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Rosalynn's ABSITE > breast > Flashcards

breast Flashcards

1
Q

clustered pleomorphic calcifications

A

DCIS

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2
Q

may advance in a segmental manner with gaps between disease areas

A

DCIS

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3
Q

five architecture types of DCIS

A

papillary, micro papillary, solid, cribriform, comedo (necrosis)

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4
Q

Surgical treatment for DCIS

A

surgical excision alone (partial mastectomy) w/margins of greater than 2 mm and adjuvant radiation

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5
Q

Surgical treatment for multicentric DCIS

A

total simple mastectomy

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6
Q

why do adjuvant radiation after partial mastectomy for DCIS?

A

decrease rate of local recurrence

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7
Q

Does adjuvant radiation improve survival benefit for DCIS?

A

No

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8
Q

For pure DCIS do you need adjuvant chemotherapy?

A

No

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9
Q

When do you use adjuvant chemotherapy for DCIS?

A

if ER positive use tamoxifen or anastrozole

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10
Q

most common histology types of invasive breast cancer

A

infiltrating ductal
infiltrating lobular
medullary
mucinous
tubular

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11
Q

What is a radical (Halsted) mastectomy?

A

total mastectomy
complete ALND (level I, II, III)
removal of pectorals major and minor muscles
removal of all overlying skin
rarely performed in practice

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12
Q

what is a modified radial mastectomy?

A

total mastectomy
ALND
indicated for patients w/clinically positive lymph nodes or positive axillary node based on previous SLNB or FNAB

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13
Q

Who gets a total (simple) mastectomy w/SLNB?

A

patients w/clinically negative axilla

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14
Q

what is a skin sparing mastectomy?

A

form of total (simple) mastectomy where you preserve the skin envelope and infra mammary ridge

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15
Q

what is the follow up after mastectomy?

A

every 3-6 months for 3 years
every 6-12 months for next 2 years
then annually

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16
Q

Does BCT w/SLND have similar survival and recurrence rates to those w/MRM?

A

Yes

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17
Q

how many lymph nodes are needed for a ALND?

A

10 nodes or more
patients with 4 or more positive lymph nodes should undergo adjuvant radiation to axilla

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18
Q

what are the most common complications after ALND?

A

infections and serum

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19
Q

if someone has unilateral nipple discharge and mammogram shows suspicious lesion but is benign on core needle biopsy, what is most likely to be and how to you treat it?

A

intraductal papilloma
excisional biopsy

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20
Q

Unilateral nipple discharge and mammogram shows no suspicious lesion, what is the treatment?

A

terminal duct excision

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21
Q

if someone has unilateral nipple discharge and mammogram shows suspicious lesion and is malignant on core needle biopsy what is the treatment?

A

cancer treatment

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22
Q

spiculated mass w/central necrosis

A

radial scar

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23
Q

proliferation of both stromal and epithelial contents
benign solid tumors w/glandular and fibrous tissue

A

fibroadenoma
excise only if symptomatic

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24
Q

fat disruption, lipid laden macrophages, chronic inflammation

A

fat necrosis
can be mixed up with cancer of radiology, must get biopsy to confirm dx
excision not necessary if dx confirmed

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25
Q

increased central cellularity w/lobules and intact my-epithelial contents
-increased fibrous tissue and interspersed glandular cells

A

sclerosing adenosis
no treatment is needed

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26
Q

rapidly growing breast mass
mixed connective tissue and epithelium
marked stromal overgrowth and hypercellularity

A

phyllodes tumor

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27
Q

what is the treatment for phyllodes tumor?

A

excision with at least 1 cm margin to decrease risk of recurrence

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28
Q

if you have calcifications on mammography and LCIS on biopsy what is the treatment?

A

excisional biopsy and tamoxifen
(because you have discordant findings on imaging and biopsy)

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29
Q

do you need negative margins for excisional biopsy of LCIS?

A

NO

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30
Q

LCIS has a loss of ?

A

E-cadherin

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31
Q

what are your treatment options for LCIS after excisional biopsy?

