BREAST

Question 1

Can you do SLN in pregnant pt?

Answer 1

Yes just can only use radioactive sulfur colloid

Question 2

Tx of pregnant pt 1st trimester with breast CA

Answer 2

Mastectomy + axillary staging
Adjuvant chemo 2nd trimester
+/- adjuvant XRT post partum
+/- adjuvant endocrine post partum

Question 3

Tx of pregnant pt late 2nd trimester/early 3rd trimester with breast CA

Answer 3

Mastectomy OR BCT + axillary staging
OR
preoperative chemo, mastectomy or BCT + axillary staging
(+/- adjuvant RT post partum +/- adjuvant endocrine post partum)

Question 4

Tx of pregnant pt late 3rd trimester with breast CA

Answer 4

Mastectomy + axillary staging
Adjuvant chemo
+/- adjuvant RT post partum +/- adjuvant endocrine post partum

Question 5

Whcih chemo is contra indicated in pregnancy?

Answer 5

Herceptin

Question 6

Coarse eggshell calcification on mammogram

Answer 6

fat necrosis

Question 7

Tx of true gynecomastia

Answer 7

Direct surgical excision of glandular tissue + liposuction

Question 8

Tx for malignant phyllodes

Answer 8

Excision with 1 cm margins

Question 9

When is XRT indicated for malignant phyllodes

Answer 9

Close margins <1 cm
Fascial/chest wall involvement
Tumors > 5 cm

Question 10

How much increased risk with atypical lobular hyperplasia?

Answer 10

4 fold

Question 11

Stain to differentiate ALH from ADH

Answer 11

E-cadherin. ALH stains negative

Question 12

Relative CI to BCT

Answer 12

Systemic scleroderma, lupus, severe cardiac dz (left sided tumors), inability to abduct arm on affected side, p53 mutation, severe pulm disease

Question 13

NEoadjuvant chemo for inflammatory breast CA

Answer 13

anthracyclines (doxorubicin) + taxanes (paclitaxel)

Question 14

Breast feeding pt - MCC mastitis?

Answer 14

S. aureus

Question 15

What mutation in bladder, breast, and colorectal CA?

Answer 15

CHEK2. Serine/threonine kinase involved in DNA damage repair and apoptosis. Also increase in male breast CA.

Question 16

BRCA1 protein function

Answer 16

Complexes with RNA polymerase in transcription

Question 17

BRCA2 protein function

Answer 17

bind directly to DNA to repair damage

Question 18

p53 assoc with

Answer 18

Li Fraumeni
breast brain lung and hematologic malignancies
sarcoma
adrenal cortical carcinoma

Question 19

Tx for lymphangiosarcoma

Answer 19

Wide local excision 3-6 cm margins

Question 20

Prognostic indicator in Stewart Treves

Answer 20

Tumor size (<5 cm is better)

Question 21

Tumor cells with a high mitotic rate, large pleomorphic nuclei, lymphoplasmacytotic infiltrate

Answer 21

Medullary CA (subtype of invasive ductal)

Question 22

Malignant epithelial cells confined by the basement membrane of the ductal-lobular interface

Answer 22

DCIS

Question 23

Pale cytoplasm, prominent nucleoli in the epidermis

Answer 23

Paget disease

Question 24

Whorled stromal cells, epitheliall ined clefts

Answer 24

phyllodes

Question 25

Adenosis, microcysts, central sclerosis, distortion of surrounding architecture

Answer 25

Radial scar

Question 26

MC site of mets in phyllodes tumors

Answer 26

Lungs (bones, brain)

