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Surgery > Breast > Flashcards

Breast Flashcards

1
Q

Extent of breast

A

Vertically - 2 to 6th ribs

Horizontally- sternum to midaxillary line

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2
Q

Extension of breast in axilla

A

Axillary tail of spence

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3
Q

Breasts are supported by

A

Suspensory ligament of Cooper

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4
Q

Breast lies over?

A

Pectoralis muscle

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5
Q

Dimpling of skin over breast is due to

A

Suspensory ligament of cooper pulls ligament inside

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6
Q

If a cancer involves lactiferous duct, it causes

A

Retraction of nipple

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7
Q

Retraction of nipple can be ?

A

Congenital
Acquired due to
Ductal ectasia - slit
Malignancy - circumferential

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8
Q

Most conspicuous of sign of malignancy involving skin of breast
It is seen due to?

A

Peau d orange

Blockade of subdermal lymphatics

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9
Q

Functional unit of breast?

A

TDLU

Terminal duct lobular unit

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10
Q

Lymphatic drainage of breast

A

Axillary 90%
Clinical division
Ant, central, apical, lateral, posterior

Surgical division by pectoralis minor
Level 1 lateral to 
Level 2 behind 
Level 3 medial 
Internal mammary 10%
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11
Q

Rotters lymph node is seen in

A

It is interpectoral lymph node
Bw pectoralis major and minor
Level 2

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12
Q

Triple assessment in breast examination

A 
Clinical examination+ history
Radiological
Less than 40 USG 
More than 40 MAMMOGRAPHY 
Histopathology
FNAC, BIOPSY
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13
Q

Why mammography is not a screening tool in young female breast examination

A

Young increaaed glandular tissue, dense breast

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14
Q

Best clinical examination technique for breast lump

A

Dial clock method

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15
Q

Views for a mammogram

A

Craniocaudal

Mediolateral oblique

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16
Q

Screening indication of mammogram

A

Annual mammography should be started at 40yrs of age

If strong family history, Risk of breast cancer more than 20%
Start screening by 35 yrs of age

If BRCA mutation
First degree relative of pt with brca mutation
Start screening at 25 yrs mri is done

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17
Q

How to differentiate between benign or malignant tumor on mammography

A

Benign - well diff, halo surrounded, macrocalcification

Malignant- irregular, distorted, lymph node inv, microcalcification

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18
Q

What is BIRADS

A

Breast Imaging Reporting and Data System

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19
Q

Birads score 3 means

A

Probably benign
Short interval follow up (6months)
Risk of cancer 0-2%

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20
Q

Usg modality is used in

A

Differentiate bw solid and cystic mass
Pregnant lady with lump
Young female with dense Breast

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21
Q

Linguini sign is seen in

A

MRI

Intracapsular rupture of breast implants

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22
Q

Investigation of choice in breast implants

A

MRI

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23
Q

USG finding, intracapsular rupture of implant

Extracapsular rupture of implant

A

Intracapsular- Stepladder pattern

Extracapsular- snowstorm appearance

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24
Q

Uses of MRI IN BREAST

A 
Ioc in breast implants
Diff bw multifocal and multicentric 
Most sensitive investigation for DCIS 
IOC  to identify local/scar recurrence after surgery
Screening of young high risk pt
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25
Q

Popcorn calcification is seen in

A

Fibrodenoma

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26
Q

Lead pipe pattern is found in

A

Fat necrosis mimics malignancy

Secondary to trauma

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27
Q

Broken needle pattern

Tea cup pattern

A

Duct ectasia

Fibrocystic ds

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28
Q

Histopathology of breast cancer is done by

A

FNAC
FNNAC
TRU CUT BIOPSY

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29
Q

FNNAC is done for

A

Superficial lesion (breast & thyroid)

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30
Q

Tru cut biopsy is a type of

Needle used?

A

Incisional biopsy

16G is best for breast biopsy

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31
Q

IOc in breast cancer

Why?

A 
Tru cut biopsy
As tissue is obtained
 Diff bw in situ and invasive ca
ER, PR, HER NEU stat can be obtained 
Less false negative rate
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32
Q

Tru cut biopsy is IOC in breast cancer

other example?

