BREAST Flashcards by Javeria Anzar

Polymastia in which syndromes

Turner
Fleisch3r syndrome

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Polymastia vs polythelia

M: Multiple breast tissue
T: Multiple Nipples

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Axillary tail of spence passes through

Foramen of Langer

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Floe of milk

Lobule»Terminal duct»Segmental duct»lactiferous sinus»lacti duct

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Role of estrogen vs proges in breast development

E helps in development of ducts
P helps in development of lobules

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Breast Ca spreads to brain through

Posterior intercostal veins
It drains into paravertebral»Batson»epidural sinus/ Lumbar vertebrae

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Batson Venous Plexus

Breast Ca metastasize to dura and lumbar vertebrae through this route.

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Level of axillary lymph nodes

There are three surgical levels of axillary lymph nodes:
level I: below the lower edge of the pectoralis minor muscle.
level II: underneath/posterior the pectoralis minor muscle.
level III: above/medial the pectoralis minor muscle.

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Level of axillary lymph nodes is described by which muscle

Pectoralis Minor

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Level 1 axillary lymph nodes

Anterior axillary lymph nodes
Posterior
Lateral

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Level 2 axillary lymph nodes

Central axillary
Rotter axillary between pectoralis major and minor muscle

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Level 3 axillary lymph nodes

Apical axillary nodes

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Nerve damag3 during breast surgery

Long thoracic
Thoracodorsal
Intercostobrachial

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If sensation lost of medial side of arm during breast surgery th3n which nerve damage

Intercostobrachial nerve

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Supply of breast

anterior and lateral cutaneous branches of the 4th to 6th intercostal nerves.

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Nipple and areola drains into

subareolar lymphatic plexus.

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Br3ast lymphatic nodes clearance

the axillary nodes (75%),
parasternal nodes (20%) and
posterior intercostal nodes (5%).

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Adjuvant radiotherapy criteria

Adjuvant radiotherapy is offered to all patients after WLE and in post-mastectomy cases with positive resection margins, tumour size >5cm, or 4 or more pathological nodes in axilla.

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Side effects of Herceptin (Trastuzumab

Cardiotoxicity

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which Kind of flap can be used only for small breasts

Latissimus Dorsi flap

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Typesof Oncoplastic Management

mammoplasty
flap formation

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Hormanal therapy in pre and post menopausal women

Tamoxifen in pre
HerCeptin (T(Trastuzumab) in post

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Perform Radical mastectomy only when

Underlying muscles are involved

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If any implant rupture related problem
Which test to do

MRI

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U/S age limit

<35 years old

straw coloured fluid after surgery

Seroma

In which syndrome gynecomastia is present

Kallman's, Klinefelter's

Most common drug cause of gynecomastia

spironolactone

Mnemonic for causes of gynaecomastia

METOCLOPRAMIDE M etoclopramide E ctopic oestrogen T rauma skull/tumour breast, testes O rchitis C imetidine, Cushings L iver cirrhosis O besity P araplegia R A A cromegaly M ethyldopa I soniazid D igoxin E thionamide

If creamy discharge from breast during involution period then diagnosis will be

Duct ectasia

Which breast diseases is Strongly associated with smoking

Periductal mastitis

Most common cause of mastitis

S. Aureus

Mass develops behind nipple vs around nipple

Duct ectasia Periductal mastitis

Diagnosis of breast abscess

USS

1st line Rx of breast abdcess

USS Drainage of abscess

A combination of nipple discharge, gynaecomastia and poor vision

Prolactinoma

MC type of breast carcinoma

Invasive ductal carcinomas are the most common type

From which structure invasive carcinoma of breast

terminal duct lobular unit

The Nottingham Prognostic Index (NPI)*

Widely used clinicopathological staging system for primary breast cancer prognosis. It is calculated by: (Size x 0.2) + Nodal Status + Grade Size is the diameter of the lesion in cm, nodal status is number of axillary lymph nodes involved (0 nodes=1, 1-4 nodes=2, >4 nodes=3), and grade is based on Bloom-Richardson classification

Soft, easily moveable ,grey, gelatinous surface of a breast tumor

Mucinous carcinoma of breast

Nottingham Prognostic Index

Tumour Size x 0.2 + Lymph node score+Grade score

Survival is 50% if NPI is

>5.4

DCIS with Paget is associated with

larger tumour size, higher grade, less ER/PR receptor positivity and higher rates of HER2 positivity

Histology of paget disease

large pale paget cells would be seen in the epidermis and IHC for CEA would likely be positive.

ER/PR and HER2 status of paget disease

Only half are ER/PR positive and over 90% are HER2 positive inferring poor prognosis

Two theories of paget disease

1. Epidermatropic 2. Transformation

IHC for CEA is positive in which breast diseas

Paget

Paget vs eczema

Paget’s disease can be differentiated from eczema on the basis that the former always affects the nipple and only involves the areola as a secondary event, whilst eczema nearly always only involves the areola and spares the nipple.

NPI good prognostic vs bad

<2.4 is good >5 is bad

Risk of metastasis to the contralateral breast is a classical feature of

Invasive lobular carcinoma

If suspected invasive lobular and breast conserving surgery has to be done then what test to perform

MRI

Atypical epithelial hyperplasia is associated with

Increased risk of breast Ca

Hormonal effect of ER and PR on breast Ca

Chances of breast carcinoma increases with over exposure to estrogen and under exposure to progesterone

Age time period of ductal versus lobular

Ductal in both pre and post menopausal Lobular only in pre

Features of LCIS

Multifocal No palpable lump Diffuse Difficult to diagnose Bilateral distribution

How paget disease is differentiated from Eczema

Eczema is Bilateral Does not destroy nipple and Is not associated with an underlying lump

Metasysis of breast tumor occurs to which organs

Lung bone liver and brain occurs by blood

Types of breast tissue on macroscopic appearance

Scirrhous Medullary Mucinous

Schirrous type macroscopic appearance of breast

Dense White Grates when cut like unripe pear

Over expression of which receptors indicates bad prognosis

C-erbB-2/HER-2

Rare tumors of breast

Medullary Tubular Mucinous Papillary

Phyllodes tumor

Mean age is 45 Can become very large Recurrence is an issue

Major types of DCIS

comedo, cribriform, micropapillary, papillary, and solid types

Blood stained benign nipple discharge

Intraductal papilloma

Drugs for high risk females with breast Ca

Pre meno : Tamoxifen Postmeno: Anastrozole Don't give for more than 5 years

Comedo necrosis is a feature of

high nuclear grade ductal carcinoma in situ

Women wish to avoid breast prosthesis What to do

offer TRAM or DIEP flaps.

Mastectomy vs Wide Local Excision criteria

Multifocal tumour Solitary lesion Central tumour Peripheral tumour Large lesion in small breast Small lesion in large breast DCIS >4cm DCIS <4cm Patient Choice Patient choice

Mastectomy vs wide local excision on basis of DCIS

If >4cm then perform mastectomy

5 years Survival according to NPI for breast Ca

2 to 2.4 >>95% 2.5 to 3.4>> 85% 3.5 to 5.4 >> 70% >5.4 >> 40%

FEC (Fluorouracil, epirubicin and cyclophosphamide) Regime usually given for breast Ca what to give when high risk tumors

docetaxal, doxorubicin and cyclophosphamide