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QUESTION NOTES > BREAST > Flashcards

BREAST Flashcards

1
Q

RF breast cancer in men

A
  • BRCA2
  • changes in estrogen:adrogen ratio (Klinefelter, testicular abn, cirrhosis, obesity)
  • alcoholism
  • NOT hx of gynecomastia
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2
Q

Staging breast CA

A 
1 = small tumor, no nodes
2 = larger tumor or minor node involvement (T3N0, T2N1)
3A/3B = local invasion + no nodes (T4N0) OR larger tumor + some nodes (T3N2)
3C = clavicular node involvement
4 = distant mets
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3
Q

MC vein involved in Mondor disease

A

lateral thoracic vein

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4
Q

If involvement of supra/infraclavicular nodes, what stage?

A

3C (bc N3)

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5
Q

Criteria of inflammatory breast cancer

A
  1. rapid onset breast erythema, edema, or peau d’orange or warm breast w/wo palp mass
  2. duration of hx <6mo
  3. erythema over >1/3 breast
  4. histology confirms invasive carcinoma
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6
Q

MC benign breast mass

A

fibroadenoma

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7
Q

Phyllodes tumor pathology stains positive for…?

A

vimentin + actin

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8
Q

DCIS w/ high risk local recurrence (hence, rec mastectomy instead of BCT)

A
  • large size
  • comedo histology
  • pos tumor margins
  • extensive multicentricity
  • young age
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9
Q

Mgmt Stewart-Treves syndrome

A

WLE 3-6cm margins, but overall poor prognosis (tumors <5cm have better prognosis)

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10
Q

Risk of malignancy associated with radial scar

A

1.5-2x RR of malignancy (similar to other proliferative lesions wo atypia)

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11
Q

Mgmt BIRADS-4B mammogram after benign, concordant core biopsy

A

observation

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12
Q

Chemotherapy regimens for breast CA

A
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13
Q

MC organism causing mastitis

A

staph aureus

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14
Q

Do you do SLNBx for phyllodes tumor?

A

NO - spreads hematogenously

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15
Q

Risks tamoxifen therapy

A

thromboembolism (DVT, PE) and endometrial CA

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16
Q

Dx imaging of choice for Mondor disease

A

US

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17
Q

Risk of lymphadenopathy in pts s/p SLBx

A

7% 6-mo after surgery

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18
Q

s/p BCT for DCIS several years ago, now presenting with lump at incision site… concern for? Dx?

A

recurrence - will occur earliest at lumpectomy site (early recurrence due to untreated disease)
Dx: scar biopsy (not mammo bc limited by post-surgical changes)

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19
Q

Absolute C/I to BCT (5)

A
  1. 2+ primary tumors in separate quads of breast (multicentric)
  2. persistent pos. margins after surgery
  3. pregnancy (bc cannot have radiation)
  4. hx radiation to breast and re-treatment wound > acceptable radiation dose
  5. diffuse malignant-appearing microcalcifications
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21
Q

Radiation recommended in post-mastectomy Stage II only if…?

A
  • extracapsular invasion
  • lymphovascular invasion
  • <40yo
  • close surgical margins
  • nodal positivity ratio >20%
  • pts who have undergone less than standard level I or II ax. dissection
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22
Q

SLNBx false-negative rates decrease if use both…?

A

radiolabeled tracer + blue dye

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23
Q

Relative C/I to BCT (3)

A
  1. hx scleroderma or active SLE
  2. large tumor in small breast (may consider neoadjuvant chemo)
  3. large or pendulous breasts
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24
Q

Paget’s disease of breast association with breast cancer?

A

Up to 92% females with Paget’s have underlying breast cancer - need partial vs. total mastectomy

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25
Q

Next step: if atypia hyperplasia on excisional biopsy and pos. margins

A

nothing. no need for neg margins. +/- tamoxifen

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26
Q

Is neoadjuvant chemoRx indicated for triple-neg breast CA?

