Breast Flashcards
Tx of Mondor dx; tender subcutaneous cord due to thrombophlebitis of lateral thoracic vein;
NSAIDs, warm compresses
Absolute contraindications to sentinel lymph node bx?
Palpable lymphadenopathy
Inflammatory breast Cancer
Previous radiation
Previous axillary surgery
Multi focal breast Ca
Radial scars?
Benign breast lesions AKA complex sclerosing lesions
When found on core needle biopsy, an excisional biopsy needs to be performed to r/o malignancy
LCIS:
Risk factor for cancer, not a pre-cancerous
Usually bilateral breasts involved (compared to DCIS)
No re-excision required if found on margin
Borders of dissection for an axillary lymphadenectomy;
Superior; ax vein
Medial; Serratus anterior
Lateral; Lat
Posterior; subscapularis
Axillary lymph node basins:
I lateral to pec minor
II underneath pec minor
III medial to pec minor
I & II level nodes are removed during an axillary dissection
Oil cysts?
Pathognomonic for fat necrosis of the beast
Usually see hx of trauma, surgery, or radiation
Tx of malignant phyllodes tumor?
Wide local excision with 1 cm margins
Why is SLND bx not done for phyllodes tumors?
Usually spread hematogenously
Need 1 cm margins
What causes gynecomastia?
Decrease in testosterone
Increase in estrogen
Malignant appearing cells with a ‘fried egg’ appearance?
Paget dx
Large cells with pale cytoplasm and prominent nucleoli?
Pagets dx
Olaparib?
Recommended for triple negative breast Ca with pts that have BRC1/2 mutations
MC site of mets of breast Ca?
Bone
Differentiating ALH from ADH;
ALH stains negative for e-Catherin
Someone’s >35 and has Mondor’s dx?
After you start NSAIDs, they need a mammogram to r/o concomitant malignancy
What do we do with radial scars?
Excise them
Upon excisional biopsy, 25% of them can be upstaged to a malignancy
Start screening mammograms at what age?
40
USPTS recommends starting at 50
Cowden syndrome;
Facial skin lesions
Breast Cancer
Thyroid Cancer
PTEN mutation
AD mutation of PTEn gene causing cancers of thyroid, breast, endometrium, benign hamartomatous skin growths;
Cowden syndrome
Stewart Trever’s syndrome?
Lymphangiosarcoma of a lymphedematous arm after radiation for breast cancer
Cause of lymphangiosarcoma (Stewart Treves syndrome)?
Tumor originates from vascular endothelial cells in chronic lymphedema
Damage to long thoracic nerve:
Winged scapula
Shoulder pain
Inability to raise arm above shoulder level
Margins for borderline or malignant phyllodes tumors?
1 cm
Spread hematogenously
Most frequent presentation of DCIS on mammogram?
Clustered calcifications
Mutation of TP53?
Li Fraumeni syndrome
AD
Rhabdomyosarcomas, breast Cancer, CNS Ca
Dense breast tissue?
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
Endocrine therapy in male breast Ca?
After mastectomy, typically 5-10 yrs of tamoxifen is given
90% of male breast ca are ER +
MRI and neoadjuvant chemotherapy?
More accurate as assessing residual disease after neoadjuvant chemotherapy than US, mammogram or physical exam
Benign inflammatory condition of breast where you form granulomas that could be mistaken for Ca;
Granulomatous mastitis
Start steroids
Her-2 therapy and tamoxifen during pregnancy?
Contraindicated
Neoadjuvant chemotherapy during pregnancy is safe
After treatment of stage II breast cancer, what surveillance plan do you need in place?
Annual mammogram
After treatment of stage II breast cancer, what surveillance plan do you need in place?
Annual mammogram
When do we use genetic testing assays in breast Ca/
ER +/ Her 2 -, at least 0.5 cm tumor size
Mutation of ATM gene is assc with cancer of breast and?
Pancreas
Mucinous carcinoma of the breast?
Better prognosis that invasive ductal ca
Rare tumor
Doesn’t mets to axillary lymph nodes, low recurrence rate
90% survival at 10 years
Aromatase inhibitors?
For post-menopausal women who need hormone therapy due to estrogen/progesterone + breast Ca
SE: joint pain, menopausal symptoms, bone sxs
SE of tamoxifen?
