ICL 10.3: Breast Disorders Pathology Flashcards
(99 cards)
1
Q
what is amasita?
A
absence of breast
unilateral amastia is more common than bilateral – usually associated with congenital absence of shoulder girdle, chest or arm
2
Q
what is accessory breast tissue?
A
accessory breast tissue is located along a line from the axilla to the groun
accessory nipples are more common than accessory nipple and areola components or accessory breast
3
Q
what are the 2 kinds of breast abscess?
A
- parenchymal breast abscess
2. subareolar breast abscess
4
Q
what is a parenchymal breast abscess?
A
usually in younger women
more common during lactation
staph Aureus is commonest bacteria
presents with very tender mass with or without erythema
initially treated with aspiration or incision and drainage and antibiotic.
5
Q
what is a subareolar breast abscess?
A
milk duct gets clogged and there’s enlargement of the duct and rupture which leads to inflammation and bacterial infiltration resulting gin abscess
staph Aureus, strep, enterococci are common organisms
the treatment requires excision of all the involved subareolar ducts and antibiotics.
has high incidence of recurrent subareolar abscess.
6
Q
what are the benign breast lesions?
A
- fibroadenoma
- ductal and lobular hyperplasia
- ductal metaplasia
- atypical ductal and tubular hyperplasia
- sclerosis adenosis
- papilloma of the ducts
- gross cystic and microcytic breast disease
- fibrocystic breast disease
7
Q
what is fibrocystic breast disease?
A
a benign disease comprised of a number of different pathologic entities including: ductal ectasia, apocrine metaplasia, fibrosis, cyst formation, ductal or lobular hyperplasia, atypical ductal or lobular hyperplasia (atypical proliferative disease, sclerosing adenosis and papillomatosis
sclerosing adenosis, atypical proliferative disease such as atypical ductal hyperplasia, or atypical lobular hyperplasia has increased risk (relative risk 3-4 times) of subsequent development of cancer
8
Q
what are the neoplastic diseases of the breast?
A
- ductal carcinoma in situ
- lobular carcinoma in situ
- invasive ductal carcinoma
- invasive lobular carcinoma
- malignant phylloides tumor
- sarcoma
- lymphoma
9
Q
what is the incidence of breast cancer?
A
projected incidence is 1 in 9 women
approximately 240,000 new cases/year
the incidence of breast cancer in average woman without any risk factor is 6%.
chance of women developing breast cancer in ten year period from age 40 to age 50 is about 1.3%
10
Q
what are the risk factors for breast cancer?
A
LOW RISK
1. early menarche/late menopause
- HRT
- multiparity
- post-menopausal
- obesity
- alcohol
INTERMEDIATE
1. one 1st degree relative with breast cancer
- CHEK-2 mutation
- 1st childbirth over 35 years old
- dense breast
HIGH
1. BRCA1 or 2 mutation
- CDH-1 mutation
- p53 suppression
- LCIS
- ADH/ALH
- early age radiation exposure
- CDH 1 mutation in female patients
11
Q
what genetic mutations are the most common causes of breast cancer?
A
92% is actually sporadic breast cancer….
all the rest are only 1%…
12
Q
what is familial breast cancer?
A
at least two 1st degree relatives involved
one of them is below age 50
one of them is bilateral or multi-centric
maternal history more important
13
Q
which gene mutations are involved in familial breast cancer?
A
- BRCA-1 mutation
- BRCA-2 mutation
- Li Fraumeni Syndrome
- CHEK-2 mutation
- MMR gene mutation (HNPCC)
- CDH-1 mutation
14
Q
which chromosomes are BRCA 1 and 2 on?
A
BRCA1 is on chromosome 17
BRCA2 is on chromosome 13
15
Q
what is the risk of breast cancer in BRCA1, 2 and CDH1?
A
BRCA 1 = 50-60%
BRCA2 = 50-65%
CDH-1 = 40%
16
Q
which gene mutation is most associated with male breast cancer?
A
BRCA2
17
Q
which cancers are associated with BRCA 2 mutations?