A

no - no survival advantage over standard adjuvant; only indicated to downstage primary tumor for cosmesis after breast conservation

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27
Q

B/l breast pain + green nipple discharge in young pt… think?

A

fibrocystic change

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28
Q

T-stage breast CA

A 
T1 = 0-2cm
T2 = 2-5cm
T3 = >5
T4 = invastion chest wall or skin (not including pec major)
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29
Q

Annual risk of contralateral breast CA for women w/ ER+ first breast cancer

A

0.3-0.5% per year (3-5% in 10 years)

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30
Q

Ataxia telangiectasia: tumor gene? associated with what CA?

A

(ATM): cerebellar and neuromotor deterioration, lymphoma, leukemia

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32
Q

Mgmt bilateral gynecomastia

A
  • stop implicated Rx if possible (spironolactone, CCB, PPI, H2-blockers, antiandrogens [prostate CA tx])
  • tamoxifen
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33
Q

What sxs should pt stop breastfeeding if have mastitis?

A

purulent nipple discharge = epidemic puerperal mastitis (due to MRSA)

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35
Q

Tx non-cyclical mastalgia

A

weight loss + sports bra

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36
Q

Steward Treves Angiosarcoma

A

lymphangiosarcoma: chronic lymphedema following ax dissection -> dark purple lesion on arm

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38
Q

Are intraductal papillomas associated with increased risk breast CA?

A

NO

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39
Q

Mondor’s disase

A

thrombophlebitis of breast

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40
Q

Chemotherapy choice during pregnancy (breast)?

A

TAC during 2nd/3rd trimester.
Tamoxifen (and other selective estrogen-R modulators) should be deferred until after pregnancy - birth defects (craniofacial malformation, ambiguous genitalia)

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41
Q

Phyllodes tumor classified as benign, borderline, or malignant based on…?

A
  • pleomorphism
  • stromal overgrowth
  • mitotic count
  • character of tumor border (circumscribed vs. infiltrative)
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42
Q

What is pathognomonic on histology for inflam breast cancer? (although its abscence does not exclude dx)

A

tumor emboli in dermal lymphatic channels

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43
Q

Veins typically effected by Mondor disease

A
  • lateral thoracic vein
  • thoracoepigastric vein
  • superficial epigastric vein
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44
Q

Stewart-Treves syndrome tumor cells originate from…?

A

dermal vascular endothelium

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45
Q

Systemic therapy for triple-neg breast cancer

A

cytotoxic chemoRx

47
Q

Mgmt inflam breast cancer

A
  • neoadjuvant (anthracycline + taxanes over 4-6mo before surgery)
  • modified radical mastectomy
  • post-op radiation
48
Q

Common sites breast CA mets

A

brain, bone, lung, liver (isolated deposits <0.2mm not considered mets)

49
Q

When do surgical I&D for breast abscess?

A
  • multiloculated
  • when there is overlying skin necrosis
  • if recur after multiple aspirations
52
Q

What is removed with simple mastectomy?

A
  • nipple-areola complex
  • breast parenchyma
  • necessary skin
53
Q

Gail model for assessment of invasive breast CA risk includes…

A
  • age
  • age at menarche
  • age at first live birth
  • first degree relative with breast CA
  • previous breast bx
  • race
54
Q

Patho periductal fistula

A

obstruction of milk duct -> collection becomes infected -> acute subareolar abscess, which drains to border or areola -> fistula helas, but bc recurrent abscess -> chronic fistula

55
Q

If T4 breast cancer, no nodes… what stage?

A

3B (locally advanced)

56
Q

MC papillary lesion of the breast

A

intraductal papilloma

57
Q

Bilateral prophylactic salpingo-oophorectomy reduces risk of ? in BRCA1/2 mutations

A
  • reduces risk breast CA (by 50%)
  • reduces risk of ovarian cancer (by 96%)
  • improves overall survival
58
Q

Pathology of clear cytoplasm, large nuclei, and Her2+ … what is it?

