Pathology Quiz: Peritoneal Cavity and Vertebral Metastases
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Questions and Answers

Which of the following tumor characteristics is associated with a worse prognosis in breast cancer?

  • Tumor size less than 1cm
  • Tumor with a discrete lymph node involvement
  • Tumor located in the upper outer quadrant
  • Tumor size greater than 2cm (correct)
  • What is the primary reason for the poor prognosis of breast cancer in pregnant women?

  • Increased risk of metastasis to the liver and peritoneum
  • Hormonal stimulation of the tumor by estrogen and progesterone
  • Impaired immunity due to pregnancy-related immunosuppression
  • Delayed diagnosis due to nodular changes in the breast during pregnancy (correct)
  • Which of the following patient-related factors is associated with a worse prognosis in breast cancer?

  • Non-invasive ductal carcinoma in situ
  • Male sex (correct)
  • Obesity
  • Older age
  • What is the most important prognostic factor among tumor-related factors in breast cancer?

    <p>Lymph node involvement</p> Signup and view all the answers

    Which of the following tumors has a good prognosis in breast cancer?

    <p>Mucinous carcinoma</p> Signup and view all the answers

    What is the significance of internal mammary lymph node involvement in breast cancer?

    <p>It is a frequent site of metastasis in breast cancer</p> Signup and view all the answers

    Which of the following breast cancer stages has the best prognosis?

    <p>Stage I</p> Signup and view all the answers

    What is the significance of skin and nipple invasion in breast cancer?

    <p>It has a poor prognosis</p> Signup and view all the answers

    What is the effect of obesity on breast cancer prognosis?

    <p>It worsens the prognosis</p> Signup and view all the answers

    Which of the following is a tumor-related factor that affects breast cancer prognosis?

    <p>Pathology type</p> Signup and view all the answers

    Study Notes

    Breast Cancer Pathology and Staging

    • Cells can seed into the peritoneal cavity
    • Intercostal veins can metastasize to the vertebral plexus (Batson plexus), causing:
      • Nodules in Douglas pouch
      • Vertebral metastases (Lumbar vertebrae), which are osteolytic (90%), osteosclerotic (5%), or mixed (5%)

    TNM Staging

    • Tx: Primary tumor cannot be assessed
    • T0: No evidence of primary tumor
    • Tis: Carcinoma in situ (ductal or lobular CIS, Paget's disease without mass)
    • T1: < 2cm (Tmic: microinvasion < 1mm, T1a: >0.5cm, T1b: >0.5-1cm, T1c: 1-2cm)
    • T2: 2-5 cm
    • T3: >5 cm
    • T4: Any size with:
      • T4a: Fixation to chest wall (ribs, intercostal ms, serratus anterior ms)
      • T4b: Skin involvement (direct infiltration, ulceration, peaud orange, satellite nodules)
      • T4c: a & b
      • T4d: Mastitis carcinomatosis

    Lymph Node Metastasis

    • Nx: Regional L.N. cannot be assessed
    • N0: No regional L.N. metastasis
    • N1: Ipsilateral mobile axillary L.N.
    • N2:
      • A: Ipsilateral matted axillary L.N.
      • B: Ipsilateral internal mammary L.N. without axillary L.N.
    • N3:
      • A: Ipsilateral infraclavicular L.N.
      • B: Ipsilateral internal mammary with axillary L.N.
      • C: Ipsilateral supraclavicular L.N.
    • M0: No evidence of metastasis
    • M1: Distant metastasis or contralateral breast or L.N.

    AJCC Staging

    • American Joint Committee Cancer (AJCC) staging system

    Pathology

    • Skin changes due to direct infiltration:
      • Skin dimpling, tethering, and puckering (earliest sign)
    • Skin changes due to lymphatic infiltration:
      • Peau d'orange (thick, non-pitting edematous skin)
      • Cancer en cuirasse (late sign, pathognomonic)
      • Cancerous satellite nodules (late sign, pathognomonic)

    Prognostic Factors

    • Patient-related factors:
      • Age (young age = worse prognosis)
      • Sex (male = worse prognosis)
      • Pregnancy (worse prognosis)
      • Obesity (bad prognosis)
    • Tumor-related factors:
      • L.N. involvement (most important)
      • Number of L.N.
      • Size (< 1cm = better, > 2cm = worse)
      • Discrete vs. matted L.N.
      • Level of L.N.
      • Site (lower inner quadrant = worst)
      • Metastasis (presence of distant metastases = worse)
      • Pathology type (medullary, mucinous = better prognosis)

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    Description

    Test your knowledge on pathology concepts related to the peritoneal cavity, vertebral metastases, and TNM staging.

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