A

Prostatic cancer

Soft tissue sarcoma

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33
Q

Gold standard for breast lump

A

Excisional biopsy

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34
Q

Incidence of breast cancer in India

A

1 in every 21 indian women develops breast cancer

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35
Q

Imp risk factors for breast cancer

A 
Age increase
Early menarche
Late menopause
Family history
Obesity
Alcohol
Smoking
HRT 
Nulliparity
Maternal age at first live birth
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36
Q

Most common gene mutation in breast cancer

A

P53 in 90% of sporadic cases

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37
Q

Most common gene mutation in familial breast cancer

A

BRCA 1

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38
Q

Location of brca gene

And which one is responsible for breast cancer

A

BRCA1 17q
BRCA 2 13q
BRCA 1> BRCA2

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39
Q

SUBTYPE OF BRCA1 breast tumor

Most common histology

A

Basal subtype

Medullary ca

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40
Q

SUBTYPE OF BRCA2 breast tumor

A

Luminal subtype

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41
Q

BRCA mutation predisposes a pt to which syndrome

A

Hereditary breast and ovarian cancer syndrome

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42
Q

Risk reduction technique if breast cancer

A

Bilateral prophylactic mastectomy
Bilateral salpingo-oophorectomy (Risk Reduction)
SERM - Tamoxifen

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43
Q

Most common quadrant affected in breast cancer

A

Upper outer

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44
Q

Single file pattern is seen in

A

Invasive lobular carcinoma

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45
Q

Types of invasive ductal carcinoma

Best and worst prognosis?

A

Tubular best prog
Mucinous
Medullary worst prog

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46
Q

Mutation in INVASIVE LOBULAR CARCINOMA

A

E cadherin

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47
Q

Molecular classification of breast cancer is based on

A

Gene expression profiling

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48
Q

Alred score is used for

A

Estrogen and progesterone receptor profiling in molecular classification of breast cancer

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49
Q

Proliferation index marker is

A

Ki67

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50
Q

Grading to measure HER2/NEU RECEPTOR

A 
0 negative
\+1 negative 
\+2 equivocal -FISH DONE IT CAN BE 
AMPLIFIED +3
NOT AMPLIFIED -NEGATIVE
\+3 positive
51
Q

Subtype of breast cancer with low proliferation index

High proliferation index

A

Low luminal A - best prognosis

High Basal type - triple negative - worst prognosis

52
Q

TNBC Paradox

A

Good response to anthracycline chemotherapy initially, but relapse in 1.5-2 yrs

53
Q

IOC for staging of breast cancer

Isotope used

A

PET CT

18-FDG

54
Q

yTNM
cTNM
MEANS

A

After neoadjuvant therapy -yTNM

Clinical TNM -cTNM

55
Q

pT1 staging is for

A

Pathological tumor staging

1 stage means tumor size more than 1 mm less than 20 mm

56
Q

Involvement of chest wall includes following str…

This TStage is

A

T4A
Chest wall inv. Serratus anterior, ribs, intercostal muscle
Pectoralis inv not considered

57
Q

T4B is involvement of

A

Skin -peau d’ orange, ulcer, satellite lesion

Dimpling retraction not considered

58
Q

Stage of matted axillary lymph nodes

A

N2 A

59
Q

Most common site of distance metastasis in breast cancer

A

Bone

60
Q

Most common bone metastasis

A

Vertebral column (Batson plexus)

61
Q

Most common vertebrae

A

lumbar> thoracic

62
Q

Metastasis type in breast cancer

A

Osteolytic >Osteoblastic

63
Q

Surgery for primary breast tumor

A

Breast conservation surgery

Mastectomy

64
Q

Recurrence rate of BCS and mastectomy

A

LRR OF BCS -4%

MASTECTOMY LESS THAN 1%

65
Q

Margin status of BCS

A

1mm of normal tissue along with lumpectony

66
Q

Typed of BCS

A

Volume displacement - when less than 15% volume resected

Volume replacement-when more than 15% volume resected

67
Q

Radiotherapy in mandate in BCS.

What are contraindications of BCS.

A

Pregnancy
Collagen vascular ds
Prior Radiotherapy exposure

68
Q

Technical contraindications of BCS

A 
Multicentric 
Multifocal 
Lobular cancer (tends to be multicentric) 
LABC 
Large tumor to breast ratio
69
Q

Radical mastectomy was described by

It is removal of-

A 
Halstead
Removal of -
Breast 
Nipple areolar complex 
Pectoralis major minor 
Level 1,2,3 axillary lymph nodes
70
Q

Incision of modified radical mastectomy

It is removal of?

