Breast Flashcards
Patients with ____ classically have symptoms of mastitis that do not improve (or only initially improve)with antibiotics.
inflammatory breast carcinoma
Presents with diffuse breast erythema, pain, and edema with skin thickening and dimpling (peau d’orange appearance).
inflammatory breast carcinoma
____ is a rapidly aggressive form of breast cancer, and many patients initially have metastatic disease.
Inflammatory breast carcinoma
Solitary, well-circumscribed & mobile mass
± Tenderness
Breast cyst
Multiple, diffuse nodulocystic masses
Cyclic premenstrual tenderness
Fibrocystic changes
Solitary, firm, well-circumscribed & mobile mass
Cyclic premenstrual tenderness
Fibroadenoma
After trauma/surgery
Firm, irregular mass
± Ecchymosis, skin/nipple retraction
Fat necrosis
Benign papillary tumor arising from breast duct lining
Unilateral bloody nipple discharge (can be non-bloody)
Intraductal papilloma
No associated breast mass or lymphadenopathy
Unilateral bloody nipple discharge (can be non-bloody)
Intraductal papilloma
Treatment for Intraductal papilloma
Mammography & ultrasound
Biopsy ± excision
Most important prognostic factor in breast cancer?
TNM staging
Tumor burden is based on TNM staging
Women <30 with complex cyst/mass, recurrent cysts, or solid mass. Next best step in management?
Core Needle Bx
Complex cysts seen on Ultrasound.
Next best step in management?
Core Needle Bx
Simple cysts seen on U/S. Asymptomatic.
Next best step in management?
Observe
Simple cysts seen on U/S. Tender.
Next best step in management?
FNA
Persistent or recurrent breast cyst s/p FNA
or
bloody aspirate in aspirate.
Next best step in management?
Core Needle Bx
+/- more imaging
Sudden-onset unilateral pelvic pain
Nausea & vomiting
± Palpable adnexal mass
U/S → Enlarged ovary with decreased or absent Doppler flow
Diagnosis & Next best step in management?
Ovarian Torsion
Laparoscopy with detorsion
or
Ovarian cystectomy
Oophorectomy (if necrotic or malignant)
Pt with unilateral breast rash, erythema, and edema. Metastatic disease (axillary lymphadenopathy) is common on initial presentation.
Inflammatory breast carcinoma (IBC)
an aggressive breast cancer w/ rapid spread
Inflammatory breast carcinoma (IBC) diagnostics to confirm include (2)
Core needle breast biopsy
&
Full-thickness skin punch biopsy
- Unilateral, spontaneous, bloody nipple discharge accompanied by a palpable breast mass and retraction of overlying skin (invasion of suspensory ligaments).
- Unilateral bloody discharge without a breast mass. No overlying skin retraction
- Invasive Ductal Carcinoma
2. Intraductal Papilloma
Presents with palpable, fluctuant breast mass with purulent nipple discharge and FEVER
Breast abscess
Lymphatic drainage from the breast passes primarily to the ___ lymph nodes.
The ____ muscle is the landmark for distinguishing the surgical levels of lymph nodes during dissection.
axillary
pectoralis minor
Sudden-onset, severe, unilateral lower abdominal pain immediately following strenuous or sexual activity
+ Pelvic free fluid on u/s
Ruptured ovarian cyst
Fever/chills, vaginal discharge, lower abdominal pain & cervical motion tenderness
± Tuboovarian abscess
PID
Amenorrhea, abdominal/pelvic pain & vaginal bleedingPositive β-hCG
Ectopic Pregnancy
Breast conserving therapy typically consists of partial ___ and ____ biopsy, followed by whole breast ___ therapy.
mastectomy (Lumpectomy)
sentinel lymph node → axillary LN dissection
radiation
- Adequate surgical excision requires negative margins.
Positive sentinel lymph node biopsy warrants axillary lymph node dissection
(typically performed for __ positive nodes).
≥3
___ is sometimes used for cancer SCREENING in high-risk patients (ex: BRCA carrier).
Breast MRI
Patients with bilateral, diffuse, and cyclic breast pain
- With mass
- W/o mass
- Imaging
2. Observe
Patients with unilateral, focal, and noncyclic breast pain
- With mass
- W/o mass
- Core needle Biopsy
- Imaging
to evaluate for cancer.
Abn imaging = CN bx
Breast ultrasound is indicated in this patient with ___ breast tissue.
dense breast tissue
no matter the age!
BRCA testing is indicated for FMH of breast cancer in __ 1º relatives (parent, sibling, child) & 1 of whom was diagnosed at age ≤ __.
≥2
≤50
*One 2º relative (cousin, aunts, grandparents, nieces, half siblings) with breast cancer diagnosed at age >50 is not an indication
