Breast Flashcards
What are the 3 parts of the breast?
Glandular tissue
Stroma
Lymphatic vessels
What is oestrogen and progesterone released by?
Ovaries
Where is prolactin released from?
Pituitary gland
What is Tietze syndrome also known as?
Costocondritis (will rub hand up and down sternum when describing, aggravated by exercise)
Benign breast disease is responsible for what proportion of symptomatic ladies?
80%
What is the common demographic for fibroadenoma?
20-30
African Women
What condition is described as a breast mouse?
Fibroadenoma
How is a diagnosis of fibroadenoma confirmed?
US core biopsy
Fibroadenoma are biphasic TRUE/FALSE
TRUE
Epithelial and stromal component
Non-cyclic is less responsive to treatment that cyclic mastalgia TRUE/FALSE
TRUE
If someone presents with mastalgia what is the treatment?
Thank you, next
IF you want to be of help…
Reassure, advise regular exercise and well fitting bra
Tamoxifen effective in 65%-90% pain but interferes with contraception and may bring on menopause
What lumps in the breast are tender esp before mensuration, may be multiple and/or bilateral and in the late reproductive years?
Cysts
What is used to diagnose and treat a cyst?
FNA
What is the most common aetiology of spontaneous nipple discharge?
Intraductal papilloma or papillomas
Why should all intraductal lesions be excised and histologically evaluated?
Not to miss the rare intraductal papilloma
What is Paget’s disease of the nipple?
High grade DCIS extending along ducts to reach the epidermis of the nipple
How does Paget’s disease usually present?
Dry, scaly, eczematous lesion
How is the diagnosis of Paget’s disease made?
Histological tissue biopsy
Causes of gynaecomastia?
Endogenous/exogenous hormones
Cannabis
Prescription drugs
Liver disease
What do you get in gynaecomastia?
Get ducts without the lobular development
Fibrocystic change is v common with the most common age group being 40-50 TRUE/FALSE
TRUE
Fibrocystic change usually resolves or diminishes after menopause TRUE/FALSE
TRUE
Under the microscope what type of change are there thin walled microscope cysts, that may have a fibrotic wall and are lined by apocrine epithelium?
Fibrocystic
What are two types of sclerosis lesions?
Sclerosing adenosis
Radial scar/complex sclerosing lesions
What histologically has a fibroelastic scar, radiating fibrosis containing distorted ductules, fibrocystic change and epithelial proliferation?
Radial scar/complex sclerosing lesion
90% of periductal mastitis affects?
Smokers
If you tried to operate on someone with periductal mastitis then you would get…
Mammary fistula
What is the diagnostic and therapeutic treatment for breast abscess?
Aspiration
(can be sent for microbiological analysis)
Has to be repeated every 3 days
What may present with pain, acute episodic episodes, bloody/purulent discharge, fistulation, nipple retraction and distortion?
Duct ectasia
Duct ectasia is associated with smoking. If you stop smoking it will go away. TRUE/FALSE
TRUE
What is non puerperal mastitis due to?
Duct ectasia
What is the treatment for nonpueral mastitis?
Augmentin or Cephalexin
If chronic mastitis and there is periareolar fistulae when should it be excised?
When the inflammation is quiescent
How does adenolipoma present?
Smooth Palpable lump
What is fat necrosis caused by?
Local trauma
Warfarin therapy
Fat necrosis even when it resides may still leave a characteristic mammography lesion. TRUE/FALSE
TRUE
What does this describe?
A palpable milk-filled cyst most commonly associate diet pregnancy/lactation
Galactocele
What can be used to diagnose and treat a galactocele?
FNA
What is Mondor’s disease?
Phlebitis and subsequent clot formation in the superficial (skin) veins of the breast
How does Mondor’s disease present?
Firm, Vertical, Cord-like structures usually associated with a history of trauma to the breast e.g. surgery
Phyllodes tumour is often described as ……. like
Leaf
What do phyllodes tumours resemble in clinical presentation and cytology?