A

lifelong surveillance
bilateral mastectomies w/reconstruction (those with high risk factors) no ALND or SLND
tamoxifen

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32
Q

cells with clear cytoplasm and oval nuclei located between normal keratinocytes of the nipple epidermis

A

Paget disease of the breast

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33
Q

what is the treatment for Paget disease of the breast

A

total mastectomy and SLNB

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34
Q

when can you do BCT for Paget disease of the breast?

A

cases where nipple areolar resection and WLE of the malignancy can be achieved w/good cosmetic and oncologic result (not big tumors)

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35
Q

what genetic mutation is associated with osteosarcoma, breast cancer?

A

TP53
Li-Fraumini syndrome
tumor suppressor gene
MC breast cancer and rhabdomyosarcoma

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36
Q

Is Li-Fraumini syndrome AD or AR?

A

AD

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37
Q

What must you need to diagnose Li-Fraumini?

A

be diagnosed with sarcoma before 45 YO
have 1st degree relative with any cancer before 45 YO
have another 1st or 2nd degree relative w/sarcoma at any age

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38
Q

why is the upper outer quadrant the most frequent site of both benign and malignant breast disease?

A

most epithelial tissue of the breast is found there

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39
Q

What is Cowden syndrome associated with?

A

facial skin lesions
breast cancer
family hx of thyroid cancer

40
Q

what germline mutation is associated with Cowden syndrome?

A

PTEN tumor suppressor gene
increased risk of breast, thyroid, and endometrium
benign hamartomas

41
Q

is Cowden syndrome AD or AR?

A

AD

42
Q

What mutation is associated with diffuse breast cancer?

A

CDH1

43
Q

what other cancer is associated with CDH1

A

gastric cancer

44
Q

what is the treatment for breast cancer found in the 1st trimester

A

mastectomy and ALND
BCT avoided d/t tech 99

45
Q

what is the treatment for breast cancer found in the 2nd trimester

A

mastectomy and ALND
adjuvant chemotherapy is safe in 2nd and 3rd trimesters

46
Q

what is the treatment for breast cancer found in the 3rd trimester

A

mastectomy or BCT
radiation should be delayed until post partum

47
Q

when do you need excisional biopsy after core needle biopsy?

A

ADH/ALH
radial scar
LCIS
columnar cell hyperplasia w/atypia
papillary lesions
phyllodes tumor
lack of concordance between imaging and biopsy
non diagnostic specimen on core needle (like when no calcifications on radiology when biopsy shows calcifications)

48
Q

fibroelastic core with entrapped ducts and surrounding adenosis

A

radial scar

49
Q

infiltrating cells of small glands lined by single row of bland epithelium

A

ductal carcinoma

50
Q

lesion with mixed stromal and glandular elements

A

fibroadenoma

51
Q

lobular lesions w/increased fibrous tissue and glandular cells

A

sclerosing adenosis

52
Q

central radiolucency with surrounding architectural distortion

A

radial scar

53
Q

how many positive sentinel nodes can you have before ALND is needed?

A

2

54
Q

does DCIS increase risk of ipsilateral breast cancer or either?

A

ipsilateral

55
Q

does LCIS increase risk of ipsilateral breast cancer of either

A

either

56
Q

If LCIS develops into breast cancer is it usually unilateral or bilateral?

A

bilateral

57
Q

is DCIS usually unicentric or multicentric

A

unicentric

58
Q

is LCIS usually unicentric or multicentric

A

multicentric

59
Q

in patients older than 65 years old with low grade tumors should you give adjuvant radiation?

A

Generally no

60
Q

which BRCA mutation increases risk for ovarian cancer

A

BRCA 2

61
Q

when do you offer a prophylactic bilateral salpingo-oopherectomy for someone with BRCA 2?

A

age 35-50

62
Q

what chromosome is BRCA 2 on

A

13

63
Q

when you find out someone has hereditary breast cancer positive for BRCA 2 what should you offer them

A

prophylactic bilateral mastectomy

64
Q

what other cancers do you have to worry about with BRCA mutations

A

ovarian (more with BRCA 1)
male breast (more with BRCA 2)
prostate (more with BRCA 2)
pancreatic (more with BRCA 2)

65
Q

what percentage of fat necrosis is due to trauma, radiation, previous surgery, infection?