A
2% pancreas
increased prostate
6% male breast cancer
10-25% ovary primary peritoneal
35% in 5 years for contralateral breast cancer
55-80% female breast cancer
18
Q
what are the prognostic markers associated with sporadic breast cancer?
A
70% ER (+)
60% PR (+)
15-20% HER2/NEU (+)
19
Q
what are the prognostic markers associated with BRCA1 breast cancer?
A
20-30% ER (+)
30% PR (+)
0-3% HER2/NEU (+)
so they’re more likely to be triple negative breast cancers….
20
Q
what are the prognostic markers associated with BRCA2 breast cancer?
A
70% ER (+)
60% PR (+)
15-20% HER2/NEU (+)
21
Q
how do you manage a BRCA mutated patient?
A
- bilateral prophylactic mastectomy offers best but not absolute protection against breast cancer (90% reduction of risk of cancer)
- bilateral prophylactic oophorectomy after childbearing decreases breast cancer by 50% and ovarian cancer by 70%
- bilateral mastectomy and bilateral oophrectomy reduces the risk of breast cancer by 95%
bilateral oophorectomy is really important because they have higher risk of mortality
22
Q
how do you manage patients with BRCA mutations that don’t want prophylactic mastectomy?
A
- self-breast exam every 6 months
- physician conducted exam every 6 months
- both yearly mammograms and MRI to start at age 5 years before youngest affected member or by age 35
- pelvic ultrasound yearly from age 30
- value of CA-125 is unproven
23
Q
how do you treat breast cancer in a gene mutated patient who has cancer?
A
- bilateral total mastectomy with SLN biopsy (AND if necessary) on side of breast cancer is the standard treatment
- partial mastectomy and rad has high incidence of IBTR after 8 yrs. period of time
- prophylactic bilateral salpingo-oophorectmy should be strongly recommended
24
Q
how do you screen for breast cancer?
A
mammography is the only acceptable population-based screening study
MRI is indicated for surveillance of high risk group but not general population
25
how accurate is mammography for screening breast cancer?
mammography is the proven main modality in screening for breast cancer
the false negative rate of mammography is between 5-15%....yikes
26
what causes false negative mammograms?
1. obscuration of the mass by overlying breast tissue
2. poor image quality
3. errors of perception
4. breast cancer indistinguishable from normal breast tissue
5. failure to image the region of interest
27
what is the BI-RADS classification system?
Breast Imaging Reporting and Data System
it standardized reporting of mammography findings, facilitates communication of findings, recommendations and medical audits
first published by The American College of Radiology in 1992, and is revised periodically
28
what are the categories of the BI-RADS?
0
- incomplete imaging - additional imaging needed
1
- negative imaging - routine screening recommended
2
- benign findings - routine screening recommended
3
- probably benign - 6 M. F/U recommended
4
- suspicious - biopsy should be considered
5
- highly suggestive - appropriate action suggested
6
- known biopsy with proven cancer
- appropriate action suggested
29
on mamograms, what are the characteristics of benign vs. suspicious calicifications?
benign = coarse, rough, large
suspicious = faint, fine, small, branching --> often a marker of ductal carcinoma in situ
30
what is the role of US in breast cancer?
ultrasound is a helpful modality for lesion characterization; cystic versus solid and in evaluating benign or malignant features of solid lesions
something benign like a fibroadenoma would be hypo echoic but there's no shadow, it's actually bright around it and there are large lobules with a relatively smooth border
something malignant like an infiltrating ductal carcinoma would also be hypo echoic but there will be a dark shadow near it, lots of smaller lobules and an irregular border
31
what is PET imagining used for with breast cancer?
essential in staging of breast cancer and also in restaging and evaluating response to therapy
32
what is the use of PET/CT for breast cancer?
allows for accurate localization of and the spread of cancer
total body technique so you can evaluate for distant metasatisis
sensitivity is high when lesions are greater than 1 cm but can be low when there's inflammation
33
when are breast MRI used?
1. evaluation of implant integrity
| 2. evaluation of breast tissue --> diagnostic or screening
34
what are the clinical uses of MRI when evaluating breast tissue?
