Fiser ABSITE Ch. 24 Breast Flashcards Preview

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Flashcards in Fiser ABSITE Ch. 24 Breast Deck (84):
1

What hormone?
duct development (double layer of columnar cells)

Estrogen

2

What hormone?
lobular development

Progesterone

3

What hormone?
synergizes estrogen and progesterone

Prolactin

4

What hormone?
breast swelling, growth of glandular tissue

Estrogen

5

What hormone?
maturation of glandular tissue; withdrawal causes menses

Progesterone

6

What hormone?
cause ovum release

FSH, LH surge

7

innervates serratus anterior; injury results in winged scapula

Long thoracic nerve

8

innervates latissimus dorsi; injury results in weak arm pullups and adduction

Thoracodorsal nerve

9

innervates pectoralis major and pectoralis minor

Medial pectoral nerve

10

innervates pectoralis major only

Lateral pectoral nerve;
lateral cutaneous branch of the 2nd intercostal nerve; provides sensation to medial arm and axilla; encountered just below axillary vein

11

when performing axillary dissection
• Can transect without serious consequences

Intercostobrachial nerve

12

List arterial supply to the breast

Branches of internal thoracic artery, intercostal arteries, thoracoacromial artery; and lateral thoracic artery

13

valveless vein plexus that allows direct hematogeous metastasis of breast CA to spine

Batson's plexus

14

Primary axillary adenopathy

#1 lymphoma

15

Supraclavicular pos lymph nodes are considered ? in TMN staging

considered M1 disease

16

Most common organisms with breast abscess

S. aureus

17

Dilated mammary ducts, inspissated secretions, marked periductal inflammation; • Symptoms: noncyclical mastodynia, nipple retraction, creamy discharge from nipple; can have sterile subareolar abscess

Periductal mastitis (mammary duct ectasia or plasma cells mastitis)

18

hypoplasia of chest wall, amastia, hypoplastic shoulder, no pectoralis muscle

Poland's syndrome

19

superficial vein thrombophlebitis of breast; feels cord Like, can be painful; • Associated with trauma and strenuous exercise; • Usually occurs in lower outer quadrant; • Tx: NSAIDs

Mondor's disease

20

can manifest as a cluster of calcifications on mammogram; with out a mass or pain, can look like breast CA; • Is differentiated from breast CA by regularity of nuclei and absence of mitosis

Sclerosing adenosis

21

Most common cause of bloody discharge from nipple

Intraductal papilloma

22

What test can be used to dx Intraductal papilloma?

contrast ductogram

23

What is the tx for Intraductal papilloma?

resection (subareolar resection usually curative)

24

Most common breast lesion in adolescents and young women;

Fibroadenoma; 10% multiple; Usually painless, slow growing, well circumscribed, firm, and rubbery

25

tx of Fibroadenoma >30yr

excisional biopsy to ensure diagnosis

26

Green nipple discharge indicates?

Fibrocystic disease
Tx: if cyclical and nonspontaneous, reassure patient

27

Bloody nipple discharge indicates

most commonly intraductal papilloma; occasionally ductal CA; Tx: need galactogram and excision of that ductal area

28

Serous nipple discharge indicates?

worrisome for cancer, especially if coming from only 1 duct or spontaneous; Tx: excisional biopsy of that ductal area

29

Tx for Spontaneous nipple discharge

no matter what the color or consistency is worrisome for cancer; • All these patients need some sort of biopsy in the area of the duct causing the discharge

30

Affects multiple ducts of both breasts
• Are larger than when they occur solitarily
• Usually have serous discharge
• Mammogram shows Swiss cheese appearance
• increased risk of breast CA (40% get breast CA)

DIFFUSE PAPILLOMATOSIS

31

Malignant cells of the ductal epithelium without invasion of the basement membrane

DCIS; Usually not palpable and presents as a cluster of calcifications on mammography; • Need a 2-3 mm margin with excision

32

most aggressive subtype of ductal carcinoma in situ; has necrotic areas; • High risk for multicentricity, microinvasion, and recurrence; • Tx: simple mastectomy

