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Flashcards in Benign Breast diseases Deck (99)
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1
Q

When does mammary tissue maximize?

A

Age 20

2
Q

Why are mammograms much better after age 50?

A

Replacement of breast tissue with fatty tissue

3
Q

Where does most of the lymph drain from the breast?

A

Axillary nodes

4
Q

What should be done if there is thickening of breast tissue?

A

Follow it in 2-3 months

5
Q

What should be done if there is a benign mass?

A

Imaging

6
Q

What should be done if there is a clinically suspicious mass?

A

imaging and bx

7
Q

Fixed to the chest wall = benign or malignant?

A

Malignant

8
Q

Bilateral/unilateral nipple discharge is concerning for malignancies?

A
Bilateral = benign
Unilateral = malignant
9
Q

What type of imaging is useful for young women? Older women?

A

US for young

Mammography for older

10
Q

True or false: imaging should always be done before bx. Why or why not?

A

True, since bx will distort tissue

11
Q

Is there a risk of breast cancer with non-proliferative breast masses? Proliferative? Atypical hyperplasia?

A

No increase in risk for nonproliferative, but 2x risk for proliferative, and 5x risk for atypical hyperplasia

12
Q

What are the two major types of atypical hyperplasia?

A

-atypical ductal or lobular

13
Q

What are the non-proliferative disorders of the breast? (4)

A

Cysts
Apocrine metaplasia
Duct ectasia
Calcifications

14
Q

What is duct ectasia?

A

Dilated duct that widens thicken, and fill with fluid, d/t milk

15
Q

Cysts are derived from what part of the breast?

A

Terminal ductal lobular unit

16
Q

What is the rate of malignancy with complex breast cysts?

A

20-43%

17
Q

True or false: any complex cyst should have cytology performed

A

True

18
Q

When should an FNA be performed for breast masses?

A

If not clear whether mass is cystic or solid

19
Q

When particularly should f/u for breast cysts be performed?

A

Discordance b/t imaging and path results

20
Q

What are the imaging characteristics of breast cysts? (3)

A
  • Thick walls
  • Cystic fluid
  • Anechoic and echogenic components
21
Q

What are the 4 major causes of abscesses of the breast?

A
  • Mastitis
  • Lactational abscess
  • Non-lactational abscess
  • Post-operative
22
Q

What is the most common infectious agent for breast cysts? treatment?

A

Staph Aureus = dicloxacillin

MRSA = vanco

23
Q

What are the four major proliferative lesions of the breast?

A
  • Fibroadenomas
  • Fibromatosis
  • Adenomas
  • Intraductal papillomas
24
Q

What are the gross characteristics of fibroadenomas?

A

Spherical or multilobulated

Firm, rubbery

25
Q

What do fibroadenomas contain?

A

Epithelial and stromal components

26
Q

What are Juvenile/giant fibroadenomas?

A

Adolescent and young adults, histologically typical , but can grow rapidly and cause overlying skin change

27
Q

What are lactating adenomas?

A

Benign stromal tumor that occurs only in association with gestation, and is typically seen from the 3rd trimester through the period of lactation

28
Q

What are the gross characteristics of lactating adenomas? Prognosis?

A

Firm, mobile, and nontender mass that regresses spontaneously with cessation of breastfeeding

29
Q

What is the treatment for lactating adenomas?

A

Bromocriptine or surgical excision

30
Q

Is there a role of oral contraceptive in treating lactating adenomas?

A

No

31
Q

When is surgical resection of lactating adenomas indicated?

A

Deferred until the resolution of lactational changes

32
Q

What are the three major causes of bloody nipple discharge?

A
  • Solitary intraductal papillomas
  • ductal hyperplasia
  • Malignancy
33
Q

What should always be done with bloody nipple discharge?

A

Bx

34
Q

What is the most common cause of bloody nipple discharge?

A

Intraductal papillomas

35
Q

What are the gross characteristics of intraductal papillomas?

A

Small, non-palpable that is close to the nipple, or beneath the areola.

36
Q

Are intraductal papillomas premalignant?

A

No

37
Q

What is the treatment for intraductal papillomas?

A

Duct excision

38
Q

What is atypical ductal hyperplasia?

A

Part of a spectrum between normal breast tissue and DCIS

39
Q

What are the gross characteristics of atypical ductal hyperplasia?

A

No sharp demarcation

40
Q

Is there an association between atypical ductal hyperplasia and in situ carcinomas?

A

Yes

41
Q

What is the treatment for atypical ductal hyperplasia? Why?

A

Complete excisional bx since it may lead to malignancies (although it itself is not a malignancy)

42
Q

Are atypical Lobular hyperplasia associated with CA?

A

Yes

43
Q

Is atypical lobular hyperplasia associated with imaging findings or calcifications?

A

No

44
Q

What is the treatment for atypical lobular hyperplasia?

A

Observation to mastectomy

45
Q

What are the two types of hyperplasia that may lead to malignancy?

A

Ductal and lobular

46
Q

What is fibrocystic disease? Clinical features? S/sx? What alters the s/sx?

A

Benign proliferation of fibrotic breast tissue that usually occurs on the outer quadrants.

Lumpy, painful breasts with discharge, that changes in response to hormones and caffeine.

47
Q

What is the effect of fibrocystic disease with the hormonal cycle? Caffeine?

A

Changes in response to the menstrual cycle and increase caffeine intake

48
Q

What is the treatment for fibrocystic disease?

A

d/c hormones and avoid caffeine—95% respond to this

49
Q

What is Mondor’s disease? S/sx? Treatment?

