Breast 2

Question 0

Edema over skin underlying breast mass – diagnosis? Worse prognosis is?

Answer 0

Peau d’orange

Invasion of the local dermal lymphatics

Question 1

Ulcerated breast lesion with underlying mass – diagnosis?

Prognosis compared to infiltrating ductal carcinoma?

Answer 1

Inflammatory carcinoma; Worse prognosis than ductal carcinoma

Question 2

Extensive edema of the breast – differential?

Answer 2

1. Inflammatory carcinoma
2. Cellulitis
3. breast abscess

Question 3

Retraction of the skin overlying breast mass suggests in invasion of?

Answer 3

Invasion of breast support structures and lymphatics

Question 4

Patient with two previous aspirations of fluid from cystic mass in breast – mass keeps recurring - next step?

Answer 4

Excise cysts to rule out cancer

Question 5

Patient with the .5 cm breast mass fixed to the deeper tissues. Fixation to the chest wall indicates? Effect on the prognosis?

Answer 5

Invasion of structures outside the breast

Worsens prognosis

Question 6

Patient with breast mass and lymph node palpable in the supraclavicular area – indicates?

Answer 6

Stage IV disease with distant metastases. Unresectable and incurable

Question 7

Patient with breast mass – Hard fixed node in axilla versus soft lymph node?

Answer 7

Metastases

versus

metastases or inflammation

Question 8

Breast mass and small nodes on skin of breast – likely diagnosis?

Answer 8

Satellite nodules of carcinoma

Question 9

61-year-old woman presents with crusty lesion on the right nipple – likely dx? Next Steps? Treatment?

Answer 9

Paget’s disease – Underlying infiltrating ductal carcinoma or DCIS

1. Mammography an exam for mass
2. Biopsy any mass
3. If confined to nipple, excision of nipple areolar complex or radiotherapy

Question 10

Breast anatomy – main structures? Arterial supply? Venus return? Lymphatics?

Answer 10

1. 15-20 lobes each with 20-40 lobules
2. Ducts drain each lobe

Internal mammary and lateral thoracic

Axillary and internal mammary vein

Axillary lymph node chain

Question 11

Modified radical mastectomy – removes? Adjunct radiation if?

Answer 11

Most common mastectomy

Removes breast tissue, skin, axillary lymph nodes. Spares pectoralis major.

Local Radiation if:

1. greater than 5 cm
2. involve margins
3. invade fascia/muscle

Axillary radiation if More than four lymph nodes involved

Question 12

Radical mastectomy – removes?

Answer 12

Breast tissue, skin, pectoralis minor and major, axillary lymph nodes

Question 13

Simple mastectomy removes? Typical used with?

Answer 13

Breast tissue, nipple-areolar complex, skin

LCIS board DCIS

Question 14

Subcutaneous mastectomy removes? How common?

Answer 14

Breast tissue only; rarely indicated

Question 15

Lumpectomy – when to perform? Removal of?

Answer 15

Solitary tumor less than 5 cm in size if patient is a good candidate for postoperative radiation

Removal of

1. primary lesion with clear gross and histologic margins
2. axillary node sampling
3. local radiotherapy of breast

Question 16

Do not perform modified radical mastectomy for tumors less than this size?

Answer 16

2 cm

Question 17

Method for lymph node sampling in breast cancer?

Answer 17

Sentinel node biopsy with technetium or Isosulfan blue

Question 18

Survival in Modified radical mastectomy versus lumpectomy with radiation?

Answer 18

No difference in stage one or two disease