Comedo pattern; increased recurrence risk with comedo type and lesions > 2.5 cm

33

Tx for DUCTAL CARCINOMA IN SITU

lumpectomy and XRT; possibly tamoxifen; • Simple mastectomy if high grade (i.e., comedo type, multicentric, multifocal ), if a large tumor not amenable to lumpectomy, or if not able to get good margins; no ALND

34

40% get cancer (either breast)
• Considered a marker for the development of breast CA, not premalignant itself
• Has no calcifications; is not palpable
• Primarily found in premenopausal women
• Patients who develop breast CA are more likely to develope ductal CA (70%)
Do not need negative margins

LCIS

35

Tx for LOBULAR CARCINOMA IN SITU

Tx: nothing, tamoxifen, or bilateral subcutaneous mastectomy (no ALND )

36

Symptomatic breast mass workup

• ultrasound
• If solid FNA; excisional biopsy if FNA is non diagnostic
• These patients most commonly have fibroadenomas that can be left alone if FNA is diagnostic. However, if the fibroadenoma enlarges, need excisional biopsy

37

Symptomatic breast mass workup
30-50 years

bilateral mammograms and FNA; excisional biopsy if FNA; nondiagnostic

38

Symptomatic breast mass workup
>5O years

bilateral mammograms and excisional or core needle biopsy

39

What is the sensitivity/ specificity of a mammogram? How large does that mass need to be?

90%, 5mm

40

What is the next step? Suspicious calcifications or architecture on mammography

perform localized stereotactic needle excisional biopsy

41

What is the next step? Indeterminate calcifications or architecture on mammography

can perform core needle biopsy; if indeterminate, perform localized stereotactic needle excisional biopsy

42

BI-RADS Classification of Mammographic Abnormalities
category 1

negative, routine screening

43

BI-RADS Classification of Mammographic Abnormalities
category 2

Benign finding, routine screening

44

BI-RADS Classification of Mammographic Abnormalities
category 3

Probably benign finding, Short-interval follow- up

45

BI-RADS Classification of Mammographic Abnormalities
Category 4

Suspicious abnormality; Definite probability of malignancy consider biopsy

46

BI-RADS Classification of Mammographic Abnormalities
Category 5

Highly suggestive of malignancy; High probability of cancer; appropriate action should be taken.

47

List Node levels

I - lateral to pectoralis minor muscle
II - beneath pectoralis minor muscle
Ill- medial to pectoralis minor muscle

48

node between the pectoralis major and pectoralis minor muscles

Rotter's nodes

49

most common distant metastasis of breast cancer

Bone

50

tumors that have increased risk of multicentricity

Central and subareolar tumors

51

TNM STAGING SYSTEM FOR BREAST CANCER
List the T

Tl : 5 cm
T4: skin or chest wall involvement

52

TNM STAGING SYSTEM FOR BREAST CANCER
List N

N1: ipsilateral axillary nodes. N2: fixed ipsilateral axillary nodes. N3: ipsilateral internal mammary nodes

53

TNM STAGING SYSTEM FOR BREAST CANCER
list the stages

I:T1 , NO ,
IIA: TO-1, N1, or T2, NO,
IIB:T2, N1, or T3, NO,
IIIA: TO-3, N2, or T3, N1-2
IIIB:Any T4 or N3 tumours
IV:M1

54

Gene mutation associated with ovarian (50%), endometrial CA

BRCA I; Consider TAH and bilateral oophorectomies in BRCA I families

55

Gene mutation associated with male breast CA

BRCA II

56

Types of Ductal CA

1. Medullary breast CA
2. Tubular CA
3. Mucinous CA (colloid)
4. Scirrhotic CA

57

Type of ductal Ca smooth borders, increased lymphocytes, ductal type cancer with bizarre cells
• Vast majority are estrogen- and progesterone receptor-positive
• More favorable prognosis

Medullary breast CA

58

Tx for ductal Ca

MRM or lumpectomy with ALND (or SLNB); postop XRT

59

10% of all breast CAs
• Does not form calcifications; extensively infiltrative; increased bilateral, multifocal, and multicentric disease
• Signet ring cells confer worse prognosis
• Tx: MRM or lumpectomy with ALND (or SLNB); postop XRT

Lobular cancer

60

May need chemotherapy and XRT 1st, then mastectomy
• Considered T4 disease
• Very aggressive, median survival of 36 months
• Has dermal lymphatic invasion, which causes peau d'orange lymph edema appearance; erythematous and warm

