skin of the nipple & areola -> involvement of the epidermis by malignant cells (Paget cells)
Paget's cells = nexts of DCIS
-large pleomorphic nuclei, prominent nucleoli, & abundant clear cytoplasm
What is the arrow pointing at?
What does the skin of the breast look like in Paget's disease?
Skin of nipple & areola is frequently fissured, crusting, ulcerated & oozing
Paget's cells
What are the arrow pointing at?
All DCIS have increased risk of developing invasive carcinoma in the SAME breast, which form has the greatest risk?

What is the treatment for DCIS?

What affects the local recurrence?

Surgical excision (lumpectomy or mastectomy), radiation

DCIS grade, size, & margins of excision
Lobular Carcinoma In Situ (LCIS)
-cells are much smaller than DCIS
-proliferation of a monotonous population of cells that expands the TDLU
-cells are small & loosely cohesive
What breast CA is seen here?
Breast CA:
-always an incidental finding in biopsies
-rarely associated with calcifications, NEVER forms a mass
-bilateral in 20-40% of cases
-increased risk of developing invasive CA in BOTH breasts
Lobular Carcinoma In Situ (LCIS)
What is the most common form of breast CA?
Invasive Ductal Carcinoma
Describe the histology of Invasive Ductal Carcinoma
Stromal invasion by malignant cells -> pronounced fibroblastic proliferation (desmoplasia) -> palpable mass
Gross appearance of this breast CA is:
-firm with irregular margins
-pale gray & gritty & flecked with yellow, chalky streaks
Invasive Ductal Carcinoma
Histology of this Breast CA:
-tumor grows as irregular nests, cords, & tubules within a fibrous stroma
-tumor cells vary from small with moderately hyperchromatic regular nuclei to huge cells with large irregular & hyperchromatic nuclei
Invasive Ductal Carcinoma
Invasive Ductal Carcinoma
-tumor cells form ducts within a desmoplastic stroma
What Breast CA is shown here?
Invasive Ductal Carcinoma
-Firm with irregular margins
-Pale gray and gritty and flecked with yellow, chalky streaks
What breast CA is shown here?
Breast CA with extensive dermal LYMPHATIC invasion by tumor
Inflammatory Carcinoma
-a descriptive term, not a histologic type
Breast CA that produces a grossly thickened, erythematous & rough skin surface with the appearance of an orange peel
Inflammatory Carcinoma
Inflammatory Carcinoma = dermal lymphatic invasion
-peau d'orange
What breast CA would cause these changes?
Inflammatory Carcinoma = dermal lymphatic invasion
What Breast CA is seen here?
Inflammatory Carcinoma
-"peau d'orange"
What breast CA causes this?
Breast CA that more frequently metastasizes to CSF, peritoneum, ovary, uterus, & GI tract
Invasive Lobular Carcinoma
Breast CA that is:
-more bilateral
-more multicentric = appears at several different sites in the body simultaneously
-more difficult to detect due to its diffusely invasive pattern
Invasive Lobular Carcinoma
Gross examination of this Breast CA is "rubbery & poorly circumscribed"
Invasive Lobular Carcinoma
Breast CA histology:
-strands of infiltrating tumor cells, often in single file (Indian file), are loosely dispersed throughout the fibrous matrix
-cells are small with little nuclear pleomorphism
-Signet-ring cells are common
Invasive Lobular Carcinoma
Invasive Lobular Carcinoma
-Single File throughout the fibrous matrix
-signet ring cells
What breast CA is seen here?
List the 3 Special Types of Breast Carcinoma
1. Medullary Carcinoma
2. Colloid (mucinous) Carcinoma
3. Tubular Carcinoma
Special type of Breast CA that commonly occurs in younger age & has association with BRCA1 gene; grossly is a well-circumscribed soft fleshy tumor
Medullary Carcinoma
Breast CA histology:
-Solid syncytial sheets of large pleomorphic cells with frequent mitoses
-moderated to marked Lymphoplasmacytic infiltrate within the tumor
-pushing (non-infiltrative) border
Medullary Carcinoma
Medullary Carcinoma
-solid syncytial sheets of large pleomorphic cells with frequent mitoses
-moderated to marked Lymphoplasmacytic infiltrate within the tumor
-pushing border
What breast CA is seen here?
Lymphocytes within this Breast CA represent an immune response that contributes to its more favorable prognosis
Medullary Carcinoma
Breast CA that occurs in older women and has a better survival rate than the "non-Special Type" Carcinomas
Colloid (mucinous) carcinoma
Breast CA that occurs in older women, is slow growing, & grossly it is extremely soft, with a pale gray-blue gelatinous consistency
Colloid (mucinous) CA
Breast CA histology:
-large mucin lakes
-small islands & isolated neoplastic cells with bland morphology
Colloid (mucinous) CA
Mucinous (Colloid) CA
What Breast CA is seen here?
Breast CA that usually occurs at a younger age, is multifocal or bilateral, well differentiated, & carries EXCELLENT prognosis
Tubular Carcinoma
Breast CA histology:
-well-formed tubules
-Myoepithelial layer ABSENT
-Apocrine snouts & luminal calcification
Tubular Carcinoma
Tubular Carcinoma
-Well-formed tubules
-Myoepithelial layer absent
-Apocrine snouts and luminal calcification
What Breast CA is seen here?
What is the primary route of Metastasis in Breast CA?
Thru Lymphatics to regional lymph nodes
-AXILLARY (most important) = B, C, D
-Internal Mammary = F
-Supraclavicular nodes = E
What are the common sites of distant metastases through the bloodstream?
1. Lungs
2. Bones
3. Liver
4. Adrenals
5. Brain
6. Meninges (Invasive Lobular)
What ratio of patients have lymph node metastasis at the time of initial diagnosis of breast CA?
What is the most important prognostic factor in Breast CA?
Lymph node metastasis
Describe the term "Sentinel Lymph Node"
The first lymph node to receive lymph fluid from a tumor. If the sentinel node is cancer-free, then it is likely that the cancerous cells have not metastasized
Which Breast CA carries a very poor prognosis?
Inflammatory Carcinoma
What does "TNM" clinical staging represent?
T = tumor size
N = regional lymph nodes
M = distant metastasis
Which tumor have a better prognosis, those + for ER or PR or those + for Her2/neu?
Better = ER or PR

