Flashcards in Breast, Endocrine, Melanoma Deck (37):
Which cell layer is breast formed from?
Ectoderm milk streak
Esterogen vs. Progesterone vs. Prolactin in breast development
E: Duct development
P: Lobular development
Prolactin: Synergizes esterogen and progresterone
Cyclic changes a/w estrogen and progesterone and breast tissue
Estrogen: breast swelling, growth of glandular tx
Progesterone: maturation of tissues, withdrawal causes menses
Nerves a/w breast surgery: LTN
LTN (innervates serratus anterior) injury results in winged scapula
What artery supplies the serratus anterior?
Lateral thoracic artery
Nerves a/w breast surgery: TD nerve
Innervates LD; injury results in weak arm pull-ups and adduction
What artery supplies the latissumus dorsi?
Medial vs. Lateral pectoral nerves
Medial: Pec major and minor
Lateral: Pec major only
Nerves a/w breast surgery: Intercostobrachial nerve
Lateral cutaneous branch of the 2nd intercostal nerve; sensation to medial arm and axilla -- just below the axillary vein when performing an axillary dissection
Most common nerve injured with MRM or ALND
* Can be transected without major consequence
Which arteries supply the breast?
Internal thoracic, intercostal, thoracoacrominal, lateral thoracic
What valveless venous plexus allows direct hematogenous mets of breast ca to the spine?
97% of breast lymph drainage is to...
2%: IM nodes
Supraclavicular nodes is considered N1 N2 or N3 in BRCA
The number one cause of primary axillary adenopathy is...
What are the suspensory ligaments of the breast called?
Cooper's ligaments -- BRCA involving these strands can dimple the skin
Most common cause of breast abscess
Staph, followed by Strep.
a/w breast feeding
Tx: perc/I+D, d/c breast feeding, breat pump, Abx
Failure to resolve in 2 weeks --> Bc to r/o necrotic breast ca
Most commonly a/w breastfeeding
Malignant cells of the ductal epithelium without invasion of the basement membrane
DCIS; 50% get cancer if not resected (ipsilateral breast); 5% get cancer in contralateral breast
Clusters of calcifications on mammography
Most aggressive type of DCIS
Comedo pattern: necrotic areas; high risk for multicentricity, microinvasion, recurrence
Treatment of DCIS/comedo
Treatment of DCIS
Lumpectomy and XRT; need one cm margins, no ALND/SLNB; possibly tamoxifen/raloxifent
When does DCIS get a simple mastectomy/SLNBx
High grade -- comedo, multicentric, multifocal; a large tume not amenable to lumpectomy or not able to get good margins
What percentage of LCIS goes onto cancer?
40% in either breast
Is LCIS pre-malignant?
No -- it's a marker for the development of BRCA
Is LCIS palpable?
No -- no microcalcifications
Is LCIS found in pre- or pos-menopausal women
Patients with LCIS are more likely to develop what type of BRCA?
Do you need negative margins in LCIS?
N -- though you do need to excisional biopsy of the suspicious area
Nothing, Tamox/Ralox, b/L subcutaneous mastectomy, no ALND
What percentage of breast cancer have negative mammogram and negative ultrasound
Workup of a symptomatic breast mass <40 y.o.
US, core needle bx, possible FNA (Mammogram if US indeterminate or suspicious)
Workup of a symptomatic breast mass >40 y.o.
B/L Mammogram, u/s, core bxb
IF core or FNA is indeterminate, non-diagnostic or non-concordant with exam findings, what is the next step
If cyst fluid is bloody
Need cyst excisional biopsy; if clear and recurs, need excisional biopsy. If complex cyst, need excisional biopsy