Inflammatory cancer

61

What are Contraindications to SLNB?

pregnancy, multicentric disease, neoadjuvant, clinically positive nodes, prior axillary surgery, inflammatory or locally advanced disease

62

• Removes all breast tissue including the nipple areolar complex
• Includes axillary node dissection ( Ievel I nodes)

Modified radical mastectomy

63

Includes MRM and overlying skin, pectoralis major and minor muscles, and Ievel l, II, and Ill lymph nodes; • Rarely performed anymore

Radical mastectomy

64

Complications of mastectomy

infection, flap necrosis, seromas

65

Complications of axillary lymph node dissection

Infection, lymphedema, lymphangiosarcoma;
Axillary vein thrombosis;
Lymphatic fibrosis;
Intercostal brachiocutaneous nerve

66

hyperesthesia of inner arm and lateral chest wall; most commonly injured nerve after mastectomy; no significant sequelae

Intercostal brachiocutaneous nerve

67

Indications for XRT after mastectomy

• >4 nodes
• Skin or chest wall involvement
• Positive margins
• Tumor > 5 cm (T3 )
• Extracapsular nodal invasion
• Inflammatory CA
• Fixed axillary nodes ( N2 ) or internal mammary nodes ( N3 )

68

Who gets Chemotherapy?

•Positive nodes - everyone gets chemo except postmenopausal women with
positive estrogen receptors get tamoxifen
•>1 cm and negative nodes - everyone gets chemo except patients with positive estrogen receptors get tamoxifen

69

List 2 main risks of Tamoxifen

1% risk of blood clots; 0.1 % risk of endometrial CA

70

Malignant tumors with a benign appearance (smooth, rounded masses)

Malignant tumors with a benign appearance (smooth, rounded masses) mucinous CA,
medullary CA,
cystosarcoma phyllodes

71

Resembles giant fibroadenoma; has stromal and epithelial elements (mesenchymal tissue);
• Can often be large tumors
• Tx: WLE with negative margins; no ALND

Cystosarcoma phyllodes;
• 10% malignant, based on mitoses per high-power field (> 5-10)

72

Lymphangiosarcoma from chronic lymphedema following axillary dissection (MRM)
• Patients present with dark purple nodule or lesion on arm 5- 10 years after surgery

Stewart-Treves syndrome

73

DEF: hypoplasia or complete absence of the breast, costal cartilage and rib defects, hypoplasia of the subcutaneous tissues of the chest wall, and brachysyndactyly

Poland's syndrome

74

DEF: ovarian agenesis and dysgenesis

Turner's syndrome

75

DEF: displacement of the nipples and bilateral renal hypoplasia) may have polymastia as a component

Fleischer's syndrome

76

Fibrous bands of connective tissue travel through the breast insert perpendicularly into the dermis, and provide structural support

Cooper's suspensory ligaments

77

The breast receives its principal blood supply from?

(a) perforating branches of the internal mammary artery; (b) lateral branches of the posterior intercostal arteries; (c) branches from the axillary artery ( including the highest thoracic, lateral thoracic, and pectoral branches of the thoracoacromial artery)

78

May provide a route for breast cancer metastases to the vertebrae, skull, pelvic bones, and central nervous system?

Batson's vertebral venous plexus, which invests the vertebrae and extends from the base of the skull to the sacrum

79

Resection of the intercostobrachial nerve causes?

Loss of sensation over the medial aspect of the upper arm

80

Name the Hormone: primary hormonal stimulus for lactogenesis

Prolactin

81

Name the Hormone: regulate the release of estrogen and progesterone from the ovaries

luteinizing hormone (LH) and follicle-stimulating hormone (FSH)

82

Name the Hormone: the release of LH and FSH from the basophilic cells of the anterior pituitary is regulated by the secretion of ?

gonadotropin-releasing hormone (GnRH) from the hypothalamus.

83

Name the hormone: initiates contraction of the myoepithelial cells, which results in compression of alveoli and expulsion of milk into the lactiferous sinuses

Oxytocin

84

Describe the GAIL model

relative risk model
1. age at menarche
2.# of biopsies
3.Age at 1st live birth
4.# of first degree relatives with BC