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OSD_Repro > All Breast Conditions > Flashcards

All Breast Conditions Flashcards

1
Q

Acute Mastitis - Cause?

A

Staph aureus (ass’d w/ breast feeding) enters & travels retrograde

(2nd most common is Streptococcal infection)
(Related to nipple fissures and milk stasis)

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2
Q

Acute Mastitis - Tx?

A
  • Continue nursing
  • Dicloxicillin (10-14 days)

(if not, then Cephalexin or Clindamycin)

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3
Q

Subareolar duct epithelium is lined by ______ cells.

A

columnar

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4
Q

Non-puerperal Mastitis - Tx?

A
  • Broad spectrum antibiotics
  • Surgical drainage if necessary

Mammogram indicated after treatment to rule out underlying carcinoma

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5
Q

Non-puerperal mastitis may be associated w/ _____

A

MRSA

also, may be related to nipple trauma or fissures

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6
Q

2 causes of fungal infection of the breast?

A

Candida Intertrigo

Tinea Versicolor

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7
Q

Fungal infection of the breast w/ Candidal intertrigo/tinea versicolor are associated w/ what 3 things?

A

Pendulous breasts
Skin maceration
Diabetes

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8
Q

Fungal infection of breast: Candidal Intertrigo - Tx?

A

Treat with skin care and topical antifungals

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9
Q

Fungal infection of breast: Tinea Versicolor - Tx?

A

Clotrimazole, selenium sulfide or other topical antifungals

Nipple cream or gentian violet

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10
Q

During breast development, when is glandular/alveolar development completed?

A

w/ pregnancy

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11
Q

Amastia:

a) Which is more common, bilateral or unilateral?
b) Is the nipple-areola complex usually intact?

A

a) Unilateral (bilateral often ass’d w/ other anomalies)

b) Nipple-areola complex usually intact

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12
Q

Most common breast anomaly?

A

Polythelia / Polymastia

  • Supernumerary nipples / breasts
  • Incidence of 0.5 – 2.5%
  • Bilateral in 30 - 50%
  • Develop along milk lines
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13
Q

Polythelia/Polymastia - Clinical importance?

A
  • May show physiologic changes of normal breasts
  • Subject to same spectrum of disease
  • Excise p.r.n.
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14
Q

What congenital anomalies is Polymastia ass’d w/?

A
  • Congenital syndromes affecting chromosomes 3 & 8

- Turner Syndrome(45,X)

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15
Q

Premature Thelarche:
__a__ age 2 usually resolves completely.

__b__ age 2 it may persist (precocious puberty).

A

a) Before

b) After

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16
Q

Gynecomastia - 3 typical causes?

A

Hyperestrogenism, Klinefelter’s, drugs

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17
Q

Juvenile breast hypertrophy - cause & clinical Sx?

A
  • Failure of arrest of normal breast enlargement; may be estrogen hypersensitivity or altered progesterone release
  • Usually bilateral, massive and idiopathic
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18
Q

Juvenile breast hypertrophy - Management?

A
  • Treat surgically; support with tamoxifen

- Rule out drug exposure

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19
Q

What is “Fibrocystic disease” of the breast?

A

Physiologic nodularity of the breast

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20
Q

In whom is Fibrocystic disease of the breast normal?

A

Premenopausal females or any woman on exogenous hormone therapy

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21
Q

Fibrocystic disease is a common complaint in _____ (whom)?

A

Common complaint in peri-menopause/often cyclic

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22
Q

When is Mastalgia normal/abnormal?

A

Normal = when it is cyclic

Abnormal = Non-cyclic – imaging indicated if unilateral, progressive and intense

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23
Q

Extramammary Mastalgia – what should be considered?

A

Costochondritis, superficial thrombophlebitis of lateral thoracic vein (Mondor disease)

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24
Q

What is Mondor Disease & when is it most commonly seen?

A
  • Rare thrombophlebitis of superficial veins on or adjacent to the breast
  • Lesion is a palpable, tender cord
  • Process is usually benign and self-limited
  • Most commonly seen as complication of cosmetic surgery
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25
Q

Mondor Disease - Tx?