Fibroadenomas
How can phyllodes tumours be differentiated from fibroadenomas?
Larger (3-6cm)
Tend to occur in older women (35-45y)
Tend to increase in size
The diagnosis of phyllodes tumour requires histological verification TRUE/FALSE
TRUE
Phyllodes tumours are biphasic, which component is neoplastic?
Stromal component
How do intraductal papilloma present?
Age 35-60
Asymptomatic at screening (nodules, calcification) OR
nipple discharge +- blood
What is intraductal papilloma?
Rare intracystic carcinoma which occurs within a cyst
What is the most common histological type of breast cancer?
Ductal carcinoma
What are the typical findings of a ductal carcinoma?
Stellate solid mass or pleomorphic casting microcalcification
US is not effective if evaluating calcifications TRUE/FALSE
TRUE
What is used to get the definitive diagnosis of ductal carcinoma?
Image-guided tissue core-needle biopsy
What is micro invasive carcinoma?
High grade DCIS with invasion of <1mm
Rare, treat as high grade DCIS
Where does DCIS arise?
TDLU, Characteristically unicentric
What is DCIS often perceived as on mammography screening?
Malignant calcifications (usually pleomorphic and non casting type)
what is the definitive diagnosis method used for DCIS?
Stereotactic vacuum-assisted core biopsy
Why is unilateral single duct nipple discharge worrying?
Sign of DCIS
Lobular carcinoma spreads diffusely with a typical histological ——- —— pattern
Indian file
Survival for breast cancer is super high TRUE/FALSE
TRUE
1y- 96%
5y-87%
10y-78%
1 in - women will develop breast cancer
8
Define breast cancer
A malignant tumour of breast epithelial cells which have breached the BM. It arises in the glandular epithelium of the terminal ductal lobular unit. (ADENOCARCINOMA)
Breast cancer. Physical activity is protective and NSAID’s lower risk?
TRUE
Where is the incidence for breast cancer highest?
Europe
What HRT reduces the risk of breast cancer?
Oestrogen-only HRT
Combined- oestrogen and progesterone increases the risk
If there is a 1st degree relative with breast cancer how does this affect their risk?
It doubles the risk
What are the 4 highest relative risk factors for the development of breast cancer?
Gene mutation
Lobular carcinoma in situ
Ductal carcinoma in situ
Atypical Hyperplasia
Why does peau d’orange occur?
Caused by oedema, tissues can’t expand due to coopers ligaments, therefore the skin has a puckered appearance.
In breast cancer with a score of 3,4 or 5 what grade would you be?
Grade 1
What are the 3 hormone receptors that are important to consider when deciding what treatment to use in breast cancer?
ER
PR
HER2
The survival is better if ER+, PR+ and HER2+ TRUE/FAL;SE
FALSE
survival is better is ER+ and PR+ but HER2-
If have the ER receptor positive then what additional therapy may be of some benefit?
OOphrectomy
Tamoxifen
Aromatase inhibitor (Latrozole)
GnRH antagonsits
If HER2 positive then what drug can be used?
Trastuzamab (Herceptin)
The Nottingham prognostic index only takes one thing into account, what is this?
Histopathology
How is NPI calculated?
0.2 x tumour diameter (cm) to interpret ( excellent if below 3, poor if above 5.4ish)
What is the triple assessment done at the one-stop shop for breast cancer?
Clinical - H&E
Imaging- Mammography, US and MRI
Pathology- Cytopathology, Histopathology
What is the technique used in order to get a sample for cytopathology?
FNA
Different tissues are aspirated to a different extent. What is the pattern of the epithelial tissues?
Flat cohesive honeycomb pattern
TRUE/FALSE
You can tell the difference on a needle core biopsy between carcinoma in situ and invasive carcinoma
DAMN GIRL DAT BE TRUE
This is what makes it different from cytopathology
If disease is impalpable then how are mammographs taken?
