Breast

Question 1

Options for lcis

Answer 1

Close obs, tamoxifen for 5 years, bilateral mastectomy

Question 2

Side effects of tamoxifen

Answer 2

Dvt, endometrial cancer, stroke, mi, cataracts

Question 3

Core biopsy response

Answer 3

Excisional biopsy:
Adh, alh, lcis, papillary, complex sclerosing, fibroadenoma, fibroepithelial w concern for phyllodes.
Pleomorphic lcis- need negative margins
Classic lcis - no need for negative margins

Dont need excisional bx:
flat epithelial atypia without ADH, pseudoangiomatous stromal hyperplasia

Question 4

Male gynecomastia workup

Answer 4

Meds, family Hx, testicular exam
Chemistry/LFT, Thyroid panel, estrogen and testosterone levels
Genetic testing

Question 5

Male BRCA2 recommendation

Answer 5

No ppx mastectomy, yearly PSA testing for prostate cancer, Annual mammogram starting 50yo or 10y before earliest known cancer in family

Question 6

Intraductal papilloma Mgmt

Answer 6

In bloody nipple discharge:
Mammogram and U/S
If no mass, MRI
If lesion seen -> core needle biopsy

Intraductal papilloma without atypia: surgical excision

If no lesion seen: total subareolar duct excision

If persistent bloody nipple discharge postop, consider incorrect diagnosis or incomplete resection. return to OR for exploration