Breast Flashcards
(124 cards)
1
Q
Extent of breast
A
Vertically - 2 to 6th ribs
Horizontally- sternum to midaxillary line
2
Q
Extension of breast in axilla
A
Axillary tail of spence
3
Q
Breasts are supported by
A
Suspensory ligament of Cooper
4
Q
Breast lies over?
A
Pectoralis muscle
5
Q
Dimpling of skin over breast is due to
A
Suspensory ligament of cooper pulls ligament inside
6
Q
If a cancer involves lactiferous duct, it causes
A
Retraction of nipple
7
Q
Retraction of nipple can be ?
A
Congenital
Acquired due to
Ductal ectasia - slit
Malignancy - circumferential
8
Q
Most conspicuous of sign of malignancy involving skin of breast
It is seen due to?
A
Peau d orange
Blockade of subdermal lymphatics
9
Q
Functional unit of breast?
A
TDLU
Terminal duct lobular unit
10
Q
Lymphatic drainage of breast
A
Axillary 90%
Clinical division
Ant, central, apical, lateral, posterior
Surgical division by pectoralis minor Level 1 lateral to Level 2 behind Level 3 medial Internal mammary 10%
11
Q
Rotters lymph node is seen in
A
It is interpectoral lymph node
Bw pectoralis major and minor
Level 2
12
Q
Triple assessment in breast examination
A
Clinical examination+ history Radiological Less than 40 USG More than 40 MAMMOGRAPHY Histopathology FNAC, BIOPSY
13
Q
Why mammography is not a screening tool in young female breast examination
A
Young increaaed glandular tissue, dense breast
14
Q
Best clinical examination technique for breast lump
A
Dial clock method
15
Q
Views for a mammogram
A
Craniocaudal
Mediolateral oblique
16
Q
Screening indication of mammogram
A
Annual mammography should be started at 40yrs of age
If strong family history, Risk of breast cancer more than 20%
Start screening by 35 yrs of age
If BRCA mutation
First degree relative of pt with brca mutation
Start screening at 25 yrs mri is done
17
Q
How to differentiate between benign or malignant tumor on mammography
A
Benign - well diff, halo surrounded, macrocalcification
Malignant- irregular, distorted, lymph node inv, microcalcification
18
Q
What is BIRADS
A
Breast Imaging Reporting and Data System
19
Q
Birads score 3 means
A
Probably benign
Short interval follow up (6months)
Risk of cancer 0-2%
20
Q
Usg modality is used in
A
Differentiate bw solid and cystic mass
Pregnant lady with lump
Young female with dense Breast
21
Q
Linguini sign is seen in
A
MRI
Intracapsular rupture of breast implants
22
Q
Investigation of choice in breast implants
A
MRI
23
Q
USG finding, intracapsular rupture of implant
Extracapsular rupture of implant
A
Intracapsular- Stepladder pattern
Extracapsular- snowstorm appearance
24
Q
Uses of MRI IN BREAST
A
Ioc in breast implants Diff bw multifocal and multicentric Most sensitive investigation for DCIS IOC to identify local/scar recurrence after surgery Screening of young high risk pt
25
Popcorn calcification is seen in
Fibrodenoma
26
Lead pipe pattern is found in
Fat necrosis mimics malignancy
| Secondary to trauma
27
Broken needle pattern
| Tea cup pattern
Duct ectasia
| Fibrocystic ds
28
Histopathology of breast cancer is done by
FNAC
FNNAC
TRU CUT BIOPSY
29
FNNAC is done for
Superficial lesion (breast & thyroid)
30
Tru cut biopsy is a type of
| Needle used?
Incisional biopsy
| 16G is best for breast biopsy
31
IOc in breast cancer
| Why?
```
Tru cut biopsy
As tissue is obtained
Diff bw in situ and invasive ca
ER, PR, HER NEU stat can be obtained
Less false negative rate
```
32
Tru cut biopsy is IOC in breast cancer
| other example?
