Breast Flashcards
Stewart-Treves syndrome
Lymphangiosarcoma
Originates in vascular endothelial cells in chronic lymphedema
Mondor disease
Thrombophlebitis of lateral thoracic or superior thoracoepigastric vein -> tender, subcutaneous cord in breast tissue
Radial scar found on core biopsy - next step?
Excisional biopsy because they may be associated with malignancy
Cowden syndrome surveillance
Breast exam q6mo with imaging (alternating MRI and mammogram)
Breast cancer in 1st trimester of pregnancy - management
Recommend termination of pregnancy; if not, mastectomy with axillary staging
Breast cancer in 2nd trimester of pregnancy - management
Mastectomy with axillary staging, or neoadjuvant chemo followed by breast conserving therapy.
Then postpartum radiation and endocrine therapy
Breast cancer in 3rd trimester of pregnancy - management
Same as any non-pregnant patient
Surgical treatment of gynecomastia
Excision of glandular tissue and liposuction of surrounding adipose tissue
Management of mild/moderate mastodynia (cyclical breast pain)
Conservative therapy, OTC pain meds, and lifestyle changes (avoid caffeine and chocolate)
Management of severe mastodynia
Tamoxifen (SERM), danazol (antigonadotropin), or bromocriptine (third line if refractory to danazol)
Lifetime risk of breast cancer if BRCA+
37-85%
Most frequent presentation of DCIS on mammogram
Clustered microcalcifications on mammogram
Diagnosis of inflammatory breast cancer
Acute onset of symptoms <6mo and pathologic confirmation
Management of inflammatory breast cancer
Neoadjuvant chemo, modified radical mastectomy, and adjuvant radiation with endocrine therapy
[Lymph node biopsy is contraindicated because tumor cells may plug dermal lymphatics]
Mammogram screening should start at age
40
Indication for PARP inhibitors (eg, Olaparib) in breast cancer
Adjuvant therapy for patients with triple negative breast cancer, and are BRCA+
Histologic findings of Paget disease
Large cells with pale cytoplasm and prominent nucleoli in epidermis
Li-Frameni syndrome manifestations
Breast cancer, soft tissue sarcoma, osteosarcoma, brain tumors, adrenal tumors, Wilms tumor, phyllodes tumor, pancreatic cancer, leukemia, neuroblastoma
Pathology of LCIS
Small uniform cells confined to lobule
Innervation of pec major
Medial pectoral nerve (upper part) and lateral pectoral nerve (lower part)
Margins for DCIS
2mm
E-cadherin staining in breast lesion
Atypical ductal hyperplasia
Margins for Phyllodes tumor
1cm margins
Indications for adjuvant chemotherapy in breast cancer
Nodal disease, tumor >1cm, and pathologic specimens with evidence of aneuploidy
Mechanism of tamoxifen
Competitive estrogen antagonist in breast
Partial agonist in non-breast tissue (uterus, liver, bone)
Amplification of this biomarker is associated with the worst prognosis in breast cancer
HER2
Breast pathology: cells with enlarged nucleoli interspersed with keratinocytes
Paget disease
Risk of developing invasive breast cancer after diagnosis of LCIS
25-35% lifetime risk
Mechanism of gynecomastia development
Decrease in androgen/testosterone production with resulting increase in estrogen
Innervation of pec minor
Medial pectoral nerve
Blood supply for a TRAM flap
Superior epigastric vessels
Blood supply for latismuss dorsi flap
Thoracodorsal artery
Most common cause of Mondor disease
Idiopathic
When to not breastfeed with mastitis
If there is purulent discharge
Borders for axillary lymph node dissection
Medial: serratus anterior
Lateral: anterior border of latissimus dorsi
Posterior: subcapsularis muscle
Superior: axillary vein
(Inferior border is less standard)
Anatomic borders of axilla
Apex: posterior border of clavicle
Anterior: pec major and minor
Posterior: subcapsularis
Medial: serratus anterior overlaying first 4 ribs and chest wall
Lateral: anterior border of latissimus dorsi
Which levels of axillary lymph nodes are taken for breast cancer?
Levels 1 and 2
Which levels of axillary lymph nodes are taken for melanoma?
Levels 1, 2, and 3
When to start breast cancer screening if BRCA+
Age 25 with yearly MRI and clinical breast exams every 6-12 months (add mammogram to screening at age 30)
