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Breast Flashcards

1
Q

Tx of Mondor dx; tender subcutaneous cord due to thrombophlebitis of lateral thoracic vein;

A

NSAIDs, warm compresses

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2
Q

Absolute contraindications to sentinel lymph node bx?

A

Palpable lymphadenopathy
Inflammatory breast Cancer
Previous radiation
Previous axillary surgery
Multi focal breast Ca

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3
Q

Radial scars?

A

Benign breast lesions AKA complex sclerosing lesions

When found on core needle biopsy, an excisional biopsy needs to be performed to r/o malignancy

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4
Q

LCIS:

A

Risk factor for cancer, not a pre-cancerous
Usually bilateral breasts involved (compared to DCIS)
No re-excision required if found on margin

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5
Q

Borders of dissection for an axillary lymphadenectomy;

A

Superior; ax vein
Medial; Serratus anterior
Lateral; Lat
Posterior; subscapularis

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6
Q

Axillary lymph node basins:

A

I lateral to pec minor
II underneath pec minor
III medial to pec minor

I & II level nodes are removed during an axillary dissection

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7
Q

Oil cysts?

A

Pathognomonic for fat necrosis of the beast

Usually see hx of trauma, surgery, or radiation

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8
Q

Tx of malignant phyllodes tumor?

A

Wide local excision with 1 cm margins

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9
Q

Why is SLND bx not done for phyllodes tumors?

A

Usually spread hematogenously

Need 1 cm margins

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10
Q

What causes gynecomastia?

A

Decrease in testosterone

Increase in estrogen

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11
Q

Malignant appearing cells with a ‘fried egg’ appearance?

A

Paget dx

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12
Q

Large cells with pale cytoplasm and prominent nucleoli?

A

Pagets dx

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13
Q

Olaparib?

A

Recommended for triple negative breast Ca with pts that have BRC1/2 mutations

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14
Q

MC site of mets of breast Ca?

A

Bone

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15
Q

Differentiating ALH from ADH;

A

ALH stains negative for e-Catherin

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16
Q

Someone’s >35 and has Mondor’s dx?

A

After you start NSAIDs, they need a mammogram to r/o concomitant malignancy

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17
Q

What do we do with radial scars?

A

Excise them

Upon excisional biopsy, 25% of them can be upstaged to a malignancy

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18
Q

Start screening mammograms at what age?

A

40

USPTS recommends starting at 50

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19
Q

Cowden syndrome;

A

Facial skin lesions
Breast Cancer
Thyroid Cancer

PTEN mutation

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20
Q

AD mutation of PTEn gene causing cancers of thyroid, breast, endometrium, benign hamartomatous skin growths;

A

Cowden syndrome

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21
Q

Stewart Trever’s syndrome?

A

Lymphangiosarcoma of a lymphedematous arm after radiation for breast cancer

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22
Q

Cause of lymphangiosarcoma (Stewart Treves syndrome)?

A

Tumor originates from vascular endothelial cells in chronic lymphedema

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23
Q

Damage to long thoracic nerve:

A

Winged scapula
Shoulder pain
Inability to raise arm above shoulder level

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24
Q

Margins for borderline or malignant phyllodes tumors?

A

1 cm

Spread hematogenously

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25
Q

Most frequent presentation of DCIS on mammogram?

A

Clustered calcifications

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26
Q

Mutation of TP53?

A

Li Fraumeni syndrome

AD

Rhabdomyosarcomas, breast Cancer, CNS Ca

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27
Q

Dense breast tissue?

A

Independent risk factor for breast Cancer

MRI not recommended in pts with dense breasts and no other risk factors

US + mammography recommended as a screening tool

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28
Q

Endocrine therapy in male breast Ca?

A

After mastectomy, typically 5-10 yrs of tamoxifen is given

90% of male breast ca are ER +

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29
Q

MRI and neoadjuvant chemotherapy?

A

More accurate as assessing residual disease after neoadjuvant chemotherapy than US, mammogram or physical exam

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30
Q

Benign inflammatory condition of breast where you form granulomas that could be mistaken for Ca;

A

Granulomatous mastitis

Start steroids

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31
Q

Her-2 therapy and tamoxifen during pregnancy?

A

Contraindicated

Neoadjuvant chemotherapy during pregnancy is safe

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32
Q

After treatment of stage II breast cancer, what surveillance plan do you need in place?

A

Annual mammogram

33
Q

After treatment of stage II breast cancer, what surveillance plan do you need in place?

A

Annual mammogram

34
Q

When do we use genetic testing assays in breast Ca/

A

ER +/ Her 2 -, at least 0.5 cm tumor size

35
Q

Mutation of ATM gene is assc with cancer of breast and?

A

Pancreas

36
Q

Mucinous carcinoma of the breast?

A

Better prognosis that invasive ductal ca

Rare tumor

Doesn’t mets to axillary lymph nodes, low recurrence rate

90% survival at 10 years

37
Q

Aromatase inhibitors?

A

For post-menopausal women who need hormone therapy due to estrogen/progesterone + breast Ca

SE: joint pain, menopausal symptoms, bone sxs

38
Q

SE of tamoxifen?

A

Blood clots, DVT, PE

Can cause endometrial Ca

39
Q

Benefit of radiation therapy after mastectomy?

