BREAST Flashcards
Blood supply of breast
Internal mammary and lateral thoracic aa
Intercostobrachial n comes off which nerve?
2nd intercostal. Provides sensation to medial arm
Medial pectoral n supplies
both pec minor and major
Lateral pectoral nerve supplies
pec minor ONLY
Poland syndrome
Amastia
Hypo plastic shoulder
No pecs
Mondor’s disease
Thrombophlebitis of superficial vein of breast
Tx of Mondor’s disease
NSAID
Rx of Mastodynia
Danazol, OCP
How many of DCIS recurrences are invasive?
50%
Cure rate of DCIS
94-100%
Surgical tx of DCIS
Excision and radiotherapy OR mastectomy. Axillary dissection NOT required as only 1% have positive nodes.
Risks of Tamoxifen
1-2% DVT, PE Cataracts Uterine adenocarcinoma, sarcoma Decreases risk of osteoporosis NO CHANGE in incidence of heart disease
Tamoxifen on survival rate of breast CA
Tamoxifen has NOT been shown to increase survival, only decrease rate of recurrence (DCIS and ipsilateral/contralateral invasive breast CA).
Van Nuys classification
May ID pts who can benefit from lumpectomy alone. Low grade W/O necrosis Margin > 1 cm Lesion <1.5 cm
Difference between LCIS and Atypical Lobular Hyperplasia (ALH)
LCIS has >50% lobular involvement and ALH <50%
Increased risk in patients with LCIS
7-10x increased risk of invasive CA in either breast
% of malignancies in Phyllodes tumor
10%
How does Phyllodes tumor spread?
Hematogenously, if at all.
Surgical tx of Phyllodes
Wide local excision, mastectomy not necessary! No ALND (doesn’t spread through LN)
1 cause of bloody nipple discharge
Intraductal papilloma – > NO RISK OF CA
Comedo breast CA
Likely multi centric. Poor prognosis. :(
What is a radial scar and what do you do about it?
Stellate arrangement of ductal structures with sclerotic background and central fibro-elastic core. Associated with carcinoma anywhere in the scar – do not stereotactically biopsy as that has increased chance of sampling error. Instead, you should do an excision biopsy
T1 breast cancer size
<2 cm
T2 breast cancer size
2.1 - 5 cm
T3 breast cancer size
> 5 cm
N1 in breast cancer
+ axillary nodes
N2 in breast cancer
matted/fixed nodes
N3 in breast cancer
internal mammary nodes
Stage I breast CA
T1 (90-95% 5 year survival)
Stage II breast CA
T2N1 or T3N0 (50-80% 5 year survival)
Stage III breast CA
T4 or N3 (30-50% 5 year survival)
In pre-menopausal women with breast CA, who gets chemo?
ER/PR-
T>1 cm
Any N, including micro (SN+)
In post menopausal women with breast CA, who gets chemo?
ER/PR- and T >2 cm
>4 nodes OR matted nodes (regardless of ER/PR, whether positive OR negative!)
Who gets axillary radiation in breast CA?
+ supraclavicular node
Matted nodes (extra capsular extension)
>4 nodes
Li-Fraumeni syndrome is a mutation of?
p53
How often do patients with Mondor disease have an underlying breast CA
6.3%
Most common etiology of Mondor
Idiopathic
Others: previous trauma, surgery, or biopsy, an underlying connective tissue disorder, breast cancer
Raloxifine can be administered to who?
POST menopausal women.
What is pseudogynecomastia (lipomastia)
Fat deposition WITHOUT glandular proliferation. Think the very obese male.
Benign breast disease associated with increased risk of malginancy
Atypical ductal hyperplasia and atypical lobular hyperplasia (4x). If family history is +, risk increases to 9x.
Cowmen’s syndrome (PTEN mutations) associated with cancers where?
Hamartomatous and/or cancerous lesions in Skin, Mucous membranes, breast, thyroid, endometrium, colon, and brain.
What should you do FIRST in the diagnostic workup of suspected Paget’s disease?
Full thickness nipple areolar skin biopsy. Dx is best made with confirmation of Paget cells involving epidermis of nipple by histology.
In the absence of radiographic findings, pathologic unilateral bloody nipple discharge should be managed with…
Terminal duct excision.
Breast RF for chest wall recurrence post-mastectomy
Presence of axillary node mets
What breast CA is difficult to detect on mammography
LCIS.
Indicators for chemo prior to breast CA surgery
Arm edema
Skin ulceration
Edema of skin of breast
Tumor fixation to serrates anterior
Recommendations for screening in known/suspected BRCA mutation
Annual MRI starting at age 25 and then annual mammogram and breast MRI beginning at age 30
Annual ovarian cancer screening (including transvaginal ovarian ultrasounds, CA-125, pelvic exams beginning at age years or 5-10 years before the earliest age of first diagnosis of ovarian cancer in the family)
Biannual clinical breast exam beginning at age 25
Monthly breast self-exams/breast awareness starting at age 18
Which systemic agent improves survival in men with ER+ breast CA?
Tamoxifen
Hormone med with androgenic properties highly effective for alleviation of breast pain
Danazol
2 endocrine disorders that cause galactorrhea
HYPOthyroidism and hyperprolactinemia
Class of drug notorious for inducing galactorrhea, amenorrhea
TYPICAL antipsychotic
Benign breast disease resulting in nipple retraction and thick yellow/green or bloody discharge
Duct ectasia
Small normal bumps on areola
Montgomery’s tubercle
Risk of developing local recurrence after mastectomy in women with DCIS
1%
Mammography findings of fat necrosis
Architectural distortion
Microcalcs
Spiculated masses
If it demonstrates mixed soft tissue density with calcified rim, dx of fat necrosis is confirmed
Why do cigarette smokers in particular get recurrent breast abscesses
Cigarette smokers have decreased blood levels of beta-carotene, which in turn affects the ability of vitamin A to protect against squamous metaplasia. Vitamin A is essential for the differentiation and preservation of normal mucosal epithelium. Deficiency of vitamin A produces a keratinizing squamous metaplasia that can lead to intermittent duct obstruction and recurrent infection.
