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Nate's! Last Test Edition - endocrine, MSK > breast > Flashcards

breast Flashcards

1
Q

intraductal papilloma presentation

A

buzzwords: bloody nipple discharge, premenopausal woman, myoepithelial cells still present

papillary growth w/in lactiferous ducts can bleed

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1
Q

where are these axillary nodes:

level I

level II

level III

rotters

A

level I - lateral to pec minor

level II - deep to pec minor

level III - medial to pec minor

rotter’s nodes - interpectoral

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1
Q

risk factors for breast cancer

A
  • increased estrogen exposure(obesity)
  • increased # of menstrual cycles
  • bein older when you have ya first baby
  • african american - increased risk for triple negative
  • BRCA1/2
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2
Q

Ki-67 index

A

nuclear marker for proliferation in breast cancer

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3
Q

invasive lobular carcinoma

A

5-10% of all breast cancers

Presentation:

  • Hard to see, even on imaging and grossly – sneaky bastard
  • Usually expresses hormonal receptors so pretty easy to treat
  • orderly rows of malignant cells(indian file)
  • bilateral w/multiple lesions in same location

Mets to: CSF, BM, GU tract, peritoneum

loss of e-cadherin means they wont be formin no ducts! discohesive.

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4
Q

periductal mastitis

A

inflammation of subareolar ducts

SMOKERS – causes relative vitamin A deficiency; lactiferous ducts cant start to become squamous tissue due to lack of vit. A; keratin plugs up lactiferous ducts causing inflammation

buzzwords: smoker, subareolar mass, nipple retraction

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4
Q

difference in chemotherapy benefit for breast cancer based on age

A

young people benefit by a greater margin than old people who are indicated for chemo

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6
Q

acute mastitis

A

bacterial breast infection(s. aureus mostly)

breast-feeding causes fissures, allows bacteria in

presents as mother with erythematous breast w/purulent discharge – drain and give dicloxacillin!

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6
Q

tubular invasive ductal carcinoma presentation

A

well formed tubules w/low-grade nuclei

LACKS MYOEPITHELIAL CELLS

young patient

ER/PR+; good prognosis

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6
Q

tamoxifen

A

anti-estrogen; blocks estrogen binding to ER+ cells

also called selective estrogen receptor modulator(SERM)

staple treatment for premenopausal patients w/early stage disease

partial agonist @ endometrium: increased cancer risk

antagonist @ breast: anti-ER+ tumor effect

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7
Q

mammary duct ectasia

A

inflammation w/dilation of subareolar(lactiferous) duct

usually seen in multiparous, POSTmenopausal woman

buzzwords: green-brown nipple discharge, periareolar mass(can mimic breast canceR)

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9
Q

phyllodes tumor presentation

A

fibroadenoma-like tumor w/excess fibrous tissue – causes leaf-like projections; can be malignant(low-grade)

more common in post-menopausal women

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10
Q

fibroadenoma presentation

A

buzzwords: small, mobile, firm mass, well-circumscribed, young

benign tumor of fibrous tissue and glands in premenopausal women; no malignant potential; no increased risk; can be left alone

estrogen sensitive - gets bigger w/more estrogen; regress after menopause

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11
Q

mucinous invasive ductal carcinoma

A

old lady(70-80)

tumor is filled w/mucous - rather indolent

estrogen/progesterone +

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12
Q

adenosis

A

increased acinii in lobules

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13
Q

non-malignant causes of breast calcifications

A

fat necrosis – saponification

sclerosing adenosis – seen in association with fibrocystic breast changes

14
Q

inflammatory subtype of invasive ductal carcinoma

A

invasion of dermal lymphatics by malignant cells

peau d’orange(breast skin looks like an orange)

bad prognosis – looks very similar to acute mastitis(erythematous, swollen breast)

  • keep inflammatory invasive ductal carcinoma in back of mind when seeing this presenation
16
Q

proliferative breast diseases and their cancer risk

A
  • *fibrocystic changes -** enlarged, cystic glands w/hyperplasia of fibrous breast stroma
  • no risk

sclerosing adenosis - excess glands that increase in fibrous tissue – can calcify!

  • 2x increased risk

epithelial/ductal hyperplasia - increased # of ductal cells – more than 2 layers in duct

  • 2x increased risk

atypical hyperplasia

  • 5x increased risk

these risks are all bilateral increases in risk!

17
Q

medullary sub-type of invasive ductal carcinoma

A

high grade malignant cells w/lymphocytic infiltrate

good prognosis

assn. w/BRCA mutation; ER-/PR-

18
Q

invasive ductal carcinoma presentation

A

“rock-hard” mass; poorly defined edges

duct-like cells - cells havent lost e-cadherin like invasive lobular

worst and most invasive

most common(76% of all breast cancers)

19
Q

how is DCIS often picked up on mammography?

A

microcalcifications in the ducts!

20
Q

HER2 mutation is _____prognostic and ________predictive

A

poor prognostic, but positive predictive

HER 2 lets you use trastuzumab or pertuzumab so positive predictive! natural course would be worse though so poor prognostic

22
Q

fibroscystic changes presentation

A

buzzwords: premenopausal, “lumpy” breast, blue dome cysts

hormone mediated change in breasts involving cystic ducts and increased fibrous change around them

23
Q

aromatase inhibitors

A

prevents formation of estrogens

staple treatment for postmenopausal patients – prolly cause they dont need estrogen for periods and stuff as much as pre-meno’s

reduced risk of second primary BC

24
Q

ER/PR/HER2 status for Luminal A and B molecular subtypes of breast cancer?

A

ER+/PR+/HER2-

25
Q

name the molecular subtypes of breast cancers

A

Luminal A

Luminal B

HER2+

Basal-like(triple-negative)

27
Q

how to differentiate intraductal papilloma vs carcinoma

A

both present with blood nipple discharge

papilloma: premenopausal and 2 cell layers present
carcinoma: postmenopausal and 1 cell layer(no myo)

28
Q

trastuzumab(herceptin) mechanism and toxicity

A

Mab against HER2(TK receptor); helps kill breast cancers overexpressing HER2 proteins

toxicity: HEARTceptin – damages the heart

29
Q

ER/PR/HER2 status for basal-like molecular subtype of breast cancer

A

triple negative for basal-like

30
Q

how are diagnostic mammograms different than the screening ones?

A
  • specialized views(spot compression, spot magnification, rolled)
  • real-time interpretation by radiologist w/results at time of exam
  • US can be performed on-site if indicated
31
Q

comedocarcinoma

A

DCIS with caseous necrosis in center

cells grow into center of duct, further from blood supply, start to die

32
Q

paget disease of breast

A

DCIS creeps up to nipple

eczematous patches on nipple

histo: paget cells are large cells in epidermis w/clear halo

can also be seen in vulva, but is NOT suggestive of DCIS there…

Nate's! Last Test Edition - endocrine, MSK (8 decks)

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