Question
Explain the molecular basis of classification and prognostic features of Carcinoma
breast.
Q68 marksShort Essays
Answer
Molecular classification of breast carcinoma (based on gene expression profiling, approximated by IHC surrogates)
- Luminal A: ER-positive, PR-positive, HER2-negative, low Ki-67 — best prognosis, typically low-grade, responsive to hormonal therapy
- Luminal B: ER-positive, variable PR, HER2-positive or negative with high Ki-67 — intermediate prognosis, more aggressive than Luminal A
- HER2-enriched: ER/PR-negative, HER2-positive — aggressive, but targetable with anti-HER2 therapy (trastuzumab), improving previously poor prognosis
- Basal-like/triple-negative: ER-negative, PR-negative, HER2-negative — most aggressive subtype, no targeted hormonal/HER2 therapy available, associated with BRCA1 mutations, poorest prognosis
Prognostic features
- Tumour size: Larger tumours carry worse prognosis
- Histological grade: Based on tubule formation, nuclear pleomorphism, mitotic count (Nottingham grading)
- Lymph node status: Single most important prognostic factor — presence and number of involved nodes correlates strongly with outcome
- Hormone receptor status (ER/PR): Positive status confers better prognosis and predicts response to hormonal therapy
- HER2/neu status: Overexpression historically worse prognosis, but predicts response to targeted anti-HER2 therapy
- Ki-67 proliferation index: Higher index indicates more aggressive behaviour
- Lymphovascular invasion: Associated with higher risk of metastasis
- Histological subtype: Certain special types (e.g., tubular, mucinous) have better prognosis than invasive ductal carcinoma NST
- Distant metastasis: Presence indicates stage IV disease, poorest prognosis
- 1Carcinoma of the Breast Risk Factors Grading and Prognosis
Other Years Asked
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She underwent FNAC followed by lumpectomy. Gross examination of the specimen
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a) Left anterior descending b) Left circumflex
c) Right anterior descending d) Right coronary artery
Long Essays. (2x10=20)
2. A 65 year old male complains of dyspepsia, nausea, weightloss and loss of appetite since 6 months.
Clinical examination reveals a mass palpable in the epigastric region. Endoscopy shows a proliferative
growth near the stomach near the lesser curvature
a) What is the probable diagnosis.
b) Describe the aetiopathogenesis of the lesion.
c) Classify and describe the morphology of the disease.
d) Enumerate the usual sites of metastasis of this lesion. (1+2+5+2)
3. Describe in detail the etiopathogenesis, clinical features, morphology and complications of
Atherosclerosis.
Short Essays. (6X6=6)
4. Risk factors and prognostic factors of carcinoma breast.
5. Types of Emphysema.
6. Germ cell tumors of testis.
7. Classification of intestinal polyps.
8. Hashimotos thyroiditis – Aetiopathogenesis and morphology.
9. Osteogenic sarcoma – Aetiopathogenesis and morphology.
Short Answers. (6x4=24)
10. Retinoblastoma.
11. Hydatidiform mole.
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13. Write briefly on the barriers to implementation of health as a universal right.
14. Renal calculi – morphology and complications.
15. Basal cell carcinoma2024 December (Supplementary) (2019 Scheme)MCQ · 1 mark
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