Question 27

Luminal A subtype

Answer 27

ER or PR + HER2 - Ki <14%

Question 28

Luminal B subtype

Answer 28

ER or PR + HER2 - Ki >14% Endocrine + adjuvant chemo

Question 29

Basal subtype

Answer 29

Triple negative

Question 30

When to excise radial scar

Answer 30

If >6 mm

Question 31

When to excise ADH

Answer 31

If >6 mm

Question 32

When to excise LCIS

Answer 32

If suspicious findings or pleomorphic subtype

Question 33

Boundaries of ax dissection

Answer 33

``` Apex: posterior border of clavicle Anterior: pec major and minor** mm Posterior: subscapularis Medial: serratus anterior Lateral: lat dorsi ```

Question 34

Bilateral SOO in premenopausal BRCA1 - breast and ovarian CA risk reduction

Answer 34

80% RR ovarian CA 4% RR breast CA | 4% RR breast CA

Question 35

Bilateral SOO in premenopausal BRCA2- breast and ovarian CA risk reduction

Answer 35

79% RR ovarian CA 82% RR breast CA | 82% RR breast CA

Question 36

Which abx should be avoided in breast feeding?

Answer 36

Ciprofloxacin, tetracycline, chloramphenicol

Question 37

Risk of CA or CA in situ in surgical excision for ADH?

Answer 37

15-30%

Question 38

Dilation of ducts with lipid material

Answer 38

Ductal ectasia. Often present with fever and localized tenderness. Not due to underlying infection. May resolve to leave subareolar nodule

Question 39

Tx for refractory mastodynia

Answer 39

SERM. Cyclical (toremifine) or non cyclical (ormeloxifene)

Question 40

Columnar cells with atypia on core biopsy

Answer 40

Up to 80% have tubular CA

Question 41

Tx of lymphangiosarcoma if no evidence of mets

Answer 41

Amputation if possible

Question 42

MC met of lymphangiosarcoma

Answer 42

Spreads lymphatically or hematogeneously. MC mets to lungs

Question 43

Tx of metastatic lymphangiosarcoma

Answer 43

Single agent doxorubicin or paclitaxel. XRT reduces local recurrence but no improvement in overall survival

Question 44

Chance of malignancy in Phyllodes

Answer 44

10%

Question 45

Phyllodes CA spread via?

Answer 45

Hematogenous

Question 46

HER2 subtype breast CA

Answer 46

Tend to be higher grade due to p53 mutations, 5-10% of breast CA,

Question 47

Gail model

Answer 47

Age Race or ethnicity History of breast disease but NOT CA, DCIS or LCIS Age at menses onset Family hx but not high risk gene mutations Age at first live birth

Question 48

MC benign finding for microcalcs on CNBx

Answer 48

Sclerosing adenosis

Question 49

Complex sclerosing lesion AKA?

Answer 49

Radial scar | Excisional bx needed!

Question 50

CHEK2 mutation a/w which CA

Answer 50

Breast, colorectal, bladder

Question 51

CHEK2 mutation protein function

Answer 51

serine/threonine kinase involved in DNA damage

Question 52

PALB2 mutation protein function

Answer 52

genome maintenance (repair of double strand DNA breaks)

Question 53

PALB2 mutation assoc CA

Answer 53

breast, pancreatic

Question 54

p53 mutation protein function

Answer 54

regulates cell division

Question 55

p53 mutation a/w which CA

Answer 55

LI FRAUMENI Breast Brain Lung Sarcoma Adrenal cortical carcinoma Wilms Phyllodes! Pancreatic Leukemia Neuroblastoma

Question 56

PTEN mutation protein function

Answer 56

phosphatase involved in cell cycle regulation

Question 57

CDH mutation protein function

Answer 57

involved in cell adhesion

Question 58

PTEN mutation a/w which CA

Answer 58

Breast thyroid GU tract Endometrium

Question 59

Margin goals in Stewart Treves

Answer 59

3-6 cm

Question 60

Where do tumor cells originate from in Stewart Treves

Answer 60

Dermal vascular endothelium

Question 61

First line pharmacologic in severe cyclical breast pain

Answer 61

SERM (tamoxifen) < 6 months, 10-20 mg daily

Question 62

Only FDA approved pharmacologic for mastalgia

Answer 62

Danazol --200 mg during luteal phase of menstrual cycle Considered 2nd line pharmacologic

Question 63

Side effects f Danazol

Answer 63

antigonadotropin agent (mild androgenic effects) -- acne, voice changes, weight gain, hot flashes ,menstrual irregularities CONTRAINDICATED in pregnancy

Question 64

Anatomic boundaries of axilla

Answer 64

Apex: posterior border of clavicle Anterior: pec major and minor Posterior: subscapularis Medial: serrates anteriorr Lateral: anterior border of lat dorsi

Question 65

p16/CDK4 assoc with?

Answer 65

familial melanoma Melanoma, pancreatic CA, dysplastic nevi, atypical moles

Question 66

APC mutation a/w

Answer 66

CRC duodenal and gastric neoplasms medulloblastomas osteomas