A

Heat & NSAIDS

Age appropriate imaging may be indicated

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26
Q

FDA-approved pharmacologic therapy for Mastalgia?

What are 3 other “potentially effective” Txs?

A

FDA-approved = Danocrine

Others:

  • Change to monophasic OCP
  • Evening Primrose Oil
  • NSAID
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27
Q

Non-pharmacologic therapy for Mastalgia?

A

Appropriate fitting bra/avoid caffeine

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28
Q

Factors ass’d w/ “suspicious” nipple discharge?

A
  • Spontaneous
  • Unilateral
  • Uniductal
  • Clear, serous, or bloody
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29
Q

Diagnostic evaluation of nipple discharge?

A
  • Exam
  • Mammogram/ultrasound

No further work up if:

  • Bilateral
  • No mass
  • Normal mammogram
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30
Q

Galactorrhea - causes?

A

Usually associated with elevated prolactin

  • Breast stimulation
  • Thyroid dysfunction
  • Prolactin adenomas
  • Medications
  • Pregnancy
  • Stress

(Not associated with intrinsic breast disease)

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31
Q

Activators & inhibitors of Prolactin secretion?

A

Serotonin → TRH→ ↑ Prolactin

Estrogen → ↑ Prolactin

Dopamine → ↓ Prolactin

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32
Q

Drugs Associated with Hyperprolactinemia or Galactorrhea?

A

Typical antipsychotics

  • Phenothiazine drugs (Chlorpromazine, Thorazine)
  • Haloperidol
  • Pimozide

Atypical antipsychotics

  • Risperidone
  • Molindone
  • Olanzapine

Antidepressant agents

  • Clomipramine
  • Desipramine

Gastrointestinal drugs

  • Cimetidine (Tagamet)
  • Metoclopramide (Reglan)

Antihypertensive agents

  • Methyldopa (Aldomet)
  • Reserpine (Hydromox, Serpasil, others)
  • Verapamil (Calan, Isoptin)

Opiates
- Codeine/Morphine

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33
Q

What is the most common non-proliferative breast lesion & where does it arise from?

A

Breast Cysts
- Arise from the terminal ductal lobular unit

(“smooth, mobile, non-tender”)

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34
Q

Management of smooth, mobile, non-tender breast lesion?

A
  1. Repeat exam 4-6 weeks after aspiration to rule out recurrence
  2. Cyst Aspiration
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35
Q

Dx?
Smooth, mobile, non-tender lesion.
On mammogram, spicules extending into surrounding tissue.

A

Breast Cyst

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36
Q

Fat necrosis - Presentation? Diagnosis?

A
  • Uncommon lesion: isolated, sharply demarcated mass, tender
  • Follows direct breast trauma
  • Early stage cases present with erythema and edema
  • Late stages mimic carcinoma
  • Diagnosis by history and mammogram; treatment is symptomatic
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37
Q

Most common benign tumor of the breast?

Peak incidence?

A

Fibroadenoma (occurs in 10% of women)

Peak incidence between 20-40

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38
Q

Fibroadenoma - basic characteristics?

A
  • Contain benign epithelial and stromal components
  • Painless, spherical, smooth, and mobile
  • Estrogen sensitive
39
Q

Fibroadenoma - Tx?

A

Observation

Excise if :

  • Double in size in less than 1 year
  • Exceed 5 cm in size
40
Q

The most common cause of spontaneous nipple discharge from a single duct?

A

Intraductal Papilloma

  • Can be solitary or multiple
  • Occurs most often in women ages 35 - 55
  • Etiology and risk factors unknown
  • Slight increase risk of malignancy (1.5-2.0%)
41
Q

Low risk factors for Breast Cancer?

A
  • Female Gender- Menarche by age 11- No live births before 35 - Post menopausal hormone replacement- Race: Non-hispanic white females- Age (increasing)
42
Q

Moderate risk factors for Breast Cancer?

A
  1. Personal Hx of breast cancer2. Biopsy proven precancerous lesion3. Hx of breast cancer in 1st degree relative4. Dense breasts
43
Q

High risk factors for Breast Cancer?

