Flashcards in The Breast Deck (31):
Define Anatomic Extension of Breast?
1) Vertical from 2nd to 6th ribs
2) Laterally from the lateral border of sternum to anterior axillary line
Define Surgical Extension of Breast?
1)Vertically from the clavicle above to the 7th or 8th ribs below
2)Laterally from midline to the edge of latissimus dorsi posteriorly
What is Montgomery’s tubercles?
Enlargement of sebaceous glands in aerola during pregnancy forming nodular elevations
Important points of Mammograhy
1)Sensitivity increases with age as the breast become less dense
2)Two standard views viz mediolateral oblique & Craniocaudal
3)Recommended for women at or after 40 years
4)Pt with known BRCA mutation should have annual mammograms & semi annual physical examination beginning at age of 25-30 yrs
5)Pt with +be Fx hx but unknown genetic mutation should’ve annual mammogram & semi annual physical Ex beginning 10 yrs earlier than the age of the youngest affected relative & no later than the age of 40 yrs
Needle biopsy Important points
Three types of it; FNAC / Core cut / Large needle biopsy
1)FNAC can’t d/f invasive Ca from in situ disease
2)Core cut d/f b/w DCIS and invasive disease
Inversion Of nipple Or Dimpling Of skin occur in which condition?
Breast Ca invades the susensory ligaments
Important points regarding Retraction
1) Circumferential retraction Of nipple = Ca
2) Slit like Retraction Of nipple = Duct Ectasia & chronic Periductal mastitis
D/f b/w Paget’s diseases & Eczema
2) Old age
3) No pruritis
4) Occur at nipple
5) No hx Of atopy
6) BC underlying
2) Young age
3) Pruritis occur
4) occur at areola
5) Hx Of atopy
6) No BC underlying
What is Poland syndrome?
Combination of amazia plus absence of sternal portion of the pectoralis major
Name the organism causing Mastits
What is antibioma Of Breast? And how’s it occur?
Chronic inflammatory abscess of the Breast
Occur when antibiotic used in the presence of undrained pus
How to d/f antibioma Of Breast from Cancer
Cancer doesn’t have past hx of acute illness while it has
Unlike Ca , resistance to the finger in the Center of abscess less than in the periphery
What is pathogonomic feature of mondor disease?
It is thrombophlebitis of superficial veins of the Breast and ant chest wall
Thrombosed subcutaneous cord attached to the skin
What is aberration of normal development & involution?
Disturbance in the Breast physiology extending from a perturbation of normality to well defined diseases process
It includes viz cyst formation/ fibrosis / hyperplasia/ papillomatosis
At what age Breast cyst occurs?
Most commonly occur in the last decade of reproductive life
Important feature of fibroadenoma (Breast mouse)
-Occur in less than 30 yrs of age
-Mobile firm , rubbery, surround by well developed capsule
-Estrogen sensitive so enlarge during pregnancy and regress after menopause
Important features of phyllodes tumor ( Cystosarcoma phyllodes / Serocystic disease of Brodie)
-Seen after the age of 40 yrs
-Mobile on the chest wall and spread via blood
-if Benign do enucleation / wide local excision
-If malignant or large or recurrent = Remove Breast
Pt has Multiple chronic abscess and sinuses associated with typical bluish attenuated appearance of the surrounding skin.What condition does she have?
Tb of the Breast
What are this genetic Rx factors associated with Breast Ca?
-BRCA 1 & 2 Mutation
-Li fraumeni Syndrome ( P52 Tumor suppressor mutation
Name the benign breast disease increases the risk for breast Ca?
No Increase Risk (C FAMDS):
F fibroadenoma/ fibrosis
D duct ectasia
S squamous metaplasia
Slightly Increased Rx:
-Papilloma with fibrovasular core
Moderately increased Rx:
Atypical ductal / lobular hyperplasia
Name the histologic subtypes Of CA Of Breast
-Infiltrating ductal / lobular Ca
Treat DCIS as a malignancy b/c it has the potential to develop into invasive Ca
While For LCIS not t/m as a malignancy but as a marker for increased breast Ca risk
What is cancer en cuirasse?
Carcinomatous infiltration Of skin of the chest occurs in cases with local recurrence after mastectomy
What is t/m of early (Stage 1 & 2) Breast Ca with Tumor less than 4 cm in diameter?
Do Breast conserving surgery followed by radiotherapy to the conserved breast
What are the contraindications for breast conserving surgery?
-Large Tumor >4cm
-Multi centric disease
-central Tumor beneath or involving the nipple
-Local recurrence after partial mastectomy
-Prior Breast radiation
-DCIS with strong fx hx
-Hx Of C/L BC OR DCIS
-1st and 2nd tri Of pregnancy
Name the other surgical procedure for Breast Ca
-Modified Radical mastectomy
-Axillary Surgery (Useful in both pre & Post menopausal women /Not combined with radio to the axilla
Name the d/f Breast reconstruction options
-Silicon gel implant under the pectoralis major muscle
-Musculocutaneous flap if a large volume of tissue is required (Latissimus dorsi muscle flap / transversus abd muscle )
What are indications for radiotherapy in Breast Ca?
Radiotherapy post mastectomy is indicated in pt with:
1) Tumor >5cm
2) locally advanced tumor
3) more than or at least 3 positive axillary lymph nodes
4) Node >2cm
5) Aggressive histology
6) +ve margins
7) Inflammatory Ca
What kinda chemotherapy recommended in post and Pre menopausal woman with a poor prognosis?
Neo adjuvant chemotherapy given particularly to younger fitter woman with high grade Ca