Breast Cancer Pathology

Question 1

The incidence of breast cancer increased in the 1980s due to _______________.

Answer 1

increased screening

Question 2

Breast cancer dropped in the early 2000s due to ______________.

Answer 2

the stopping of long-term hormone-replacement therapy

Question 3

The vast majority of breast cancers (70% - 80%) are __________.

Answer 3

sporadic

Question 4

About _____ percent of breast cancer is due to BRCA mutations.

Answer 4

10 - 20

Question 5

Although most hereditary breast cancer is due to BRCA, there are many other genes implicated in familial breast cancer: ___________.

Answer 5

PTEN, p53, and CHEK2

Question 6

The most common tumors of the breast are _______________.

Answer 6

epithelial tumors (from the lining of the ducts and lobules)

Note: tumors can also arise from the stroma and lymphoid tissue.

Question 7

What are the three stages of epithelial hyperplasia in the breast?

Answer 7

Usual ductal hyperplasia
Atypical ductal hyperplasia
CIS

Question 8

Paget’s disease arises from ___________ epithelium.

Answer 8

ductal

Question 9

CIS can be cured with _______________.

Answer 9

surgery

Question 10

Low-grade DCIS often expresses ____________, but is Her2/neu-negative. High-grade DCIS is just the opposite.

Answer 10

hormone receptors

Question 11

Paget’s disease starts out as _____________.

Answer 11

crusty, dry nipples

Question 12

What cells are typical of Paget’s disease?

Answer 12

Large cells with cleared-out cytoplasm

Question 13

LCIS looks really ________________.

Answer 13

monotonous

Question 14

How is lobular carcinoma distinguished from ductal carcinoma?

Answer 14

Lobular Lacks E-cadherin and ductal has it.

Question 15

_____________ is often multicentric and bilateral.

Answer 15

LCIS

Question 16

Invasive carcinoma most often arises in the __________ quadrant.

Answer 16

superolateral

Question 17

_______________ can invade dermal lymphatics.

Answer 17

Invasive inflammatory

Question 18

True or false: ductal carcinoma has a worse prognosis.

Answer 18

False. If matched stage for stage, ductal and lobular carcinomas have the same prognosis.

Question 19

Which carcinoma presents as “Indian file” lines?

Answer 19

Invasive lobular carcinoma

Question 20

_____________ is a type of ductal carcinoma that has an excellent prognosis.

Answer 20

Tubular carcinoma

Question 21

Mucinous carcinoma tends to express ____________.

Answer 21

hormone expression

Question 22

Talk about how hormone receptors and Her2/neu affect prognosis.

Answer 22

Best prognosis: hormone receptor positive
Intermediate prognosis: Her2/neu positive
Worst prognosis: negative for ER, PR, and Her2/neu

Question 23

_______________ will appear with few epithelial cells and lots of pale material.

Answer 23

Mucinous carcinoma

Question 24

What is the exception to the rule that triple-negative breast cancers have a poor prognosis?

Answer 24

Medullary carcinoma

It is negative for all, but typically has a good prognosis.

Question 25

Medullary carcinoma presents with ______________.

Answer 25

lymphocytic infiltrate and syncytial growth

Question 26

______________ is not encapsulated but is still strangely well circumscribed.

Answer 26

Medullary carcinoma

Question 27

Metaplastic carcinoma typically grows very fast and can present with _______________ on histologic examination. It can develop out of invasive ductal carcinoma.

Answer 27

heterologous tissue growth (like bone)

Question 28

Which neoplasm can present with either lack of differentiation or chondroid-like growth?

Answer 28

Metaplastic carcinoma

Question 29

Radiation therapy raises future risk of _______________.

Answer 29

angiosarcoma, a stromal tumor

Question 30

Where does the name phyllodes come from?

Answer 30

Leaf-like!

Phylogeny = branching like a leaf

Question 31

Which hematologic malignancy “loves” to home in on carcinomas of the breast?

Answer 31

CLL (which can often appear alongside a breast tumor)

Question 32

Most breast neoplasms have what molecular signature?

Answer 32

ER +

Her2/neu –

Question 33

What molecular signature is associated with breast cancers arising from Li-Fraumeni syndrome?

Answer 33

Her2/neu +

Question 34

Which chromosome is the Her2 gene on?

Answer 34

17

Think of the Broken Social Scene song “Anthems for a 17-Year-Old Girl.”

Question 35

What type of protein is BRCA?

Answer 35

Tumor suppressor (both types)

Question 36

_____________ presents with expanded ducts with punched out holes.

Answer 36

DCIS

Question 37

In terms of risk, what is the difference between DCIS and LCIS?

Answer 37

LCIS raises risk of cancer bilaterally while DCIS raises risk of cancer ipsilaterally.

Question 38

What type of breast cancer presents with sparse stroma, no mucin, and occasional bizarre giant cells?

Answer 38

Medullary carcinoma

Question 39

______________ raises risk of breast sarcoma.

Answer 39

Radiation (say, from a prior breast cancer)

Question 40

Her2 is found on the _________ chromosome.

Answer 40

17th

Question 41

For breast cancer, what’s the difference between stage II and stage III?

Answer 41

III has more than 3 lymph nodes involved

Question 42

Which two cancers do not overexpress Her2/neu?

Answer 42

Medullary and mucinous

Question 43

What is metaplastic carcinoma?

Answer 43

Any carcinoma with non-glandular growth (such as squamous cell, spindle cell, or heterologous cancer)

These are usually ER/PR-negative

Question 44

The majority of breast cancers proceed down the ____________ molecular pathway.

Answer 44

ER-positive

Question 45

Only about _________ percent of breast cancers are Her2-positive.

Answer 45

20