1. assess extent of known carcinoma
2. search for additional occult carcinoma
3. monitor pre surgical chemotherapy
4. evaluate axillary mets with occult breast primary
5. palpable lump not evident on US/Mamms
6. evaluate indeterminate imaging findings
7. spectroscopy is helpful in confirming malignancy
35
when do you use MRI to screen for breast cancer?
1. personal history of breast cancer treated by lumpectomy or mastectomy
MRI is really useful if there's a strong family history or genetic predisposition; this is the only 2 things that insurance would even cover
2. dense breast with high risk of breast cancer
3. history of ADH or LCIS in biopsy
36
what are the enhancement patterns seen on breast MRI and what do they mea?
I: contrast continues to accumulate in tumor
II: contrast levels plateaus in the tumor
III: contrast levels decrease in the tumor --> this is the most concerning; the other 2 types are usually benign
37
what are the limitations of screening the breast using MRI?
1. cost
2. high sensitivity but limited specificiity
3. limited detection of DCIS
38
how do you manage clear nipple discharge?
do not do cytology; it will show degenerating cells
if clinical exam and imaging studies are negative – follow the patient.
water clear serous discharge from a single duct has higher incidence of cancer and needs ductogram and duct excision for histologic examination.
39
how do you manage milky nipple discharge?
rule out pregnancy and drugs
obtain prolactin level if no history of pregnancy or drugs.
obtain MRI or CT Sella Turcica if prolactin is high.
10% prolactinoma associated with MEN-1.
40
how do you manage bloody nipple discharge?
Intraductal papilloma – 95% (all age groups)
%5 change it's malignancy
needs physical exam and imaging
if no cancer is found, needs selective duct excision
41
what is the common presentation of a patient with breast cancer?
most cases are detected by screening mammography (>/= 70%).
1. palpable breast or axillary mass (20%)
2. bloody nipple discharge
3. clinical feature of metastatic disease
4. commonest cause of enlarged axillary node in absence of a breast mass is benign adenopathy
42
how do you work up a palpable breast mass?
1. ultrasound of the mass. If the mass is solid then do core needle biopsy. If the mass is cystic then do fine needle aspiration
2. mammogram
ALWAYS BIOPSY A PALPABLE SOLID BREAST MASS
43
how do you work up a cystic breast mass?
1. if you get bloody fluid on aspiration then send fluid for cytology and biopsy the lesion
2. if you get clear fluid on aspiration and if mass disappears completely – follow patient.= --> but if mass persists after FNA or reappears then do a biopsy
44
what are the types of biopsy for breast tissue?
1. fine needle aspiration – doesn’t differentiate in situ cancer from invasive cancer.
2. core needle biopsy: over all best diagnostic biopsy procedure
3. stereotactic biopsy (Image guided Bx)
4. excisional or incisional biopsy (NOT good)
45
what are the types of benign epithelial lesions?
1. nonproliferation breast disease
fibrocystic changes and lactational adenoma; no increased risk fo carcinoma
2. proliferative breast disease without atypia
epithelial hyperplasia, sclerosis adenosis, papilloma, complex sclerosis lesion; increased cancer risk of 1.5-2x
3. proliferative breast disease with atypia
atypical ductal hyperplasia and atypical lobular hyperplasia; increased cancer risk of 4-5x
46
how are cysts formed?
dilation and unfolding of lobules
grossly large cyst dn their contents may appear blue in color = blue dome cysts
47
what causes fibrosis?
due to ruptured cysts leading to scarring
48
what is apocrine metaplasia?
characterized by large polygonal cells having an abundant, granular, eosinophilic cytoplasm with small, round nuclei
resembles normal apocrine epithelium of sweat glands
49
what is adenosis?
increased number of acini per lobule
50
what is the progression of breast cancer?
normal --> proliferative without atypia --> proliferative with atypia --> carcinoma in situ (DCIS, LCIS) --> invasive cancer (ductal, lobular)
51
what is Paget's disease of the nipple?