Prostatic cancer
| Soft tissue sarcoma
33
Gold standard for breast lump
Excisional biopsy
34
Incidence of breast cancer in India
1 in every 21 indian women develops breast cancer
35
Imp risk factors for breast cancer
```
Age increase
Early menarche
Late menopause
Family history
Obesity
Alcohol
Smoking
HRT
Nulliparity
Maternal age at first live birth
```
36
Most common gene mutation in breast cancer
P53 in 90% of sporadic cases
37
Most common gene mutation in familial breast cancer
BRCA 1
38
Location of brca gene
| And which one is responsible for breast cancer
BRCA1 17q
BRCA 2 13q
BRCA 1> BRCA2
39
SUBTYPE OF BRCA1 breast tumor
| Most common histology
Basal subtype
| Medullary ca
40
SUBTYPE OF BRCA2 breast tumor
Luminal subtype
41
BRCA mutation predisposes a pt to which syndrome
Hereditary breast and ovarian cancer syndrome
42
Risk reduction technique if breast cancer
Bilateral prophylactic mastectomy
Bilateral salpingo-oophorectomy (Risk Reduction)
SERM - Tamoxifen
43
Most common quadrant affected in breast cancer
Upper outer
44
Single file pattern is seen in
Invasive lobular carcinoma
45
Types of invasive ductal carcinoma
| Best and worst prognosis?
Tubular best prog
Mucinous
Medullary worst prog
46
Mutation in INVASIVE LOBULAR CARCINOMA
E cadherin
47
Molecular classification of breast cancer is based on
Gene expression profiling
48
Alred score is used for
Estrogen and progesterone receptor profiling in molecular classification of breast cancer
49
Proliferation index marker is
Ki67
50
Grading to measure HER2/NEU RECEPTOR
```
0 negative
+1 negative
+2 equivocal -FISH DONE IT CAN BE
AMPLIFIED +3
NOT AMPLIFIED -NEGATIVE
+3 positive
```
51
Subtype of breast cancer with low proliferation index
| High proliferation index
Low luminal A - best prognosis
| High Basal type - triple negative - worst prognosis
52
TNBC Paradox
Good response to anthracycline chemotherapy initially, but relapse in 1.5-2 yrs
53
IOC for staging of breast cancer
| Isotope used
PET CT
| 18-FDG
54
yTNM
cTNM
MEANS
After neoadjuvant therapy -yTNM
| Clinical TNM -cTNM
55
pT1 staging is for
Pathological tumor staging
| 1 stage means tumor size more than 1 mm less than 20 mm
56
Involvement of chest wall includes following str...
| This TStage is
T4A
Chest wall inv. Serratus anterior, ribs, intercostal muscle
Pectoralis inv not considered
57
T4B is involvement of
Skin -peau d' orange, ulcer, satellite lesion
| Dimpling retraction not considered
58
Stage of matted axillary lymph nodes
N2 A
59
Most common site of distance metastasis in breast cancer
Bone
60
Most common bone metastasis
Vertebral column (Batson plexus)
61
Most common vertebrae
lumbar> thoracic
62
Metastasis type in breast cancer
Osteolytic >Osteoblastic
63
Surgery for primary breast tumor
Breast conservation surgery
| Mastectomy
64
Recurrence rate of BCS and mastectomy
LRR OF BCS -4%
| MASTECTOMY LESS THAN 1%
65
Margin status of BCS
1mm of normal tissue along with lumpectony
66
Typed of BCS
Volume displacement - when less than 15% volume resected
| Volume replacement-when more than 15% volume resected
67
Radiotherapy in mandate in BCS.
| What are contraindications of BCS.
Pregnancy
Collagen vascular ds
Prior Radiotherapy exposure
68
Technical contraindications of BCS
```
Multicentric
Multifocal
Lobular cancer (tends to be multicentric)
LABC
Large tumor to breast ratio
```
69
Radical mastectomy was described by
| It is removal of-
```
Halstead
Removal of -
Breast
Nipple areolar complex
Pectoralis major minor
Level 1,2,3 axillary lymph nodes
```
70
Incision of modified radical mastectomy
| It is removal of?