A
  • Hx of chest radiation btwn ages 10-30- BRCA gene mutation- Li-Fraumeni syndrome- Cowden syndrome- BRCA gene mutation, Li-Fraumeni syndrome or Cowden syndrome in 1st degree relative
44
Q

BRCA gene mutations

A
  • Most common hereditary cause of breast cancer- Tumor suppressor genes on the long arm of chromosome 17
45
Q

______ gene increases the risk of developing male breast cancer

A

BRCA2

46
Q

_____ gene mutation increases the risk of developing breast cancer (80%) and ovarian cancer, usually serous type (50%)

A

BRCA1

47
Q

BRCA gene breast cancer - Presentation?

A

Young woman with a high-grade (poorly differentiated) breast cancer

48
Q

Breast Cancer Screening methods

A
  • Monthly self breast exam.- Annual breast exam by healthcare professional.- Annual mammogram starting at age 40.- + MRI for high-risk patients
49
Q

In-situ Breast carcinomas – types?

A
  • Ductal carcinoma in-situ- Lobular carcinoma in-situ- Paget’s disease
50
Q

Dx?- Almost always detected by mammogram- Usually presents as micro calcifications- Represents up to 30% of breast cancers

A

Ductal Carcinoma In-Situ (DCIS)

51
Q

Lobular Carcinoma in-situ – Tx?

A

Anti-Estrogen

52
Q

Dx?- Always an incidental finding- More common in PREmenopausal women- Not associated with calcifications

A

Lobular Carcinoma in-Situ (LCIS)

53
Q

Dx?- A form of in-situ carcinoma, where tumor cells grow within the epidermis of the nipple and/or areola.- Present 1-4% of breast carcinoma.- Almost always associated with underlying high-grade DCIS or invasive carcinoma

A

Paget’s Disease

54
Q

Dx?Presents as an eczematous, red, crusted nipple lesion.

A

Paget’s Disease

55
Q

How does Paget’s Disease present?

A

Presents as an eczematous, red, crusted nipple lesion

56
Q

DCIS - Almost always detected by ______

A

mammogram

57
Q

DCIS - Usually presents as ______

A

microcalcifications

58
Q

DCIS - how is it characterized prognostically?

A
  1. Comedo (grossly, if you squeeze the cut surface of the lesion, the necrotic material is pushed out like comedons) or Non-Comedo2. Low, Intermediate, or High Grade — based on degree of nuclear atypic
59
Q

Intraductal proliferation with punched out spaces “cookie cutters” – this sub-type of DCIS is referred to as ______ type.

A

DCIS: Cribriform type

60
Q

What sub-type of DCIS is described below?The duct is completely filled with a monotonous population of cells; also note associated microcalcification.

A

DCIS: Solid type

61
Q

How does invasive breast cancer present clinically?

A
  • Presents as a mass, either palpable or mammographically detected- Central tumors may cause retraction of the nipple
62
Q

________ is a high grade carcinoma by default.

A

Inflammatory carcinoma

63
Q

Inflammatory Carcinoma - characteristics?

A
  • Carcinoma that presents with swollen erythematous breast.- Invasion of the dermal lymphatics blocks drainage leading to lymphedema, swelling and thickening of skin- Tethering of the skin of the breast to the Cooper ligaments mimics an orange peel “peau d’orange”
64
Q

Dx?Carcinoma that presents with swollen erythematous breast

A

Inflammatory Carcinoma

65
Q

What causes Inflammatory Carcinoma to mimic an orange peel (“peau d’orange”)?

A

Tethering of the skin of the breast to the Cooper ligaments

66
Q

What causes Inflammatory Carcinoma to present w/ lymphedema & swelling?

A

Invasion of the dermal lymphatics blocks drainage leading to lymphedema, swelling and thickening of skin

67
Q

Invasive Lobular Carcinoma:a) Usually ____ Gradeb) Usually focal or multifocal?c) Prognosis similar to ____ of same grade and stage

A

a) Lowb) Multifocalc) IDC

68
Q

What are the most characteristic histologic features of invasive lobular carcinoma?