malignant cells aka Paget cells extends from DCIS within the ductal system via the lactiferous insures into nipple skin without crossing the BM
involves skin of the nipple and areola and resembles eczematoid skin rash --> pruritus may be mistaken for eczema....
presents with unilateral erythematous nipple with clay crust
always invasive ductal carcinoma with or without palpable mass
involved skin has pagetoid cells
treated with either modified radical mastectomy or central mastectomy, SLN bx and radiation
palpable mass in 50-60% and almost all of these women have underlying invasive carcinoma -- most women without a palpable mass only have DCIS
52
what is lobular carcinoma in situ?
clonal proliferation of cells within ducts and lobules that grow in a discohesive fashion, usually due to an acquired loss of the tumor suppressive adhesion protein E-cadherin
incidental finding
bBilateral in 20% to 40% of cases, compared with 10% to 20% of cases of DCIS.
uniform population of cells with oval or round nuclei and small nucleoli involving ducts and lobules
not associated with calcifications or stromal reactions
almost always expresses ER and PR
53
what does invasive ductal carcinoma look like?
grossly, the tumors often are retracted, firm, white, with chalky yellow streaks or gritty calcifications
may have a “stellate” or “crab-like” appearance
less commonly, tumors present as deceptively well-circumscribed masses having scant stromal reaction, or may be almost imperceptible, having scattered neoplastic glands or single tumor cells infiltrating otherwise unremarkable fibrofatty tissue
54
what do invasive ductal carcinomas look like histologically?
the tumor cells are arranged as glands or sheets and infiltrate a fibrotic stroma +/- DCIS component
55
what is inflammatory carcinoma?
invasive carcinoma involving superficial dermal lymphatic spaces
poor prognosis (T3 disease)
erythema and induration of the skin, so called “inflammatory changes”.
peau d’orange-dimpling of
involved skin due to retraction
caused by lymphatic involvement
and obstruction
56
what are the most common types of invasive carcinoma of the breast?
Ductal, No Specific Type (NST: 70-80%)
lobular 10%
tubular 6%
mucinous (colloid) 2%
medullary 2%
papillary 1%
metaplastic <1%
57
what is a phyllodes tumor?
arise from intralobular stroma but mostly benign --> does not spread to axillary lymph node
most present in the sixth decade, 10 to 20 years later than the peak age for fibroadenomas
associated with clonal acquired chromosomal changes, with gains in chromosome 1q being the most frequent
the larger lesions often have bulbous protrusions (phyllodes is Greek for “leaflike”) due to the presence of nodules of proliferating stroma covered by epithelium. In some tumors these protrusions extend into a cystic space
phyllodes tumors are distinguished from fibroadenomas on the basis of higher cellularity, higher mitotic rate, nuclear pleomorphism, stromal overgrowth, and infiltrative borders
58
what are the 3 types of malignant breast pathology?
1. ductal cancer in situ
2. lobular cancer in situ
3. invasive ductal cancer
59
what is lobular cancer in situ?
younger pre-menopausal population
presents as an incidental lesion
35% incidence of subsequent development of invasive breast cancer (50% in ipsilateral breast and 50% in contralateral breast) in 15 to 20 years -- you dont know where the subsequent invasive carcinoma, you can't do targeted therapy so you just observe....
incidence of invasive cancer increases with increasing multifocal sites
almost all subsequent invasive cancer are invasive ductal cancer
subsequent invasive cancer has excellent prognosis even when presents as a palpable mass - 90% 10 year survival.
