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Which cancers are bilateral and multifocal?
- Cysts and fibrosis
- lobular carcioma in situ
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Which cancers are b/l?
Infiltrating lobular cancer of the breast
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Which cancers have a poor prognosis?
- Those with a high proliferation rate
- Overexprssion of HER2/NEU
- Angiogenesis (increased likelihood of METS)
- Multiple intraductal papillomas likely to become malignant
- Infiltrating lobular carcinoma of the breast
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Prominent lymphocytic infiltrate
Medullary carcinoma of the breast
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Inflmmatory component
Inflammatory cancer (rapidly spreading tumor)
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infiltrating lobular cancer
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An absence of ERs and PRs affects tx how?
less responsive to hormonal therapy, but more responsive to chemo
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Which type of fibrous masses are more likely to progress to cancer?
- Fibrocystic changes: benign to increased risk of carcinoma
- Fibroadenomas RARELY malignant
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Which masses have a minimal or no increased risk for cancer?
fibrosis, mild hyperplasia, ductal papillomatosis
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Which masses have a slightly increased risk for cancer?
moderate to florid hyperplasia, ductal papillomatosis,
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Which masses have a significantly increased risk for cancer?
atypical hyperplasia
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Where is breast cancer most likely to spread?
- the IPSILATERAL LN first
- Bones, lungs, liver
- may invade perineural, perivascular spaces and BVs
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Tumoer adherent to muscles or deep fascia
fixation
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rapid spreading tumor causing an acute inflammatory reaction
inflammatory cancer
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When is microcalcification common and uncommon?
infrequent in intraductal cancer, more common in infiltrating cancer
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Which breast tends to be affected more?
left
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Most breast cancers arise in what part of the breast?
upper outer quadrant in the ductal epithelium
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nipple retraction, skin dimpling (tugging on cooper's ligaments)
IDC
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Bleeding, whitish discharge and ulceration of the nipple
Paget's disease
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Fissured and ulcerated, oozing areola and nipple
Paget's disease
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Hyperchromatic cells with pleomorphic nuclei surrounded by a halo
Paget's disease
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What determines the prognosis of Paget's disease?
extent of ductal cancer
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Palpable lumps that can vary during menstrual cycles
fibrocystic changes
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Blue dome cysts containing turbid fluid
cysts and fibrosis
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Cysts lined by cells with granular pinkish eosinophilia
Apocrine metaplasia, associated with cysts and fibrosis
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Proliferation of cells with a duct NOT producing a clinically discrete masses
epithelial hyperplasia
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hard rubbery consistency
sclerosis adenosis
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Masses of small gland patterns with firbous stroma
sclerosing adenosis
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Discrete palpable, encapsulated, freely moveable with tan/white color
fibroadenoma
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Leaf like, may be massive in size
Phyllodes tumor
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Papillary growth withi a duct leading to bloody nipple discharge
intraductal papilloma
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anaplastic cells that are proliferating within the DUCT, but do not permeate the BM
Intraductal carcinoma
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difficult if not impossible to palpate
lobular carcinoma in situ
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3-4 cm stony hard consistency
invasive ductal carcinoma
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Typical intraductal cancer that extends to and infiltrates the skin of the nipple and areola
Paget's disease
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Large, soft, and fleshy
Medullary carcinoma of the breast
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Soft, bulky, gray-blue mass
Colloid (mucinous) carcinoma
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Poorly circumscribed, rubbery, difficult to palpate
infiltrating lobular cancer of the breast
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Most common benign tumor of the breast
fibroadenoma
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Age range affected by fibroadenomas
3rd decade
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Fibroblastic stroma with duct like spaces
fibroadenoma
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subareolar tumor
intraductal papilloma
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rare to have nipple retraction
intraductal papilloma
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necrotic tumor tissue in the middle of ducts
comedocarcinoma, associated with intraductal carcinoma
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Most common form of breast cancer
invasive ductal carcinoma
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Dense fibrous stroma (desmoplasia) with nests or cords of tumor cells that can cause nipple retraction and skin dimpling
invasive ductal carcinoma
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Large cells not forming sheet like infiltration and lymphocytic infiltration
Medullary carcinoma of the breast
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Strands of tumor cells one cell in width (Indian filing)
Infiltrating lobular cancer of the breast
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Most common type of alteration in the breast
non-proliferative change
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Clinical and morphologic features similar to a carcinoma
sclerosis adenosis
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Benign and cured by excision
phyllodes tumor
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starburst appearance
intrdcutal carcinoma
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size of mass indicating a favorable prognosis
<2 cm, although they often aren't palpated until 3 or 4 cm
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Survival rate based on LN involvement
- None: 80% 5 year survival
- >4: 21% five year survival
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Affect of proliferative rate on tx
Poorer prognosis but respond better to chemo
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may invade perineural, perviascular spaces and blood vessels
invasive ductal carcinoma
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