A
  • Infiltration of tumor cells in single files- They are commonly arranged circumferentially around benign residual ducts in a “targetoid” fashion (arrow)
69
Q

Dx?Small, low grade tumor composed entirely of small tubules, with pointed ends “tear-drop shape”

A

Tubular Carcinoma

70
Q

Tubular Carcinoma - Prognosis? Risk of metastases?

A
  • Low risk of metastases- Excellent prognosis
71
Q

T or F?In Tubular Carcinoma, the tubules are lined by a single layer of bland tumor cells with hardly any mitotic activity.

A

True

72
Q

Dx?Composed entirely of aggregates of tumor cells floating in pools of mucin.

A

Mucinous (Colloid) Carcinoma

73
Q

Mucinous (Colloid) Carcinoma:a) ____- Grade tumorb) Demographic?c) Prognosis?

A

a) Low-grade tumorb) Elderly womenc) Good prognosis(Composed entirely of aggregates of tumor cells floating in pools of mucin)

74
Q

Medullary CA:a) Gross appearance?b) Histology?c) Genetics?

A

a) Sharply-circumscribed, soft fleshy tumorb) Malignant cells admixed with intense lymphocytic infiltration.c) More common in BRCA1 carriers

75
Q

________ typically has a well-circumscribed pushing (as opposed to infiltrating) border and syncytial sheets of tumor cells in a stroma rich in lymphocytes and plasma cells.

A

Medullary carcinoma

76
Q

Dx?Adenocarcinoma but not forming glands!

A

Metaplastic CA(Metaplastic component may be squamous, spindle cells, fibroblasts, bone, cartilage, etc…)

77
Q

Metaplastic CA:______ outcome than other types

A

Worse

78
Q

What are the Modified Bloom-Richardson Criteria for tumor prognosis?

A
  1. % of tubule formation2. Degree of nuclear atypic3. # of mitotic figures in 10HPFLow grade = More tubules, less nuclear atypia, fewer MFThe higher the grade, the worse the prognosis
79
Q

How is tumor “Stage” determined?

A

TNMT = Tumor Size.N = lymph Node metastasesM = distant MetastasesRule #1: Inflammatory carcinoma is considered T4Rule #2: Distant metastases is stage IV

80
Q

For TNM staging, inflammatory carcinoma is considered ____.

A

T4

81
Q

The most important prognostic factor for Breast cancer?

A

Axillary Lymph Node metastases

82
Q

Molecular Classification - 3 classifications & prognosis of each?

A
  1. Luminal-type Carcinomas express Estrogen and have the BEST prognosis. 2. Her2-type cancers do not express ER or PR but show Her2-gene amplification. They have a BAD prognosis3. Basal-like breast cancer are negative for all 3 markers & have the WORST prognosis(more common in African-American women)
83
Q

What are “Triple Negative” breast cancers?

A

Basal-like breast cancers, which are negative for all 3 markers (ER, PR, & HER-2). Of the 3 molecular classifications, these have the WORST prognosis.

84
Q

What are “Triple Negative” breast cancers?

A

Basal-like breast cancers, which are negative for all 3 markers (ER, PR, & HER-2). Of the 3 molecular classifications, these have the WORST prognosis.

85
Q

Pathologic features of Luminal-type-A breast cancers?

A
  • WD IDC- Lobular cA- Tubular CA- Mucinous CA
86
Q

Pathologic features of Luminal-type-B breast cancers?

A
  • MD IDC- Lobular CA
87
Q

Pathologic features of Basal-like breast cancers?

A
  • Poorly-differentiated IDC- BRCA1- assoc- African-American women
88
Q

Pathologic features of Basal-like breast cancers?

A
  • Poorly-differentiated IDC- BRCA1- assoc- African-American women
89
Q

Luminal Type A breast cancer – Tx?

A

Tamoxifen

90
Q

Luminal Type B breast cancer – Tx?

A

Tamoxifen

91
Q

Basal-like breast cancer – Tx?

A

Chemotherapy

92
Q

Basal-like breast cancer – Tx?

A

Chemotherapy

93
Q

Trastuzumab - MOA?

A

Monoclonal antibody to HER-2 receptors- binds receptor on tumor cells to induce an antigen-antibody-reaction leading to cytotoxicity of tumor cells.

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