Rp: Breast Pathology (#20)

Front 1

What is a fibroadenoma?
- microscopically?
- what do carcinomas feel like, in contrast?

Back 1

solitary, frim, rubbery, MOBILE mass found in young women. Grows slowly.
- biphasic neoplasm comprised of benign ductal epithelium and benign stromal cells with distinct architectural pattern, very well circumscribed.
- often "rock-hard"

Front 2

What is the presentation of an intraductal papilloma?
- seen microscopically?

Back 2

unilateral bloody nipple discharge, subareolar intraductal mass.
- intraductal papillary neoplasm w/ fibrovascular cores lined by benign ductal and myoepithelial cells.

Front 3

Breast cancer is the __ most common cause of cancer mortality in women.

Is it the most common malignancy of women in the US?

Which race has the higest incidence rate?

Back 3

2nd (lung is first).

Yes.

White women.

Front 4

What presents following trauma as a firm mass w/ indistinct borders --> v. concerning on mammogram (irregular margins)?
- what is seen histologically?

Back 4

Fat-necrosis
- fat necrosis w/ foamy histiocytes, inflammation, and multinucleated giant cells.

Front 5

Which confers a higher risk of lifetime breast cancer, BRCA 1 or 2?

Does non-proliferative fibrocystic change confer an increased breast cancer risk?

How about proliferative fibrocystic change w/o atypia?

Back 5

1 (85%)
2 (40%)

No, Yes (1.5-2x)

Front 6

What is the evolution of breast cancer?
- does all DCIS turn into invasive carcinoma?
- does DCIS have metastatic potential?
- does DCIS usually present as a palpable mass?
+ most common method of detection?
+ to where are the carcinoma (DCIS) cells confined?

Back 6

Ductal hyperplasia --> atypical ductal hyperplasia --> DCIS --> invasive ductal carcinoma
- no.
- no.
- no.
+ identifying calcifications on mammogram.
+ w/i ducts and lobules; NO involvement of breast stroma. They're surrounded by myoepithelial cells and/or basement membrane.

Front 7

RE: the histologic patterns of DCIS:
- what do we call the high-grade nuclei w/ central necrosis that is often associated w/ microcalcifications?
- carcinoma fills/distends the ducts?
- Forms a rigid "Roman bridge" gladular pattern?
- tufts that emanate from a single epithelial layer?
- intraductal proliferation w/ fibrovascular support?

Back 7

- comedo (high-grade form)
- non-comedo:
+ solid
+ cribriform
+ micropapillary
+ papillary

Front 8

Lobular carcinoma in situ (LCIS) is a precursor or a risk factor for invasive cancer in BOTH breasts?
- tx surgx?
- hetero/monotonous cell population? Low/high nuclear grade?
- produces masses or calcifications?

Back 8

risk factor, unlike DCIS which is considered a precursor lesion.
- no
- mono, low.
- no.

Front 9

What often shows up as a stellate (spiculated) density on mammongram w/ or w/o associated calcifications?
- can all breast cancers be seen on mammography?
- what does this look like pathologically?

Back 9

Invasive carcinoma of the breast
- no
- gross: firm, tan-white, spiculated; micro: invasive

Front 10

Of the invasive breast cancer types, which accounts for 75-80% of tumors?
- what do you need to dx inflammatory type?

Back 10

Ductal carcinoma (NOS)
- need the clinical hx of red swelling, orange peel, etc... can't do it just pathologically.

Front 11

What is the second most common form of invasive breast cancer?
- why it is important to note this one?
- most are hormone receptor +/-? Her2neu?
- what do you see microscopically?
+ see a desmoplastic stromal response (what is commonly seen as surrounding fibrosis in NOS)?

Back 11

Infiltrating lobular carcinoma
- often more clinically/mammographically occult; tends to be larger than clinically estimated; increased propensity to be bilateral/multicentric; increased mets to unusual sites
- +, -
- linear (make lines!), single cell or targetoid pattern of malignant cells w/ LOW nuclear grade and generally minimal mitotic activity.
- no.

Front 12

In the inflammatory type of invasive breast cancer, what do you see in the dermal lymphatic spaces?

Back 12

tumor cells.

Front 13

Do you ever call a cancer M0 w/o an autopsy?
- describe the M stages.

What is the MOST IMPORTANT prognostic factor re: invasive breast cancer?

Back 13

no.

MX- Distant metastases cannot be assessed
M0- No distant metastases
M1- Distant metastases present

Regional lymph node status.

Front 14

Describe T staging.

Describe N staging.

Back 14

T1 < 2 cm
T2 > 2.0 cm but < 5.0 cm
T3 > 5.0 cm
T4 skin involvement as ulceration or satellite nodules; invasion of chest wall; inflammatory changes

NX- Cannot be assessed
- Previously removed or not studied
N0- No regional nodal metastases
N1- Metastasis to moveable ipsilateral axillary lymph nodes
N2- Metastases in ipsilateral axillary nodes fixed or matted

Front 15

What unusual sites can lobular carcinoma met to?

Back 15

gynecologic tract, GI tract, etc.

Front 16

What is by far the most common invasive breast cancer type in males?
- associated mutation?
- present at more advanced stage?

Back 16

infiltrating ductal carcinoma.
- BRCA2
- yes.

Front 17

What is Paget's dz?
- What is it almost always associated with (>95%)?
- What benign skin lesions can mimic the localized skin erythema, scaling, and ulceration typically involving the nipple?
- what is seen histologically?

Back 17

Epidermal involvement of the nipple or areola by malignant cells, singly or in small nests
- underlying in situ or invasive carcinoma
- eczematous dermatitis
- Tumor cells in small nests or singly with abundant pale cytoplasm and atypical nuclei infiltrating the skin epidermis

Front 18

The large majority of invasive tumors are HR +/-?
- is this a good thing?

Back 18

+ (~75%)

yes, it's associated w/ better prog.

Front 19

What can be used to detect HER2 amplification?

Back 19

dual color FISH

Front 20

What do we call a biphasic (epithelial AND stromal) tumor w/ risk for local recurrence or mets, depending on the grade?
- is it common?
- clinical presentation?
- gross histo?
- micro?
- which grade is at risk for local recurrance?
- mets?
- do you see mitotic figures? Is this like or unlike fibroadenomas?

Back 20

Phyllodes Tumor
- rare
- older age than fibroadenoma (~45y mean), Large size and/or hx of rapid growth favors phyllodes over fibroadenoma.
- Discrete, solitary, circumscribed firm mass.
- "leaf-like" processes
- low
- high; tumor behaves like sarcoma.
- yes, unlike.