Breast

Question 1

Stewart-Treves syndrome

Answer 1

Lymphangiosarcoma
Originates in vascular endothelial cells in chronic lymphedema

Question 2

Mondor disease

Answer 2

Thrombophlebitis of lateral thoracic or superior thoracoepigastric vein -> tender, subcutaneous cord in breast tissue

Question 3

Radial scar found on core biopsy - next step?

Answer 3

Excisional biopsy because they may be associated with malignancy

Question 4

Cowden syndrome surveillance

Answer 4

Breast exam q6mo with imaging (alternating MRI and mammogram)

Question 5

Breast cancer in 1st trimester of pregnancy - management

Answer 5

Recommend termination of pregnancy; if not, mastectomy with axillary staging

Question 6

Breast cancer in 2nd trimester of pregnancy - management

Answer 6

Mastectomy with axillary staging, or neoadjuvant chemo followed by breast conserving therapy.
Then postpartum radiation and endocrine therapy

Question 7

Breast cancer in 3rd trimester of pregnancy - management

Answer 7

Same as any non-pregnant patient

Question 8

Surgical treatment of gynecomastia

Answer 8

Excision of glandular tissue and liposuction of surrounding adipose tissue

Question 9

Management of mild/moderate mastodynia (cyclical breast pain)

Answer 9

Conservative therapy, OTC pain meds, and lifestyle changes (avoid caffeine and chocolate)

Question 10

Management of severe mastodynia

Answer 10

Tamoxifen (SERM), danazol (antigonadotropin), or bromocriptine (third line if refractory to danazol)

Question 11

Lifetime risk of breast cancer if BRCA+

Answer 11

37-85%

Question 12

Most frequent presentation of DCIS on mammogram

Answer 12

Clustered microcalcifications on mammogram

Question 13

Diagnosis of inflammatory breast cancer

Answer 13

Acute onset of symptoms <6mo and pathologic confirmation

Question 14

Management of inflammatory breast cancer

Answer 14

Neoadjuvant chemo, modified radical mastectomy, and adjuvant radiation with endocrine therapy
[Lymph node biopsy is contraindicated because tumor cells may plug dermal lymphatics]

Question 15

Mammogram screening should start at age

Answer 15

40

Question 16

Indication for PARP inhibitors (eg, Olaparib) in breast cancer

Answer 16

Adjuvant therapy for patients with triple negative breast cancer, and are BRCA+

Question 17

Histologic findings of Paget disease

Answer 17

Large cells with pale cytoplasm and prominent nucleoli in epidermis

Question 18

Li-Frameni syndrome manifestations

Answer 18

Breast cancer, soft tissue sarcoma, osteosarcoma, brain tumors, adrenal tumors, Wilms tumor, phyllodes tumor, pancreatic cancer, leukemia, neuroblastoma

Question 19

Pathology of LCIS

Answer 19

Small uniform cells confined to lobule

Question 20

Innervation of pec major

Answer 20

Medial pectoral nerve (upper part) and lateral pectoral nerve (lower part)

Question 21

Margins for DCIS

Answer 21

2mm

Question 22

E-cadherin staining in breast lesion

Answer 22

Atypical ductal hyperplasia

Question 23

Margins for Phyllodes tumor

Answer 23

1cm margins

Question 24

Indications for adjuvant chemotherapy in breast cancer

Answer 24

Nodal disease, tumor >1cm, and pathologic specimens with evidence of aneuploidy

Question 25

Mechanism of tamoxifen

Answer 25

Competitive estrogen antagonist in breast Partial agonist in non-breast tissue (uterus, liver, bone)

Question 26

Amplification of this biomarker is associated with the worst prognosis in breast cancer

Answer 26

HER2

Question 27

Breast pathology: cells with enlarged nucleoli interspersed with keratinocytes

Answer 27

Paget disease

Question 28

Risk of developing invasive breast cancer after diagnosis of LCIS

Answer 28

25-35% lifetime risk

Question 29

Mechanism of gynecomastia development

Answer 29

Decrease in androgen/testosterone production with resulting increase in estrogen

Question 30

Innervation of pec minor

Answer 30

Medial pectoral nerve

Question 31

Blood supply for a TRAM flap

Answer 31

Superior epigastric vessels

Question 32

Blood supply for latismuss dorsi flap

Answer 32

Thoracodorsal artery

Question 33

Most common cause of Mondor disease

Answer 33

Idiopathic

Question 34

When to not breastfeed with mastitis

Answer 34

If there is purulent discharge

Question 35

Borders for axillary lymph node dissection

Answer 35

Medial: serratus anterior Lateral: anterior border of latissimus dorsi Posterior: subcapsularis muscle Superior: axillary vein (Inferior border is less standard)

Question 36

Anatomic borders of axilla

Answer 36

Apex: posterior border of clavicle Anterior: pec major and minor Posterior: subcapsularis Medial: serratus anterior overlaying first 4 ribs and chest wall Lateral: anterior border of latissimus dorsi

Question 37

Which levels of axillary lymph nodes are taken for breast cancer?

Answer 37

Levels 1 and 2

Question 38

Which levels of axillary lymph nodes are taken for melanoma?

Answer 38

Levels 1, 2, and 3

Question 39

When to start breast cancer screening if BRCA+

Answer 39

Age 25 with yearly MRI and clinical breast exams every 6-12 months (add mammogram to screening at age 30)