```
Elliptical Stewart incision
Breast
Nipple areolar complex
Pectoralis fascia
Level 1,2,3 axillary lymph nodes
```
71
Variant of MRM
Auchincloss pectoralis minor is retracted
Scanlon pectoralis minor is cut
Patey \\
72
Variant of MRM
Auchincloss pectoralis minor is retracted
Scanlon pectoralis minor is cut
Patey \\
73
What is simple mastectomy
Removal of breast NAC PECTORALIS fascia
| Axillary lymph nodes not removed
74
Simple mastectomy is done in
Phyllodes
DCIS
Toilet mastectomy
Fungating cancer
75
What is axillary clearance
Minimum 10 axillary lymph nodes removal
76
Complications of axillary clearance
```
Bleeding
Intercostobrachial nerve injury during mrm
Flap necrosis
Seroma
lymphedema
Scar recurrence
Phantom breast syndrome
```
77
Winging of scapula is due to
Long thoracic nerve injury
78
Most common complications of MRM
Management
Prevention
Seroma - accumulation of fluid beneath flap
Mgt
Aspirate under aseptic conditions and do pressure
Dressing,
Prevention
Insert drain and remove if output less than 40cc/ day for 2 consecutive days
79
```
What is the cause of lymphedema
Incidence
Prevention
Management
Prognosis if not treated
```
If axillary clearance and radiotherapy are given to axilla - lymphedema of UL
2-5%
PREVENTION - Sentinel LN biopsy
Management- arm stocking, exercise,
Long standing cases can develop secondary malignancy - Stewart Treves Syndrome( angiosarcoma)
80
Management of Stewart treves syndrome
Forequarter amputation
81
Most common cause of upper limb lymphedema
Post mastectomy lymphedema
82
Cancer en curasse?
Nodules cover chest wall like an armor in local/scar recurrence
83
Most common cause of phantom breast syndrome
ICBN neuralgia
84
➡️Breast 4⬅️
Q lactation Breast abscess m c cause can be?
Source of infection?
Staph aureus
| Oropharynx of child
85
Fluctuation as a late sign is seen in which abscess?
```
Breast
Parotid
Palmar
Plantar
Ischiorectal
```
86
Breast abscess occuring in peri menopausal women
Causative organism
Diagnosis can be made through?
Mgt
```
Breast abscess ass with duct ectasia
Aerobic and anaerobic
Diag by USG
Mgt
Antibiotics
Surgery-Hadfield procedure
```
87
Management of lactational breast abscess
```
Antibiotics - co amoxiclav
Analgesic
In case of pus,
Usg guided aspiration (at least 2 attempt)
if fails I&D
```
88
In management of lactational breast abscess
| After I & D next step would be to?
Suppress lactation by cabergoline to prevent fistula formation
89
In case of non healing abscess next step should be?
Suspect TB or inflammatory breast cancer
| To confirm -Biopsy from wall of lesion
90
Aberration of normal development and involution (ANDI) conditions mc in
15-25 yrs of age
25 -40 yrs of age
>40 yrs of age
Fibroadenoma
Fibrocystic disease
Fibrocystic disease
91
Most common cause of breast lump
Incidence
C/F
Diagnosis
Fibroadenoma
15-25 yrs of age
Firm mobile lump
Painless
Usg ,
mammogram -popcorn calcification
92
Types of fibroadenoma
Pericanalicular- hard
| Intracanalicular
93
Indication for surgery of fibroadenoma
```
. Painful
. Cosmetic
. Rapid increase in size
. Fam hist of breast cancer
. Giant fibroadenoma>5 cm
```
94
Types of incision used in fibroadenoma
Peri areolar incision ➡️ closure of incision by subcuticular suture
Gillard Thomas incision➡️ inframammary incision
95
Methods of scarless fibroadenoma surgery
RFA
Radio frequency ablation
MAMMOTOME
Vacuum assisted biopsy system
96
Needle used in mammotome
| Limitations of scarless fibroadenoma surgery
8G needle
Limitation