A

paget’s disease of breast

58
Q

Absolute C/I SLNBx

A
  • inflam breast CA

- presence of mets ax lymphadenopathy

59
Q

Cowden: tumor gene? associated with what CA?

A

(PTEN): mucocutaneous lesions, thyroid CA, endometrial CA, colon CA, brain CA

60
Q

Tx cyclical mastalgia

A

tamoxifen, danazol, COP, bromocriptine

61
Q

Do we do SLNBx for inflam breast CA?

A

NO - lymphatic involvement of tumor cells and unreliable SLN - need to do ax LN dissection.

61
Q

Typical demographics for pt w/ Mondor disease

A
  • female (3:1 F>M)
  • 30-60yo
  • no correlation to race/family hx
62
Q

Blood supply for transverse rectus abdominis muscle (TRAM) flap?

A

superior epigastric artery and vein

63
Q

Next step: atypia hyperplasia on CNB

A

excisional biopsy

64
Q

Mgmt BIRADS-5 mammogram after benign core biopsy

A

excision - bc deemed “benign-discordant)

65
Q

Rx that can cause glactorrhea

A
  • OCP
  • phenothiazines
  • TCA
  • metoclopramide
66
Q

Pathology of Paget’s disease

A

large cells w/ pale cytoplasm + prominent nucleoli involving epidermis of nipple

67
Q

Who needs Level 1 and 2 axillary dissection?

A
  • clinically pos nodes confirmed by FNA or CNB
  • palpable nodes
  • sentinel nodes (need 3) not identified during SLNBx
69
Q

Typical demographic of pts w/ triple-neg breast CA

A
  • young females (<40yo)
  • AA, Hispanics
  • BRCA1
70
Q

Indications for MRI

A
  • annual MRI screening start 30-yo if have lifetime risk >20%
  • untested and 1st degree w/ BRCA
  • has known BRCA
  • radiation to chest ages 10-30yo
  • Li-Fraumeni, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome in pt or 1st degree
71
Q

% CA risks for BRCAI

A

higher ovarian CA risk compared to BRCA2 (breast:ovarian CA risk = 65% vs. 40%)

72
Q

Malignant phyllodes tumors MC mets to where?

A

lungs (heme mets)

73
Q

Patho of sclerosing adenosis

A

typically found in pts with fibrocystic changes - increased number of small terminal ductules associated with stromal tissue proliferation

74
Q

Why bone common location for breast mets?

A

Batson venous plexus (valveless veins that connect deep pelvic veins + thoracic veins - drains bladder, breast, prostate)

74
Q

Benefit of endocrine therapy on risk of developing contralateral breast CA

A

decrease risk of contralateral development

74
Q

Method of excision for fibroadenoma, if indicated

A

enucleation - possible bc well-encapsulated

75
Q

Li-Fraumeni: tumor marker? associated with what CA?

A

(p53): sarcoma, brain tumors, leukemia, adrenocortical malignancy

76
Q

Most common etiology of Mondor disease?

A

idiopathic (although hx trauma, surgery/biopsy, or underlying connective tissue or breast CA may contribute)

78
Q

DCIS histology types (from best to worst)

A
  1. papillary (well-diff, nonpleomorphic)
  2. cribiform (cellular polarity, atypia)
  3. comedo (architectural distortion, cellular necrosis, Ca deposition)
79
Q

Muier-Torre: tumor gene? associated with what CA?

A

(MLH1, MLH2): multiple skin tumors, benign and malignant tumors of GI/GU tracts

80
Q

Dx Paget’s disease of breast

A

full-thickness biopsy - bc dermal based lesion

81
Q

Bilateral prophylactic mastectomy reduces risk of ? in BRCA1/2 mutations

A

reduces risk of breast CA (by >90%)

does NOT affect overall survival

82
Q

What is granulomatous mastitis? Demographic?