A

<50%
most idiopathic

66
Q

patients are high risk for a TRAM flap if they

A

are obese
smoke

67
Q

gynecomastia presents as

A

hypo echoic mass

68
Q

what meds are associated with gynecomastia

A

digoxin
thiazides
estrogens
theophylline
phenothiazines
spironolactone
TCA
reserpine
methyldopa
finasteride

69
Q

what has a greater role on risk for breast cancer, family hx of breast cancer or ADH

A

ADH (3-5 times)

70
Q

well circumscribed non fluid filled mass with coarse calcifications

A

fibroadenoma

71
Q

stellate spiculated mass

A

radial scar

72
Q

non-calcified mass with focal asymmetry

A

pseudoangiomatous stromal hyperplasia

73
Q

tamoxifen is metabolized by

A

CYP2D6

74
Q

which drugs should be stopped before starting tamoxifen

A

SSRI (CYP2D6 inhibitor, decreased active metabolite of tamoxifen)

75
Q

risk factors for male breast cancer

A

klinefelter syndrome
obesity
gynecomastia
exogenous estrogen exposure
BRCA 2

76
Q

When to stop breast feeding when patient has mastitis after a baby

A

if having purulent nipple discharge

77
Q

what margins are needed for DCIS

A

2 mm

78
Q

If you do a lumpectomy for DCIS that is ER positive, but have 1 mm positive margins what is the treatment?

A

re-excision to get 2 mm margins, radiation, and adjuvant endocrine therapy

79
Q

best reconstruction for inflammatory breast cancer undergoing MRM and radiation

A

delayed autologous breast reconstruction
Deep inferior epigastric perforator flap (DIEP flap)

80
Q

mammary findings of a highly suspicious lesion

A

spiculated, irregular, or asymmetric mass with linear or segmental calcifications

81
Q

What are the margins for invasive breast cancer getting BCT?

A

no tumor touching the inked specimen margins

82
Q

What do inflammatory and triple negative breast cancers all get?

A

neoadjuvant chemo

83
Q

what is the treatment for triple negative breast cancer

A

neoadjuvant chemo
surgery based on size/stage
adjuvant chemo and radiation

84
Q

what is the treatment for locally advanced breast cancer (T3, T4, N2, and/or N3 clinical disease)

A

bone scan
CT C/A/P
non inflammatory LABC:
neoadjuvant chemo (cyclophosphamide, anthracycline, taxane), followed by surgery, and radiation, may need additional adjuvant chemo

85
Q

A patient has erythema and firmness over prior scar for DCIS done 3 years ago. What is the next step?

A

Scar biopsy and mammogram

86
Q

what is the tumor recurrence rate after BCT?

A

1% per year

87
Q

what only disorder has a clear associated between gynecomastia and breast cancer?

A

Klinefelter’s syndrome

88
Q

what is an aggressive variant of a fibro epithelial lesion in the breast?

A

phyllodes tumor

89
Q

what is a not aggressive variant of fibre epithelial lesion in the breast?

A

fibroadenoma

90
Q

which vessels do TRAM flaps rely on?

A

superior epigastric vessels

91
Q

which vessels do latissimus doors flaps rely on?

A

thoracodorsal vessels

92
Q

absolute contraindications for BCT are?

A

radiation therapy during pregnancy, diffuse malignant appearing micro calcification, wide spread disease involving more than 1 quadrant, positive pathological margin

93
Q

relative contraindications for BCT?

A

previous radiation, active connective tissue disease, tumor >5 cm, diffusely positive margin

94
Q

Adjuvant radiation is recommended for

A

T3/T4 and N2/N3 disease, extra capsular invasion, chest wall involvement, inflammatory breast cancer, 4 positive nodes, >5 cm

95
Q

MCC mastitis

A

staph aureus

96
Q

adjuvant radiation is considered in stage II disease when?

A

extra capsular extension, lymphovascular invasion, age 40 or younger, close surgical margins, nodal positivity ratio of 20% or greater, pts who have undergone less than a standard I or II axillary dissection

Rosalynn's ABSITE (33 decks)

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