Blood clots, DVT, PE
Can cause endometrial Ca
Benefit of radiation therapy after mastectomy?
Decreases ipsilateral breast recurrence
Has no effect of survival
PALb2?
Partner and localizer of BRCA2
44% lifetime risk of breast Cancer
STK11 mutation?
Peutz Jeghers syndrome
See GI ca, melanocytic macules, breast Cancer
MRI recommended in these pts b/c risk of breast cancer is >20%
Most common autologous flap used for breast reconstruction?
TRAM flap
Based on superior epigastric artery
TRAM flap is based on what blood supply?
Superior epigastric artery
BIRADS 3?
Probably benign
<2 % of malignancy
6-month follow up imaging recommended
BIRADS 5?
Highly suggestive of malignancy
> 95%
Why should we remove atypical ductal hyperplasia?
25% of upstaging to carcinoma or in situ
Damage to intercostobrachial nerve?
Pain and numbness upper inner arm
Previous chemotherapy a contraindication for neoadjuvant chemotherapy?
NO
Diagnosing inflammatory breast cancer?
Clinically done; biopsy not required to established a diagnosis
Examples of aromatase inhibitors:
Lestrozole
Ezemstane
Anastrozole
Designation of inflammatory breast cancer as per TNM?
T4d
T staging of breast cancer?
T1; <2 cm
T2; 2-5
T3; >5
T4; any size with direct extension into chest wall/skin
Tx of DCIS?
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
Tx of intraductal papilloma?
MC of bloody nipple discharge, can be treat with simple duct excision
Absolute contraindications to breast conserving surgery?
Pregnancy
Diffuse malignant appearing calcifications
Positive pathological margins
Wide spread disease >1 quadrant
Absolute contraindications to breast conserving surgery?
Pregnancy
Diffuse malignant appearing calcifications
Positive pathological margins
Wide spread disease >1 quadrant
When suspecting inflammatory breast Ca, the first step in the work up includes?
B/l diagnostic mammography
Stewart Treves syndrome?
Post-mastectomy lymphangiosarcoma
Slow-slow growing; takes 10 years
High malignant potential
Lesions resemble bruises or blotches of erythema
Treatment of Stewart Treves lymphangiosarcoma after mastectomy?
Wide local excision with 3-6 cm margins
Overall poor prognosis
Tumor cells originate from dermal vascular endothelium:
Lymphangiosarcoma (Stewart Treves syndrome)
How do we treat pleomorphic LCIS differently?
Need 2mm margins
Tamoxifen and LCIS?
Tamoxifen for 5 years has shown a 56% risk reduction in development of breast cancer in either breast
LCIS vs DCIS:
LCIS lacks e-cadherin expression
Margins for LCIS?
Not needed for classic type
If atypical or pleomorphic, need 2 mm margins,
Injury to the thoracodorsal nerve causes what symptoms;
Can’t extend arm
Can’t internally rotate arm
Can’t adduct arm
Damage of lacteral pecotral nerve that innervates pec major causes what sxs?
Weak flexion of arm at shoulder
Damage to medial pectoral nerve that innervates pec major/minor;
Weak arm extension, adduction, internal rotation at shoulder
(similar to damage to thoracodorsal nerve)
Mastitis in breast feeding patient is most commonly caused by:
S. Aureus
Tx of Mondor dx?
4-6 weeks of NSAIDs and warm compresses
Thrombophlebitis of subq veins of lateral chest wall
ADH and negative margins?
Resect ADH but you don’t need negative margins
However, pts should receive hormonal therapy post-resection
Simple mastectomy?
AKA total mastectomy
Remove all breast tissue, NAC, skin, while leaving adequate skin flaps to close wound
Helps calculate a woman’s risk of breast cancer in next five years and lifetime;
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)
Phyllodes tumor margins?
Need 1 cm margins
And malignant phyllodes tumors need post-op radiation
Leaf like pattern, hypercellular, sarcomatous;
Phyllodes tumor
Can have malignant potential or be malignant
Complex sclerosing lesions?
Radial scars
Excise them when seen on core needle bx
How do we treat radiation induced angiosarcoma of the breast?
Mastectomy and excision of the overlying skin
CHEK2 mutation:
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
What can be given to relax the sphincter of oddi?
Glucagon; 1 mg
