Morphology of Breast Carcinoma

by Carlo Raj, MD

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    00:01 Our topic now brings us to breast cancer.

    00:04 A couple of things that we want to make sure that we go through with malignant breast cancer is, well, who is your patient and what are some risk factors.

    00:14 A lot of this we’ve kind of already talked about with our molecular pathology.

    00:18 Let’s put everything together here.

    00:20 Commonly, you’ll find this postmenopausal, not always.

    00:24 Arises from the mammary duct epithelium and, later on, when we get into clinical anatomy, I’ll show you the glands that are affected.

    00:33 Students often get the lactiferous and the lobule confused, but they’re two different entities.

    00:39 The lactiferous sinus will be located by the breast.

    00:41 The lobule will be closer to the stroma.

    00:45 What are you worried about with breast cancer especially if it’s malignancy? Let’s set up the foundation here.

    00:50 You’re going to test your patient for estrogen and progesterone.

    00:54 We call this ER/PR, estrogen or progesterone receptor positive.

    00:58 If your patient tests positive for estrogen receptor, then this to you means that maybe perhaps you can use drugs such as tamoxifen or raloxifene.

    01:09 The other major genetic test that you want to keep in mind is called ERBB2.

    01:13 You have two breasts, ERBB2.

    01:17 Another name for this is HER2/neu.

    01:21 You focus upon HER2 and in neoplasia, we talked about HER2/neu and we call this an epidermal growth factor receptor.

    01:30 This is an epidermal growth factor receptor pathology.

    01:33 And if this takes place and you find this to be positive, then you should be thinking about drugs such as your trastuzumab.

    01:41 The number one prognostic indicator, I’ve mentioned this a few times, will be the axillary lymph node.

    01:46 And if the axillary lymph node is involved, then your prognosis drops like crazy.

    01:51 The most common place that you would find tumors in general would be -- what part of the breast? I’ll show you a picture coming up in which majority of percentage of your breast tumors will be located in the upper quadrant.

    02:04 Upper outer quadrant.

    02:07 What are my risk factors for malignant breast cancer? They include the following: Estrogen exposure, so any female that has exposure to increased estrogen including hormone replacement therapy, including early menarche, late menopause, including the fact that she might be suffering from polycystic ovarian syndrome.

    02:29 Increased total number of menstrual cycles, that would then mean what? Increased exposure to estrogen.

    02:35 Use your physiology to understand why increased number of menstrual cycles could increase the risk.

    02:42 Live birth and obesity.

    02:44 Obesity once again, the more obese a female is, the more adipocyte, and the name of the enzyme there is called? Aromatization.

    02:53 Therefore, once again, increased estrogen.

    02:56 Eventually, the risk factor that you want to keep in mind is obesity associated with increased estrgen exposure.

    03:04 Remember a couple patients here, just a female who’s obese or polycystic ovarian syndrome.

    03:10 Many of your patients especially postmenopausal are associated with obesity.

    03:15 That, you very much want to keep in mind.

    About the Lecture

    The lecture Morphology of Breast Carcinoma by Carlo Raj, MD is from the course Breast Disease.

    Included Quiz Questions

    1. HER2/neu receptor positive
    2. Estrogen receptor positive
    3. Intraductal papilloma
    4. Mammary duct ecstasia
    5. Progesterone receptor positive
    1. Tamoxifen
    2. Trastuzumab
    3. None of the answers are correct
    4. Total mastectomy
    5. Oral contraceptives
    1. Excessive estrogen exposure is negatively correlated with incidence.
    2. It arises from mammary duct epithelium or lobular glands.
    3. Its most common location is in the upper-outer quadrant of the breast.
    4. The axillary node involvement is the single most important prognostic factor.
    5. It commonly affects postmenopausal women.

    Author of lecture Morphology of Breast Carcinoma

     Carlo Raj, MD

    Carlo Raj, MD

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    don't" like it
    By Ibrahim A. on 11. October 2017 for Morphology of Breast Carcinoma

    don't" like it deficient im sorry Dr. Raj but this is my opinion