A

idiopathic inflam condition of breast; often presents with abscess and fistulas at multiple locations of breast; nonwhite women of childbearing age

83
Q

Mgmt phyllodes tumor; do you need ax-node dissection?

A

WLE w/ 1-2cm margins; if too large may need mastectomy; NO ax-node dissection bc tumor spreads heme (rare LN mets)

84
Q

Radiological abnormality of LCIS

A

none - often found incidentally on core needle biopsy for something else

85
Q

% CA risks for BRCAII

A

breast: ovarian CA risk = 45% vs. 10%

- note that increased panc and prostate CA in men

85
Q

Mgmt milk fistula s/p needle biopsy during breast feeding

A

stop breast feeding

85
Q

Dx granulomatous mastitis

A

CNB w/ granulomas; tissue should be sent for acid-fast bacilli and fungal stains to r/o underlying disease

87
Q

Who gets chemotherapy (breast)?

A
  • tumors >1cm (or >0.5cm in men)
  • positive nodes
  • triple negative nodes
  • high oncotype dx recurrence score
88
Q

If N2 breast cancer, at least what stage?

89
Q

Mgmt granulomatous mastitis

A

oral steroids; excision only if refractory (often recurs)

90
Q

Pathology of numerous dermal tumor emboli in papillary and reticular dermis of skin… what is it?

A

inflammatory breast CA

91
Q

N-stage breast CA

A 
N1 = 1-3 nodes
N2 = 4-9
N3 = 10+ OR supra/infraclavicular nodes
91
Q

Use of preoperative MRI prior to BCT?

A

none - does not demonstrate lower rates +margins; actually increases use of mastectomy

91
Q

Dx LCIS increases risk by ? per year for breast CA

A

1-2% per year equally on both breasts (10-20% in 10yrs) - 8-10x higher risk than general population

93
Q

Next step: cellular fibroadenoma on CNB

A

excision biopsy (bc cannot distinguish from phyllodes tumor - both have fibroepithelial component)

93
Q

Annual risk of breast CA in pts with atypical ductal hypreplasia

A

0.5-1% per year (5-10% in 10 years) - 4x increase risk than general population

93
Q

What is removed with modified radical mastectomy?

A
  • nipple-areola complex
  • breast parenchyma
  • skin
  • level I-II axillary LN (pec major spared)
94
Q

Mgmt periductal fistula

A

excision of entire fistula tract

94
Q

Axillary radiation associated with ? risk lymphedema

A

increased, ~20%

95
Q

Adjuvant radiation therapy after mastectomy for…?

A

All T3-T4 or N2-N3 disease

96
Q

1 and #2 factor most predictive of poor prognosis in pts with breast cancer

A 
#1 - LN status
#2 - HER2 status (associated with poor differentiation, high proliferative rates, decreased expression of steroid-hormone-R, and increased likelihood of having LN mets)
97
Q

Margins for Phyllodes tumor

98
Q

Phyllodes tumor is characterized based on…

A
  • cellular atypical
  • mitotic activity
  • stromal overgrowth
99
Q

C/I nipple-sparing mastectomy

A
  • > 2cm tumors
  • centrally located lesions with small tumor-to-nipple distance
  • lymphovascular invasion
100
Q

Mgmt close surgical margin (<1mm) at fibroglandular boundary of breast (skin or chest wall) after lumpectomy for DCIS

A

Higher boost dose radiation to lumpectomy site can be considered - surgical re-excision not indicated

101
Q

Peutz-Jeghers syndrome associated with…

A
  • intestinal hamartomas
  • hyperpigmented lesions of oral mucosa
  • extracolonic cancers: breast, cervical, thyroid, lung (screening starting @25yo)
102
Q

Dx for lymphedema

A

lymphoscintigraphy - radiolabeled macromolecular tracer injected intradermal within interdigit space of affected limb

QUESTION NOTES (28 decks)

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