Worse = Her2/neu
Chemotherapy given to patients with tumors expressing Estrogen Receptor
What does the term "Biphasic Tumors" mean?
Tumors that arise from both Intralobular Stroma & Epithelium
List the 2 Biphasic Benign Breast Tumors
1. Fibroadenoma

2. Phyllodes tumor
Most common benign tumor of the female breast in women < 35 years of age
What are the gross features of Fibroadenomas?
1. round, sharply demarcated rubbery tumor

2. freely movable
What Breast tumor is this?
-Stroma = intralobular stroma, loose, myxomatous to hyalinized
-Ducts = elongated & branching; compressed by stroma to curvilinear slits
What breast tumor is this?
Low grade neoplasm that rarely metastasizes & usually occurs in older age (50-60)
Phyllodes tumor
Breast tumor histology:
-mitotic activity
-nuclear pleomorphism
-infiltrative borders
-Leaf-like pattern
Phyllodes tumor
Phyllodes tumor
-stroma is more cellular than Fibroadenoma
-leaf-like pattern
What Breast tumor is seen here?
What is the treatment for Phyllodes tumors?
Local excision with wide margins or Mastectomy to avoid local recurrences
Breast tumor that arises from INTERLOBULAR stroma & is usually a complication of radiation therapy
Benign tumor that occurs in middle-aged women that arises from the major lactiferous ducts & presents with bloody nipple discharge
Intraductal Papilloma
Describe the features of the Male Breast
1. resembles the immature female breast

2. consists of large to intermediate sized ducts

3. NO Terminal Ductal Lobular Units
Unilateral or bilateral subaerolar enlargement of the male breast
Gynecomastia is an important indicator of what?
-testicular tumor
-Cirrhosis of the liver
-Klinefelter's syndrome
-Drugs - Spironolactone (blocks Androgen receptors)
What is the histologic appearance of Gynecomastia?
1. Micropapillary hyperplasia of ductal epithelium

2. Periductal hyalinization & fibrosis
-periductal hyalinization & fibrosis
What is this?
-micropapillary hyperplasia of ductal epithelium
What is seen here?
Are Male Breast CA's common or rare?
Rare = <1% of all breast cancers
What type of CA are most Male Breast CA's?
Invasive Ductal Carcinoma

**Lobular CA's are also seen
T or F: Invasion of the chest wall muscles is more frequent in Male Breast CA