Breast Flashcards
48 yo with Large painless breast lump, no lymphadenopathy, rapidly growing, leaf-like appearance tumor under microscope
Phyllodes tumor- benign tumor that looks like fibroadenoma in imaging
Mastalgia, cyclic pain with menses, clear/white discharge
Fibrocystic Breast disease
A rapid introduction proliferation of cells that leads to necrosis and cellular debris within the ducts. On microscope: solid growth of large, paleo Orphic, high-grade cell’s with central expansile necrosis, mitotic figures, periductal inflammation and fibrosis and coarse microcalcifications
Comedocarcinoma- a type of ductal carcinoma in situ with rapid introduction proliferation of cells
Painless breast mass, skin changes (retraction, dimpling, edema), nipple retraction, bloody discharge, microcalcifications and stromal invasion on biopsy
Invasive ductal carcinoma
<35yo F, presents as a solitary, nontenders, mobile mass, “popcorn” calcification on mammography, biopsy show benign hyperplastic stroma encapsulating ductal tissue
Fibroadenoma
Sometimes palpable, single or multiple lesions with serous or bloody nipple discharge, biopsy. Show a central, branching, fibrovascular core with surrounding myoepithelial and epithelial cells
Intraductal papilloma
Painless breast nodule with microcalcification and speculations on mammogram and malignant cels in lobules and monomorphic cells in single rows referred to as “Indian file” pattern on biopsy
Invasive lobular carcinoma
Drug with Increased risk of endometrial hyperplasia? Why?
Tamoxifen; unopposed estrogen on uterus (estrogen agonist)
Drug with decreases the risk of endometrial hyperplasia? Why? What is its SE?
Raloxifene; estrogen antagonist in breast and the uterus ; but risk of thromboembolic events
Medication for Mastitis?
Dicloxacillin or cephalexin (strong activity against Stap aureus)
Continue to Breastfeed to avoid abcess development
If MRSA- use TMP-SMX (Bactrum) but risk of kernicterus in newborn
Galctorrhea, headaches, MRI mass in the sella turcica suggests ? What will be the hormonal levels for Dopamine? LH? & FSH?
Pituitary lactotroph adenoma; dopamine is high because prolactin stimulates it, LH & FSH will be low due to negative feed back by inhibition of GnRH secretion
28YO F, with multiple right inframammary lumps, foul-smelling odor, painful welling sin her axillae, erythematous nodules and fistula discharging pus is? Risk factors?
Hidradenitis Suppurativa (HS) or acne inversa- risk: smoking, obesity, hyperandrogenism, impaired glucose tolerance, IBD
6YO F, AA, with 95% height, 99% weight and BMI, coarse hair under both axilla and sparse dark hair on the mons pubis and along the labia majora, no palpable glandular breast tissue? Cause? Risk?
Isolated premature adrenarche or peripheral precocious puberty (PPP). Due to High levels of insulin: Risk: obese pt, AA
42yof with Irregular menstrual periods, nipole discharge, on atypical antipsychotics. Cause of symptoms?
Medication Risperidone, D2 antagonist, no inhibition of prolactin, then prolactin inhibiting GnRH
34F, increased breast tenderness, N, wt gain, urinary frequency for 2 month. Trying to get pregnant for 6 month, B-hCG is neg. Vaginal ultrasonography no abnormalities.
pseudocyesis
First line treatment for prolactinomas & macroadenomas?
Dopamin receptor agonist (Cabergoline or bromocriptine); transsphenoidal hypophysectomy for macro-adenomas
Drug used for HER2 cancer ? Also used for ?
Transtuzumab(Blocks HER2 receptor) also used in Gastric cancer
Drug used for MS, CLL
Alemtuzumab
Drug used for Colorectal cancer, Renal cell carcinoma, Non-small cell lung cancer, and neovascular age-related muscular degeneration
Bevacizumab
Drug used to treat Rheumatoid arthritis, ITP, CLL, B-cell non-hodgkin lymphoma and symptomatic waldernstrom macroglobulinemia
Rituximab
Loss of heterozygosity in tumor suppressor gene p53, cause multiple cancers
Li-Fraumeni syndrome
45Yo, F, with itchy rash on L nipple, jello watery discharge, blood-tinged, weeping, ulcerated lesion involving the entire left nipple-areolar complex
Paget’s disease of the breast- ductal carcinoma that infiltrates the nipple-areola complex
29YO, F with blood-tinged discharge from L nipple, NSIM?
Subareolar ultrasound
Atypical antipsychotic drug with no hyperprolactinemia SE?
Aripiprazole
Why does Hypothyroidism cause hyperprolactinemia?
Low T3,T4 -> high TSH
Low T3,T4->stimulates hypothalamus to release TRH which in turn increases TSH and also excessive TRH stimulates the lactotroph cells of the anterior pituitary to release prolactin
Turner syndrome child is at risk for osteoporosis because?
Ovarian dysgenesis-> estrogen deficient, increased osteoclast activity, decreased osteoblast activity and bone reabsorption
A sex cord-stomal tumor with elevated estrogen & progesterone is
A granulose cell tumor ( Cell-Exner bodies on histology)
CA 125 is increased in what kind of ovarian tumors?
Epithelial eg: serous cystuadenocarcinoma (Shows psammoma bodies)
What can be used as a tumor marker for ovarian tumors like dysgerminomas (Fried-egg appearance)
Lactate dehydrogenase (LDH): B-hCG levels are increased )
Standard screening test for breast cancer Women 50-74 yo by USPTF
Every 2 years (average risk for breast cancer)
Development of secondary sexual characteristics in 7yo girl indicates
Precocious puberty
Lack of elevation of LH levels following GnRH agonist stimulation indicates
peripheral precocious puberty caused by estrogen-secreting ovarian tumors like granulosa cell tumors
Precocious puberty with prostatic fibrous dysplasia and abnormal skin pigmentation (cafe-au-lait spots)
McCune-Albright syndrome
Increased TSH indicates
hypothyroidism
Galactorrhea and irregular menstrual cycles suggest
hyperprolactinemia
Excess TRH (from Low T3, T4) causes increase TSH and stimulates what other cells
lactotroph cells to release prolactin
Gynecomastia causing medications
- Ketoconazole
- Spironolactone
- Digoxin
- Flutamide
- Leuprolide
- H2 antagonists (cimetidine)