A

Decreases ipsilateral breast recurrence

Has no effect of survival

40
Q

PALb2?

A

Partner and localizer of BRCA2

44% lifetime risk of breast Cancer

41
Q

STK11 mutation?

A

Peutz Jeghers syndrome

See GI ca, melanocytic macules, breast Cancer

MRI recommended in these pts b/c risk of breast cancer is >20%

42
Q

Most common autologous flap used for breast reconstruction?

A

TRAM flap

Based on superior epigastric artery

43
Q

TRAM flap is based on what blood supply?

A

Superior epigastric artery

44
Q

BIRADS 3?

A

Probably benign

<2 % of malignancy

6-month follow up imaging recommended

45
Q

BIRADS 5?

A

Highly suggestive of malignancy

> 95%

46
Q

Why should we remove atypical ductal hyperplasia?

A

25% of upstaging to carcinoma or in situ

47
Q

Damage to intercostobrachial nerve?

A

Pain and numbness upper inner arm

48
Q

Previous chemotherapy a contraindication for neoadjuvant chemotherapy?

A

NO

49
Q

Diagnosing inflammatory breast cancer?

A

Clinically done; biopsy not required to established a diagnosis

50
Q

Examples of aromatase inhibitors:

A

Lestrozole
Ezemstane
Anastrozole

51
Q

Designation of inflammatory breast cancer as per TNM?

A

T4d

52
Q

T staging of breast cancer?

A

T1; <2 cm
T2; 2-5
T3; >5
T4; any size with direct extension into chest wall/skin

53
Q

Tx of DCIS?

A

Partial mastectomy with post op radiation, tamoxifen if path shows ER+

SNLDbx typically not done unless:
Large >2 -2.5 cm, high grade DCIS, palpable mass, undergoing mastectomy

54
Q

Tx of intraductal papilloma?

A

MC of bloody nipple discharge, can be treat with simple duct excision

55
Q

Absolute contraindications to breast conserving surgery?

A

Pregnancy
Diffuse malignant appearing calcifications
Positive pathological margins
Wide spread disease >1 quadrant

56
Q

Absolute contraindications to breast conserving surgery?

A

Pregnancy
Diffuse malignant appearing calcifications
Positive pathological margins
Wide spread disease >1 quadrant

57
Q

When suspecting inflammatory breast Ca, the first step in the work up includes?

A

B/l diagnostic mammography

58
Q

Stewart Treves syndrome?

A

Post-mastectomy lymphangiosarcoma
Slow-slow growing; takes 10 years
High malignant potential
Lesions resemble bruises or blotches of erythema

59
Q

Treatment of Stewart Treves lymphangiosarcoma after mastectomy?

A

Wide local excision with 3-6 cm margins
Overall poor prognosis

60
Q

Tumor cells originate from dermal vascular endothelium:

A

Lymphangiosarcoma (Stewart Treves syndrome)

61
Q

How do we treat pleomorphic LCIS differently?

A

Need 2mm margins

62
Q

Tamoxifen and LCIS?

A

Tamoxifen for 5 years has shown a 56% risk reduction in development of breast cancer in either breast

63
Q

LCIS vs DCIS:

A

LCIS lacks e-cadherin expression

64
Q

Margins for LCIS?

A

Not needed for classic type

If atypical or pleomorphic, need 2 mm margins,

65
Q

Injury to the thoracodorsal nerve causes what symptoms;

A

Can’t extend arm

Can’t internally rotate arm

Can’t adduct arm

66
Q

Damage of lacteral pecotral nerve that innervates pec major causes what sxs?

A

Weak flexion of arm at shoulder

67
Q

Damage to medial pectoral nerve that innervates pec major/minor;

A

Weak arm extension, adduction, internal rotation at shoulder

(similar to damage to thoracodorsal nerve)

68
Q

Mastitis in breast feeding patient is most commonly caused by:

A

S. Aureus

69
Q

Tx of Mondor dx?

A

4-6 weeks of NSAIDs and warm compresses

Thrombophlebitis of subq veins of lateral chest wall

70
Q

ADH and negative margins?

A

Resect ADH but you don’t need negative margins

However, pts should receive hormonal therapy post-resection

71
Q

Simple mastectomy?

A

AKA total mastectomy

Remove all breast tissue, NAC, skin, while leaving adequate skin flaps to close wound

72
Q

Helps calculate a woman’s risk of breast cancer in next five years and lifetime;

A

Gail model; uses 6 key factors;

Age at first birth
Age of menses onset
Age
Race/ethnicity
Hx of breast biopsy
Family hx (not high risk gene mutations)

73
Q

Phyllodes tumor margins?

A

Need 1 cm margins

And malignant phyllodes tumors need post-op radiation

74
Q

Leaf like pattern, hypercellular, sarcomatous;

A

Phyllodes tumor

Can have malignant potential or be malignant

75
Q

Complex sclerosing lesions?

A

Radial scars

Excise them when seen on core needle bx

76
Q

How do we treat radiation induced angiosarcoma of the breast?

A

Mastectomy and excision of the overlying skin

77
Q

CHEK2 mutation:

A

Assc with bladder, breast, colon Ca

CHEK2 is a threonine/serine kinase involved in DNA damage repair and apoptosis

Also assc with increased male breast cancer risk

78
Q

What can be given to relax the sphincter of oddi?

A

Glucagon; 1 mg

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