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ABS > BREAST > Flashcards

BREAST Flashcards

1
Q

Can you do SLN in pregnant pt?

A

Yes just can only use radioactive sulfur colloid

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2
Q

Tx of pregnant pt 1st trimester with breast CA

A

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

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3
Q

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

A

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

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4
Q

Tx of pregnant pt late 3rd trimester with breast CA

A

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

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5
Q

Whcih chemo is contra indicated in pregnancy?

A

Herceptin

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6
Q

Coarse eggshell calcification on mammogram

A

fat necrosis

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7
Q

Tx of true gynecomastia

A

Direct surgical excision of glandular tissue + liposuction

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8
Q

Tx for malignant phyllodes

A

Excision with 1 cm margins

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9
Q

When is XRT indicated for malignant phyllodes

A

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

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10
Q

How much increased risk with atypical lobular hyperplasia?

A

4 fold

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11
Q

Stain to differentiate ALH from ADH

A

E-cadherin. ALH stains negative

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12
Q

Relative CI to BCT

A

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

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13
Q

NEoadjuvant chemo for inflammatory breast CA

A

anthracyclines (doxorubicin) + taxanes (paclitaxel)

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14
Q

Breast feeding pt - MCC mastitis?

A

S. aureus

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15
Q

What mutation in bladder, breast, and colorectal CA?

A

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

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16
Q

BRCA1 protein function

A

Complexes with RNA polymerase in transcription

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17
Q

BRCA2 protein function

A

bind directly to DNA to repair damage

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18
Q

p53 assoc with

A

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

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19
Q

Tx for lymphangiosarcoma

A

Wide local excision 3-6 cm margins

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20
Q

Prognostic indicator in Stewart Treves

A

Tumor size (<5 cm is better)

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21
Q

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

A

Medullary CA (subtype of invasive ductal)

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22
Q

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

A

DCIS

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23
Q

Pale cytoplasm, prominent nucleoli in the epidermis

A

Paget disease

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24
Q

Whorled stromal cells, epitheliall ined clefts

A

phyllodes

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25
Q

Adenosis, microcysts, central sclerosis, distortion of surrounding architecture

A

Radial scar

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26
Q

MC site of mets in phyllodes tumors

A

Lungs (bones, brain)

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27
Q

Luminal A subtype

A

ER or PR +
HER2 -
Ki <14%

28
Q

Luminal B subtype

A

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

29
Q

Basal subtype

A

Triple negative

30
Q

When to excise radial scar

A

If >6 mm

31
Q

When to excise ADH

A

If >6 mm

32
Q

When to excise LCIS

A

If suspicious findings or pleomorphic subtype

33
Q

Boundaries of ax dissection

A 
Apex: posterior border of clavicle
Anterior: pec major and minor** mm
Posterior: subscapularis
Medial: serratus anterior
Lateral: lat dorsi
34
Q

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

A

80% RR ovarian CA
4% RR breast CA

4% RR breast CA

35
Q

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

A

79% RR ovarian CA
82% RR breast CA

82% RR breast CA

36
Q

Which abx should be avoided in breast feeding?

A

Ciprofloxacin, tetracycline, chloramphenicol

37
Q

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

A

15-30%

38
Q

Dilation of ducts with lipid material

A

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

39
Q

Tx for refractory mastodynia

A

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

40
Q

Columnar cells with atypia on core biopsy

A

Up to 80% have tubular CA

41
Q

Tx of lymphangiosarcoma if no evidence of mets

A

Amputation if possible

42
Q

MC met of lymphangiosarcoma

A

Spreads lymphatically or hematogeneously. MC mets to lungs

43
Q

Tx of metastatic lymphangiosarcoma

A

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

44
Q

Chance of malignancy in Phyllodes

A

10%

45
Q

Phyllodes CA spread via?

A

Hematogenous

46
Q

HER2 subtype breast CA

A

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

47
Q

Gail model

A

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

48
Q

MC benign finding for microcalcs on CNBx

A

Sclerosing adenosis

49
Q

Complex sclerosing lesion AKA?

A

Radial scar

Excisional bx needed!

50
Q

CHEK2 mutation a/w which CA

A

Breast, colorectal, bladder

51
Q

CHEK2 mutation protein function

A

serine/threonine kinase involved in DNA damage

52
Q

PALB2 mutation protein function

A

genome maintenance (repair of double strand DNA breaks)

53
Q

PALB2 mutation assoc CA

A

breast, pancreatic

54
Q

p53 mutation protein function

A

regulates cell division

55
Q

p53 mutation a/w which CA

A

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

56
Q

PTEN mutation protein function

A

phosphatase involved in cell cycle regulation

57
Q

CDH mutation protein function

A

involved in cell adhesion

58
Q

PTEN mutation a/w which CA

A

Breast
thyroid
GU tract
Endometrium

59
Q

Margin goals in Stewart Treves

A

3-6 cm

60
Q

Where do tumor cells originate from in Stewart Treves

A

Dermal vascular endothelium

61
Q

First line pharmacologic in severe cyclical breast pain

A

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

62
Q

Only FDA approved pharmacologic for mastalgia

A

Danazol –200 mg during luteal phase of menstrual cycle

Considered 2nd line pharmacologic

63
Q

Side effects f Danazol

A

antigonadotropin agent (mild androgenic effects) – acne, voice changes, weight gain, hot flashes ,menstrual irregularities

CONTRAINDICATED in pregnancy

64
Q

Anatomic boundaries of axilla

A

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

65
Q

p16/CDK4 assoc with?

A

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

66
Q

APC mutation a/w

A

CRC
duodenal and gastric neoplasms
medulloblastomas
osteomas

ABS (23 decks)

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