A
  • Rare Phlebitis of superficial breast veins
  • Abrupt onset of superficial pain and edema and erythema of the area, possibly with a mass
  • Self limiting and benign
50
Q

What are the top three leading causes of cancer death in women?

A
  1. Lung
  2. Breast
  3. Colon
51
Q

Most carcinomas of the breast arise from where?

A

The epithelium at the terminal duct lobular unit

52
Q

What are the top three leading causes of cancer death in men?

A
  1. Lung
  2. Prostate
  3. Colon
53
Q

What are the top three cancers by incidence in women?

A
  1. Prostate
  2. Lung
  3. Colon
54
Q

What are the top three cancers by incidence in men?

A
  1. Breast
  2. Lung
  3. Colon
55
Q

Why is postmenopausal obesity a risk factor for the development of breast cancer?

A

Adipose tissue produces estrogen, which may influence estrogen sensitive breast lesions

56
Q

True or false: multiparity is a risk factor for breast disease

A

False-nulliparity is

57
Q

Which is more concerning for the development of cancer: dense breast tissue, or fatty breast tissue

A

Dense

58
Q

What chromosome is the BRCA1/2 gene located on?

A

17

59
Q

What is the risk of breast cancer by age 90?

A

1 in 8 (12.5%)

60
Q

What percent of breast cancers in the US are associated with the BRCA gene?

A

5-10%

61
Q

True or false: most breast cancers are sporadic, and not inherited

A

True

62
Q

When is BRCA testing indicated? (3)

A
  • Family h/o breast CA at young age
  • New diagnosis under 45
  • Triple receptor negative breast cancer
63
Q

What is N1?

A

1-3 axillary lymph nodes

64
Q

What is N2?

A

4-9 axillary lymph nodes

65
Q

What is N3?

A

Spread to axillary nodes and internal mammary nodes (more than 10 nodes)

66
Q

What is hyperplasia of the duct due to?

A

May be due to delayed differentiation, rather than genetic damage

67
Q

What defines atypical ductal hyperplasia?

A

Alterations of cell adhesion and polarity as the epithelium begins to pile up and distended acini

68
Q

What defines the transition from DCIS to invasive CA?

A

Breakage through the BM

69
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma

70
Q

Where does Invasive ductal carcinoma begin?

A

Mild duct epithelium of the TDLU

71
Q

What percent of breast cancers are infiltrating ductal CA?

A

80%

72
Q

Where does Invasive lobular carcinoma begin?

A

Milk producing glands lobules)

73
Q

What percent of breast cancers are invasive lobular carcinoma?

A

10%

74
Q

What are grades 1-3 of breast cancer?

A

1 = well differentiated
2 = moderately
3 =poorly

75
Q

What fraction of breast cancers have at least one estrogen/progesterone receptor?

A

2/3

76
Q

What is the chemotherapy drug that antagonizes estrogen receptors?

A

Tamoxifen

77
Q

What is the HER2/Neu receptor?

A

Y-kinase

78
Q

What is the malignancy potential with HER2/neu breast cancers?

A

Tend to grow faster and spread more rapidly

79
Q

What is the drug that targets HER2/Neu specifically?

A

Trastuzumab

80
Q

What are the characteristics of Triple negative breast cancers?

A

Fast and hard to treat

81
Q

True or false: ER/PR+, HER2/Neu - is the majority of invasive breast cancer status

A

True

82
Q

What is inflammatory breast cancer?

A

Lymphatic invasion of the skin that produces a characteristics peau d’orange texture and erythema

83
Q

How do you diagnose inflammatory breast cancer?

A

Punch Bx

84
Q

What four types of breast tumors have a better prognosis than IDC, but are treated like IDC?

A
  • Medullary
  • Mucinous
  • Papillary
  • Tubular
85
Q

What is Paget’s disease of the nipple? What is it associated with? How common is this?

A
  • A type of breast cancer that starts in the breast ducts, and spreads to the skin around the nipple.
  • Almost always associated with DCIS
  • It is rare.
86
Q

What is the clinical appearance of paget’s disease of the nipple? s/sx?

A

Crusted, scaly, and red with areas of bleeding or oozing

Burning or itching

87
Q

What is the treatment for paget’s disease of the breast?

A

Mastectomy

88
Q

What is the screening modality for ages 25-40?

A

q1-3 breast exams and edu

89
Q

When do mammographies start? How often?

A

40+, annually

90
Q

What are the three major breast imaging options?

A
  • Mammography
  • US
  • MRI
91
Q

What is BRADS 1-6?

A
1 = normal mammography
2 = benign finding
3 = probably benign, f/u
4 = Maybe malignant
5 =Strongly suggestive of malignant
6= known malignancy
92
Q

What is the single most important determinant of prognosis for breast CA?

A

Axillary lymph node involvement

93
Q

How do you bx axillary nodes?

A

Sentinel lymph node biopsy (SLN bx). If negative in this node, then no need to resect further nodes.

94
Q

How is sentinel lymph node bx performed?

A

Inject radioactive Tc and use a geiger counter to locate

95
Q

What is the treatment outcome difference between lumpectomy + sentinel lymph node bx + XRT, compared to mastectomy?

A

Same outcome

96
Q

What is contralateral breast cancer risk after a primary dx of unilateral breast cancer?

A

low

97
Q

What is the treatment for locally advanced breast cancer?

A

Neoadjuvant chemo, then surgery

98
Q

True or false: any atypia needs to be removed

A

True

99
Q

What is T1 - T4 stages of tumor size for breast cancer?

A
T1 = 2 cm or less
T2 = 2-5 cm
T3 = More than 5 cm
T4 = Any size growing into chest wall