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Flashcards in The Breast Deck (31):
1

Define Anatomic Extension of Breast?

1) Vertical from 2nd to 6th ribs
2) Laterally from the lateral border of sternum to anterior axillary line

2

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

3

What is Montgomery’s tubercles?

Enlargement of sebaceous glands in aerola during pregnancy forming nodular elevations

4

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

5

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

6

Inversion Of nipple Or Dimpling Of skin occur in which condition?

Breast Ca invades the susensory ligaments

7

Important points regarding Retraction

1) Circumferential retraction Of nipple = Ca
2) Slit like Retraction Of nipple = Duct Ectasia & chronic Periductal mastitis

8

D/f b/w Paget’s diseases & Eczema

Paget’s Disease
1) Unilateral
2) Old age
3) No pruritis
4) Occur at nipple
5) No hx Of atopy
6) BC underlying

Eczema
1) B/L
2) Young age
3) Pruritis occur
4) occur at areola
5) Hx Of atopy
6) No BC underlying

9

What is Poland syndrome?

Combination of amazia plus absence of sternal portion of the pectoralis major

10

Name the organism causing Mastits

S aureus

11

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

12

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

13

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

14

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

15

At what age Breast cyst occurs?

Most commonly occur in the last decade of reproductive life

16

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

17

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

18

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

19

What are this genetic Rx factors associated with Breast Ca?

-BRCA 1 & 2 Mutation
-Ataxia Telangiectasia
-Li fraumeni Syndrome ( P52 Tumor suppressor mutation
-Cowden syndrome

20

Name the benign breast disease increases the risk for breast Ca?

No Increase Risk (C FAMDS):
C cyst
F fibroadenoma/ fibrosis
A adenosis
M mastitis
D duct ectasia
S squamous metaplasia

Slightly Increased Rx:
-Papilloma with fibrovasular core
-Hyperplasia

Moderately increased Rx:
Atypical ductal / lobular hyperplasia

21

Name the histologic subtypes Of CA Of Breast

-Infiltrating ductal / lobular Ca
-Mucinous Ca
-Medullary Ca
-Tubular Ca

22

Important point

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

23

What is cancer en cuirasse?

Carcinomatous infiltration Of skin of the chest occurs in cases with local recurrence after mastectomy

24

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

25

What are the contraindications for breast conserving surgery?

-Pt choice
-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
-Ct disorder
-Hx Of C/L BC OR DCIS

-1st and 2nd tri Of pregnancy
-Male BC

26

Name the other surgical procedure for Breast Ca

-Radical mastectomy
-Modified Radical mastectomy

-Simple Mastectomy
-Axillary Surgery (Useful in both pre & Post menopausal women /Not combined with radio to the axilla

27

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 )

28

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

29

What kinda chemotherapy recommended in post and Pre menopausal woman with a poor prognosis?

Adjuvant chemotherapy

30

Important point

Neo adjuvant chemotherapy given particularly to younger fitter woman with high grade Ca

31

Important point of hormone therapy

-Tamoxifen used for receptor +ve (ER /PR) BC in pre menopausal women

-Anastrozole used for receptor +ve (ER) BC in post menopausal women