60
how do you manage lobular carcinoma in situ?
observation only or antiestrogen therapy
margin positive LCIS patient does not need re-excision
core biopsy showing LCIS does need re-excision (needle localized excisional Bx).
mastectomy is indicated only for mutation positive patient
management of Pleomorphic lobular Ca in situ is lumpectomy. Radiation is used in selected cased
61
what is ductal carcinoma in situ?
mostly peri- or post-menopausal women
presents as an index lesion
following complete excision (except in some select patients), 30% chance of subsequent development of invasive Breast Cancer in 7 to 10 years ):
most of these invasive Breast Cancer will be in ipsilateral breast and most will originate (70%) in same quadrant of same breast.
subsequent invasive cancer are all ductal type with 60% 10 year survival
incidence of axillary node metastasis is 1%
62
how do you among ductal carcinoma in situ?
non-palatable, less than 1cm lesion with low-grade tumor (papillary or cribiform pattern) may be managed with lumpectomy only
all other DCIS require either lumpectomy and radiation or total mastectomy
adequate margin following lumpectomy for DCIS is at least 2mm
63
how does anti estrogen therapy help treat ductal carcinoma in situ?
anti estrogen therapy reduces the risk of recurrence but does not improve survival
64
how do you stage breast cancer?
Based on :
Size of the primary tumor (T stage)
Metastasis in regional lymph nodes (N stage)
Metastasis in distant site or organs (M stage)
LN metastasis 0.2mm or less in size is considered as negative for metastasis
65
what are the prognostic factors for breast cancer?
1. size
2. presence of Axillary Nodal metastases Best prognostic marker.
3. number of Axillary nodal metastases.
4. molecular Prog. markers (ER, PR, Her-2/NEU, Ki 67)
5. menopausal status
6. histology
7. age of patients: Young patients have higher incidence of in breast recurrence with partial mastectomy and radiation
8. nvasive Ca with extensive DCIS has higher incidence of in breast recurrence
66
how do you manage invasive breast cancer?
all invasive breast carcinomas are managed exactly the same way irrespective of histology except PURE invasive tubular carcinoma
the incidence of lymph node metastasis in pure invasive tubular carcinoma is exceedingly low and does not need axillary lymph node biopsy or axillary node dissection
67
what are the 2 issues to consider when trying to decide on management of early invasive breast cancer?
1. partial mastectomy (lumpectomy) vs. Total mastectomy
| 2. selected Lymph node biopsy (SLN Bx) and SLN based AxND or routine axillary node dissection
68
what are the advantages of lumpectomy over mastectomy?
lumpectomy preserves the breast (when done along with radiation after lumpectomy) without any higher incidence of recurrence or metastasis for invasive breast cancer in well selected patient population compared to total mastectomy.
69
what is the criteria that would indicate a lumpectomy?
1. must have microscopically negative margin
2. must not have extensive loss of volume of breast
3. patient must not have contraindication for radiation to breast after lumpectomy
70
what is the selection criteria that would indicate a lumpectomy?
1. location of lesion --> do the lumpectomy
2. multicentricity; can be done unless triple negative
3. size of breast and size of lesion --> small breast with big lesion it's better to just do mastectomy
4. morphology --> starburst pattern is bad
5. age of patients --> younger patients have higher recurrence after lumpectomy
6. tumor free margin
7. associated in situ carcinoma
71
what are the contraindications for lumpectomy?
1. early pregnancy before 22 weeks
2. h/o prior breast radiation
3. diffuse microcalcification
4. multi-centric tumor involving different quadrants
5. persistent positive margin
6. scleroderma, active lupus
72
what are the types of mastectomy?
1. radical mastectomy
2. modified radical mastectomy
3. total mastectomy with sacrifice of nipple and areola
4. total mastectomy with preservation of nipple and areola
73
what is a radical mastectomy?
remove pec major, minor and lymph nodes
not done anymore
74
how do you manage axillary nodes in a patient with?
selective axillary node dissection based on sentinel Lymph node Biopsy -- leave axilla alone unless there's a high volume tumor
prophylactic axillary node dissection isn't really done any more for breast carcinoma because a lot of patients get lymphedema
75
what is the sentinel lymph node?
first draining Lymph node(s) from any given area of the body is the Sentinel LN
the presence or absence of metastatic tumor cells in Sentinel LN indicates the lymph node metastasis status for the tumor.
76
when would you biopsy the sentinel lymph node?
axillary node dissection after SLN biopsy is indicated if:
more than 2 positive nodes or any number of positive LN if external beam radiation is not used for axilla
77
what are the contraindications for sentinel lymph node biopsy?
