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Flashcards in Breast, Endocrine, Melanoma Deck (37):
1

Which cell layer is breast formed from?

Ectoderm milk streak

2

Esterogen vs. Progesterone vs. Prolactin in breast development

E: Duct development
P: Lobular development
Prolactin: Synergizes esterogen and progresterone

3

Cyclic changes a/w estrogen and progesterone and breast tissue

Estrogen: breast swelling, growth of glandular tx
Progesterone: maturation of tissues, withdrawal causes menses

4

Nerves a/w breast surgery: LTN

LTN (innervates serratus anterior) injury results in winged scapula

5

What artery supplies the serratus anterior?

Lateral thoracic artery

6

Nerves a/w breast surgery: TD nerve

Innervates LD; injury results in weak arm pull-ups and adduction

7

What artery supplies the latissumus dorsi?

Thoracodorsal artery

8

Medial vs. Lateral pectoral nerves

Medial: Pec major and minor
Lateral: Pec major only

9

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

10

Most common nerve injured with MRM or ALND

Intercostalbrachial nerve
* Can be transected without major consequence

11

Which arteries supply the breast?

Internal thoracic, intercostal, thoracoacrominal, lateral thoracic

12

What valveless venous plexus allows direct hematogenous mets of breast ca to the spine?

Batson's plexus

13

97% of breast lymph drainage is to...

Axillary nodes
2%: IM nodes

14

Supraclavicular nodes is considered N1 N2 or N3 in BRCA

N3

15

The number one cause of primary axillary adenopathy is...

Lymphoma

16

What are the suspensory ligaments of the breast called?

Cooper's ligaments -- BRCA involving these strands can dimple the skin

17

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

18

Infectious mastitis

Most commonly a/w breastfeeding

19

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

20

Clusters of calcifications on mammography

DCIS

21

Most aggressive type of DCIS

Comedo pattern: necrotic areas; high risk for multicentricity, microinvasion, recurrence

22

Treatment of DCIS/comedo

Simple mastectomy

23

Treatment of DCIS

Lumpectomy and XRT; need one cm margins, no ALND/SLNB; possibly tamoxifen/raloxifent

24

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

25

What percentage of LCIS goes onto cancer?

40% in either breast

26

Is LCIS pre-malignant?

No -- it's a marker for the development of BRCA

27

Is LCIS palpable?

No -- no microcalcifications

28

Is LCIS found in pre- or pos-menopausal women

Pre

29

Patients with LCIS are more likely to develop what type of BRCA?

Ductal cancer

30

Do you need negative margins in LCIS?

N -- though you do need to excisional biopsy of the suspicious area

31

Treatment LCIS

Nothing, Tamox/Ralox, b/L subcutaneous mastectomy, no ALND

32

What percentage of breast cancer have negative mammogram and negative ultrasound

10%

33

Workup of a symptomatic breast mass <40 y.o.

US, core needle bx, possible FNA (Mammogram if US indeterminate or suspicious)

34

Workup of a symptomatic breast mass >40 y.o.

B/L Mammogram, u/s, core bxb

35

IF core or FNA is indeterminate, non-diagnostic or non-concordant with exam findings, what is the next step

Excisional biopsy

36

If cyst fluid is bloody

Need cyst excisional biopsy; if clear and recurs, need excisional biopsy. If complex cyst, need excisional biopsy

37

CNBx vs. FNA

Architecture vs. Cytology