A 
Elliptical Stewart incision
Breast
Nipple areolar complex
Pectoralis fascia
Level 1,2,3 axillary lymph nodes
71
Q

Variant of MRM

A

Auchincloss pectoralis minor is retracted
Scanlon pectoralis minor is cut
Patey \

72
Q

Variant of MRM

A

Auchincloss pectoralis minor is retracted
Scanlon pectoralis minor is cut
Patey \

73
Q

What is simple mastectomy

A

Removal of breast NAC PECTORALIS fascia

Axillary lymph nodes not removed

74
Q

Simple mastectomy is done in

A

Phyllodes
DCIS
Toilet mastectomy
Fungating cancer

75
Q

What is axillary clearance

A

Minimum 10 axillary lymph nodes removal

76
Q

Complications of axillary clearance

A 
Bleeding
Intercostobrachial nerve injury during mrm
Flap necrosis
Seroma 
lymphedema
Scar recurrence 
Phantom breast syndrome
77
Q

Winging of scapula is due to

A

Long thoracic nerve injury

78
Q

Most common complications of MRM
Management
Prevention

A

Seroma - accumulation of fluid beneath flap
Mgt
Aspirate under aseptic conditions and do pressure
Dressing,
Prevention
Insert drain and remove if output less than 40cc/ day for 2 consecutive days

79
Q 
What is the cause of lymphedema
Incidence
Prevention
Management 
Prognosis if not treated
A

If axillary clearance and radiotherapy are given to axilla - lymphedema of UL
2-5%

PREVENTION - Sentinel LN biopsy
Management- arm stocking, exercise,
Long standing cases can develop secondary malignancy - Stewart Treves Syndrome( angiosarcoma)

80
Q

Management of Stewart treves syndrome

A

Forequarter amputation

81
Q

Most common cause of upper limb lymphedema

A

Post mastectomy lymphedema

82
Q

Cancer en curasse?

A

Nodules cover chest wall like an armor in local/scar recurrence

83
Q

Most common cause of phantom breast syndrome

A

ICBN neuralgia

84
Q

➡️Breast 4⬅️

Q lactation Breast abscess m c cause can be?
Source of infection?

A

Staph aureus

Oropharynx of child

85
Q

Fluctuation as a late sign is seen in which abscess?

A 
Breast 
Parotid
Palmar
Plantar
Ischiorectal
86
Q

Breast abscess occuring in peri menopausal women
Causative organism
Diagnosis can be made through?
Mgt

A 
Breast abscess ass with duct ectasia 
Aerobic and anaerobic 
Diag by USG
Mgt
Antibiotics
Surgery-Hadfield procedure
87
Q

Management of lactational breast abscess

A 
Antibiotics - co amoxiclav 
Analgesic 
In case of pus, 
Usg guided aspiration (at least 2 attempt) 
 if fails I&D
88
Q

In management of lactational breast abscess

After I & D next step would be to?

A

Suppress lactation by cabergoline to prevent fistula formation

89
Q

In case of non healing abscess next step should be?

A

Suspect TB or inflammatory breast cancer

To confirm -Biopsy from wall of lesion

90
Q

Aberration of normal development and involution (ANDI) conditions mc in
15-25 yrs of age
25 -40 yrs of age
>40 yrs of age

A

Fibroadenoma

Fibrocystic disease

Fibrocystic disease

91
Q

Most common cause of breast lump
Incidence
C/F
Diagnosis

A

Fibroadenoma

15-25 yrs of age

Firm mobile lump
Painless

Usg ,
mammogram -popcorn calcification

92
Q

Types of fibroadenoma

A

Pericanalicular- hard

Intracanalicular

93
Q

Indication for surgery of fibroadenoma

A 
. Painful
. Cosmetic
. Rapid increase in size
. Fam hist of breast cancer
. Giant fibroadenoma>5 cm
94
Q