1. pregnant patients
2. presence of metastatic lymph nodes
3. previous axillary procedure
4. reduction/augmentation mammoplasty
5. locally advanced lesions or after adjuvant chen-radiation therapy
previous breast biopsy and multricentric lesions are not contraindication for SLN biopsy
78
what is the sequence of treatment for early breast cancer?
1. lumpectomy
2. chemotherapy (when indicated) with 4 cycles of Adriamycin and Cytoxan at 28 day intervals and herceptin when indicated (Her-2 neu amplified tumor) for one year.
3. 4500 rads radiation to whole breast with additional 1000 rads radiation to area of lumpectomy after completion of systemic chemotherapy.
4. anti estrogen therapy (with Tamoxifen or aromatase inhibitor (only in post menopausal patients), for estrogen receptor positive tumors for 5 years after radiation therapy is completed
79
when do you give adjuvant therapy for breast carcinoma?
you would give it to high risk patients for subsequent recurrence or metastasis receives additional local, regional or systemic therapy to reduce the risk of recurrence:
1. adjuvant radiation therapy:
all patients with invasive breast cancer after lumpectomy
selected patients after total mastectomy if primary tumor is larger than 5 cm or patient has 4 or more positive LNs.
2. adjuvant systemic therapy:
adjuvant Hormone therapy for ER positive patients or adjuvant chemotherapy for high risk tumor or high recurrence scor based on tumor genetic study (mammaprint or oncotype) or if Her 2 neu is amplified
80
when do you give neoadjuvant systemic therapy?
give before lumpectomy or mastectomy if:
1. ER Neg PR Neg Her-2 neu Neg (Triple negative tumors)
2. tumors which are borderline for lumpectomy obtaining a negative margin.
3. as initial treatment of locally advanced or inflammatory cancer
81
what are the characteristics of neoadjuvant chemo?
1. increase in local recurrence without higher mortality from breast cancer.
2. pathologic response rate is less than clinical response rate and complete pathologic response occurs in about 15% of patients.
3. all patients with complete response should still undergo lumpectomy
4. increases breast conservation
5. does not increase survival
82
what is the molecular assessment for adjuvant therapy?
1. ER+/PR+/HER2/NEU -
premenopausal: tamoxifen +/- chemo, consider oophorectomy
postmenopausal: aromatase inhibitors +/- chemo
2. ER+/PR+/HER2/NEU +
premenopausal: chemo, herceptin, tamoxifen, consider oophrectomy
postmenopausal: chemo + herceptin + aromatase inhibitors
3. ER-/PR-/HER2/NEU -
chemo for both
4. ER-/PR-/HER2/NEU +
chemo + herceptin for both
83
what adjuvant hormone therapy do you give for breast cancer?
tamoxifen for pre-menopausal patients
aromatase inhibitors for post-menopausal patients
adjuvant hormone therapy is given for 5 years
longer than 5 yrs. therapy reduces risk of local recurrence by 2 to 3%
bilateral Oophorectomy has best result as adjuvant hormone therapy and for ER positive metastatic disease
84
what is locally advanced breast cancer?
1. breast cancer with skin or muscle involvement --> nodule or ulceration of the skin; not just attachment to the skin
2. breast cancer larger than 5 cm and matter lymph nodes in axilla or internal mammary chain
85
what is inflammatory breast cancer?
edema and redness involving 1/3 or more of the skin of the breast which has biopsy-proven carcinoma
involvement of skin or dermal lymphatics by cancer cells are not necessary for diagnosis of inflammatory breast ca.
86
how do you treat locally advanced inflammatory breast cancer?
1. incisional biopsy and ER/PR/Her-2/Neu assay.
2. metastatic work-up with CT scan and or PET scan.
3. initial treatment is ALWAYS Induction chemotherapy preferably with Adriamycin
herceptin is added if the tumor is positive for HER-2/neu over expression.