Fibroadenoma more than equal to 2cm
Away from midline
97
Other name of phyllodes tumor
| Incidence
Aka cytosarcoma phyllodes
| Occurs in 3-4th decade
98
How to diagnose phyllodes tumor
Trucut and excisional biopsy
| Number of mitotic figures and diff bw benign and malignant
99
Fnac finding of phyllodes
No role of FNAC
100
Clinical features of phyllodes
MC site of its hematogenous spread
Rapidly enlarging breast lump
Dilated veins
Lungs
101
Mgt of phyllodes tumor
Surgery-
Lumpectomy
Simple mastectomy
102
Indication of simple mastectomy in phyllodes tumor
Recurrence
Very large tumor
Malignant
103
Types of mastalgia
Cyclical and non cyclical
104
Cyclincal mastalgia is seen in
| Incidence and clinical features
Fibroadenosis
Incidence-25-40yrs
Clinical features
Pain at beginning of cycle
105
Examination, diagnosis finding of fibro adenosis
| Mgt
```
Lumpy breast
Diag by usg
Mgt
Weight reduction
Lowering of tea coffee
```
Vit e primrose oil capsule for 2 months
If pain persists
Low dose tamoxifen, danozol
106
Non cyclical mastalgia causes
| Treatment
```
Tietze syndrome (costochondritis)
Intralesional triamcinolone
```
```
Mondor disease (superficial thrombophlebitis of chest vein)
T/t analgesic
```
107
Vein involved in mondors ds
| Clinical presentation
Lateral thoracic vein
| Cord like str, pain
108
Mgt of breast cyst
Diagnosis usg
If large complex, aspirate
Bloody Residual cyst,
send for cytology and excise
Non bloody
Cyst resolve completely
Monitor pt
No need to send for cytology
109
Serous nipple discharge from
single duct
Multiple duct
Surface of nipple
```
Single and multiple duct
Pregnancy
Puberty
Cancer
Duct ectasia
```
Surface of nipple
Pagets
Eczema
110
Greenish bluish nipple discharge
Multiple duct ectasia
111
Most common cause of pathological nipple discharge
Multiple duct ectasia
112
Bloody discharge
Single duct
Multiple duct
Single-
Duct papilloma
Multiple
Cancer
Duct ectasia
113
Most common cause of bloody nipple discharge
Duct papilloma
114
Diagnosis of duct papilloma can be done by?
| Mgt
USG-ectatic duct
Cytology of nipple discharge
Ductoscopy
Mgt
Microdochetomy -tennis racket incision single duct and lump is excised
115
What leads to zuska's disease
Duct ectasia, leads to stasis of secretion and periductal mastitis k/a Zuska's Disease
116
Manifestation of Zuska's disease
| Diagnosis and management
Peri areolar abscess /sinus formation
Bluish greenish discharge (multiple ducts)
Diagnosis
USG-multiple dilated ducts
Mgt
Antibiotics
Hadfield procedure ie cone excision of multiple ducts
117
How to differentiate pagets from eczema
Pagets is U/L while eczema is bilateral
Nipple areola complex destroyed in pagets
Not destroyed in eczema
118
How to diagnose pagets ds
Punch biopsy -
| Paget cells in epidermis
119
What is polymastia
Mc site
Mgt
Accesory breast tissue
Axilla
Excision
120
Poland syndrome
Absence of breast tissue and unilateral pectoralis major
121
Polythelia
| Athelia
Accesory nipples
| Absence of nipple
122
Breast reduction surgery is done for?
Pattern used?
Dist bw 2 nipples in breast reduction
Done for breast hypertrophy
Inverted T pattern
19-21cm
123
Gynecomastia and its causes
Enlargement of. Male breast tissue
Causes
Physiological
Puberty, newborn, senile
```
Pathological
Idiopathic
Drugs-digoxin isoniazid spironolactone cimetidine ketoconazole estrogen
Mumps orchitis
Others
```
124
Diagnosis of gynecomastia
| Tumor causing gynecomastia
```
Usg - 3 cm diameter disc of breast tissue
Tumors-
Rcc
Hcc
Testicular ass c paraneoplastic syndrome
```