Types of incision used in fibroadenoma

A

Peri areolar incision ➡️ closure of incision by subcuticular suture

Gillard Thomas incision➡️ inframammary incision

95
Q

Methods of scarless fibroadenoma surgery

A

RFA
Radio frequency ablation
MAMMOTOME
Vacuum assisted biopsy system

96
Q

Needle used in mammotome

Limitations of scarless fibroadenoma surgery

A

8G needle

Limitation
Fibroadenoma more than equal to 2cm
Away from midline

97
Q

Other name of phyllodes tumor

Incidence

A

Aka cytosarcoma phyllodes

Occurs in 3-4th decade

98
Q

How to diagnose phyllodes tumor

A

Trucut and excisional biopsy

Number of mitotic figures and diff bw benign and malignant

99
Q

Fnac finding of phyllodes

A

No role of FNAC

100
Q

Clinical features of phyllodes

MC site of its hematogenous spread

A

Rapidly enlarging breast lump
Dilated veins

Lungs

101
Q

Mgt of phyllodes tumor

A

Surgery-
Lumpectomy
Simple mastectomy

102
Q

Indication of simple mastectomy in phyllodes tumor

A

Recurrence
Very large tumor
Malignant

103
Q

Types of mastalgia

A

Cyclical and non cyclical

104
Q

Cyclincal mastalgia is seen in

Incidence and clinical features

A

Fibroadenosis
Incidence-25-40yrs
Clinical features
Pain at beginning of cycle

105
Q

Examination, diagnosis finding of fibro adenosis

Mgt

A 
Lumpy breast
Diag by usg
Mgt 
Weight reduction
Lowering of tea coffee

Vit e primrose oil capsule for 2 months
If pain persists
Low dose tamoxifen, danozol

106
Q

Non cyclical mastalgia causes

Treatment

A 
Tietze syndrome (costochondritis) 
Intralesional triamcinolone
Mondor disease (superficial thrombophlebitis of chest vein) 
T/t analgesic
107
Q

Vein involved in mondors ds

Clinical presentation

A

Lateral thoracic vein

Cord like str, pain

108
Q

Mgt of breast cyst

A

Diagnosis usg
If large complex, aspirate

Bloody Residual cyst,
send for cytology and excise

Non bloody
Cyst resolve completely
Monitor pt
No need to send for cytology

109
Q

Serous nipple discharge from
single duct
Multiple duct
Surface of nipple

A 
Single and multiple duct 
Pregnancy
Puberty
Cancer
Duct ectasia

Surface of nipple
Pagets
Eczema

110
Q

Greenish bluish nipple discharge

A

Multiple duct ectasia

111
Q

Most common cause of pathological nipple discharge

A

Multiple duct ectasia

112
Q

Bloody discharge
Single duct
Multiple duct

A

Single-
Duct papilloma

Multiple
Cancer
Duct ectasia

113
Q

Most common cause of bloody nipple discharge

A

Duct papilloma

114
Q

Diagnosis of duct papilloma can be done by?

Mgt

A

USG-ectatic duct
Cytology of nipple discharge
Ductoscopy

Mgt
Microdochetomy -tennis racket incision single duct and lump is excised

115
Q

What leads to zuska’s disease

A

Duct ectasia, leads to stasis of secretion and periductal mastitis k/a Zuska’s Disease

116
Q

Manifestation of Zuska’s disease

Diagnosis and management

A

Peri areolar abscess /sinus formation
Bluish greenish discharge (multiple ducts)

Diagnosis
USG-multiple dilated ducts

Mgt
Antibiotics
Hadfield procedure ie cone excision of multiple ducts

117
Q

How to differentiate pagets from eczema

A

Pagets is U/L while eczema is bilateral
Nipple areola complex destroyed in pagets
Not destroyed in eczema

118
Q

How to diagnose pagets ds

A

Punch biopsy -

Paget cells in epidermis

119
Q

What is polymastia
Mc site
Mgt

A

Accesory breast tissue
Axilla
Excision

120
Q

Poland syndrome

A

Absence of breast tissue and unilateral pectoralis major

121
Q

Polythelia

Athelia

A

Accesory nipples

Absence of nipple

122
Q

Breast reduction surgery is done for?
Pattern used?
Dist bw 2 nipples in breast reduction

A

Done for breast hypertrophy
Inverted T pattern
19-21cm

123
Q

Gynecomastia and its causes

A

Enlargement of. Male breast tissue
Causes
Physiological
Puberty, newborn, senile

Pathological
Idiopathic
Drugs-digoxin isoniazid spironolactone cimetidine ketoconazole estrogen
Mumps orchitis
Others
124
Q

Diagnosis of gynecomastia

Tumor causing gynecomastia

A 
Usg - 3 cm diameter disc of breast tissue 
Tumors-
Rcc
Hcc
Testicular ass c paraneoplastic syndrome

Surgery (5 decks)

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