4. radiation to breast
5. mastectomy only for residual disease
6. following radiation/mastectomy complete 6 more cycles of adriamycin --> this is followed by taxol 4 cycles if there is persistent distant metastases
7. herceptin for 1 yr. when tumor is positive for HER-2/NEU.
Antiestrogen for all receptor (+) tumor.
87
how do you treat a pure tubular carcinoma?
all invasive carcinomas are treated exactly the same way based on size, axillary nodal status and status of distant metastasis except pure tubular carcinoma
it's treated by total mastectomy or lumpectomy and radiation without axillary node biopsy or dissection.
88
how do you treat phyllodes tumors?
treated with excision
mastectomy is done only if lumpectomy is technically not possible
treatment for local recurrence is re-excision
axillary node dissection is not indicated because it doesn't spread to axillary lymph nodes
89
what male breast cancer is most common?
almost all male breast cancers are invasive ductal type
most are 70 ears old and present with unilateral mass or nipple mass
BRCA2 associated
high incidence of estrogen receptor (90-95%) = very hormone responsive
90
how do you screen for breast cancer in males?
screening mammography is not done for early detection of male breast cancer
if there is a palpable mass, it should be biopsied.
if there is no palpable mass, routine screening mammography has no role in detection of male breast cancer
91
what do you do if you find a solid breast mass in a pregnant woman?
ALL palpable solid breast mass in pregnant patients, just like in any adult patient must be biopsied promptly without delay
it is unnecessary to terminate pregnancy for early stage breast cancer (Stages I & II)
modified radical mastectomy is the treatment of choice prior to 22 wks. Breast preservation with radiation may be considered beyond 22 weeks of pregnancy if patient is candidate for adjuvant chemotherapy
if patient is not a candidate for adjuvant chemotherapy, then modified radical mastectomy is treatment of choice up to 32 weeks
pregnant patient cannot receive radiation until the baby is delivered
do not give systemic adjuvant chemotherapy during first trimester
never give Methotrexate during pregnancy
antifolate activity results in neural tube development deficit.
92
The initial treatment for Inflammatory Breast cancer is:
1. Chemotherapy
2. Radiation Therapy
3. Total Mastectomy
4. Adequate Lumpectomy
5. Immunotherapy.
1. Chemotherapy?
93
Which one of the following breast cancers has a worse prognosis with adequate treatment?
1. ER + / PR + / HER-2 NEU negative
2. ER + / PR - / HER-2 NEU positive
3. ER - / PR - / HER-2 NEU negative
4. ER - / PR + / HER-2 NEU negative
3. ER - / PR - / HER-2 NEU negative?
94
The best management option for lobular carcinoma in situ (lobular neoplasia) in a patient without any family history is:
1. Lumpectomy with radiation
2. Radiation only
3. Observation
4. Total mastectomy and sentinel lymph node biopsy
5. Modified radical mastectomy
3. Observation?
95
All of the following are risk factors for breast cancer except:
1. Estrogen
2. BRCA mutation
3. CDH-1 mutation in female patients
4. Trauma
5. Radiation at a young age
4. Trauma?
96
Which of the following is not associated with increased risk of breast cancer?
1. Lobular carcinoma in situ
2. Sclerosing adenosis
3. History of ductal cancer in situ
4. Personal history of breast cancer
5. History of ductal hyperplasia
?
97
Which one of the following breast cancers has the lowest incidence of lymph node metastasis?
1. Inflammatory breast cancer
2. Invasive lobular carcinoma
3. Invasive ductal carcinoma
4. Male breast cancer
5. Pure tubular breast cancer
?
98
A 32 year old pregnant female (8th week of gestation) noted a 1.5 cm mass in the upper outer quadrant of the left breast. The best management option is:
1. Ultrasound every 3 months and biopsy if there is a change in size.
2. MRI of the breast and biopsy if it looks suspicious
3. Mammogram of the breast and biopsy if it looks suspicious
4. Biopsy of the mass.
?
99
Phyllodes tumors are:
1. Always benign
2. Malignancy is confirmed if there is recurrence
3. Lymph node metastasis is common
4. Needs excision with about 1 cm normal tissue margin.
?