Insert a wire first and then take the mammographs
If breast conserving surgery is chosen as a treatment option then radiotherapy is used alongside. How is the radiotherapy administered?
Administered in daily fractions (5 days a week) for 3-6 weeks
When would have have radiotherapy post-mastectomy?
Involvement of 3+ nodes
Positive surgical margins
Tumours >5cm
What does total mastectomy remove?
The entire breast inc the overlying skin and axillary lymph nodes
What muscle is preserved in mastectomy and facilitates wound healing and potentially allow reconstruction?
Pectoralis major
Long term survival is the same for BCS and Mastectomy. I ain’t even saying is it TRUE/FALSE. IT’S TRUE!
TRUE (did you seriously just turn over the card)
Having a mastectomy reduces the chances of cancer. TRUE/FALSE
FALSE-IT does not reduce the chances
Name 4 risks of implants
Infection
Capsular contracture
Implant rippling
Implant migration
TRUE/FALSE
The breast implant is put in just infront of the pectorals major muscle
FALSE
It is just under the muscle
What percentage of women get an infection and lose the implant?
1 in 4
What is a sentinel node biopsy?
Labelled radioisotope, blue dye injected into the aureola and the sentinel nodes pick up the blue dye and they are removed
Why is axillary node clearance associated with heavy arm?
Due to lymphoma
TRUE/FALSE
Aromatase inhibitors are more effective than tamoxifen neoadjuvantly
TRUE (Reserved for postmenopausal women)
Non difference in survival when used adjuvantly
Radiotherapy is often used Neo-adjuvantly TRUE/FALSE
FALSE
It is never used for that purpose , can be used adjuvant though(halves the risk of recurrence)
How is adjuvant radiotherapy usually given?
External beam over 3 weeks
indication to boost treatment would be young age or positive margins
What is the most commonly used hormonal therapy?
Tamoxifen
How do gCSF injections produce severe axial skeleton pain?
from marrow stimulation
Name two things that taxes induce (as SE)
Myalgia
Peripheral neuroapthy
HER2 receptor is found over expressed in what percentage of breast cancers?
15%
What drug is 1st line for treatment of metastatic breast cancer?
Bevacizumab
What drug can be given palliatively for those with bone mets from breast cancer?
Bisphosphonates ( as prevention)
What is the most likely diagnosis if there is bone pain after breast cancer?
Metastasis
Who group of patients might have a positive bone scan even though they do not have mets?
Those with osteoporosis
Should you care about neutropenia following chemotherapy?
YES obv
If patient has hot flushes with tamoxifen/AI then what can be given?
Clonidine
Mirena coil is CI if there has been breast cancer TRUE/FALSE
TRUE
If there appears a new lump post treatment unless cancer is extremely aggressive it is unlikely to be a met. What is it most likely?
Fat necrosis- due to tissue damage
With HER-2 positive breast cancer where do the mets preferentially go to?
CNS and Pleura
Where does lobular breast cancer preferentially go to?
Peritoneum
Gut
Where do most breast cancers occur?
In the upper outer quadrant
hence why an oblique view on mammography is used
TRUE/FALSE
Women with denser breasts are at higher risk of breast cancer
TRUE
What does mammography look for?
Calcification
Most young women have dense (more fibroglandular tissue) breasts therefore it is easier to detect cancer TRUE/FALSE
FALSE c’mon
When does calcification look suspicious?
if it is in a line “looks like it is rough and sharp if rubbed between fingers”
TRUE/FALSE
If lots of fatty breast tissue then the sensitivity of the mammogram will be high
TRUE
A biopsy should be done in all women if there is a soft grey lump on USS TRUE/FALSE
FALSE
No longer biopsy or follow up in women under 40 if there is a soft grey lump on USS
What is there commonest breast lump in those <30?
Fibroadenoma
What is the commonest breast lump in those 30-50?
Cyst
What is the commonest breast Lump in those >50?
Cancer
On USS is a lump has echoes in it then it is solid, if it is entirely black then it is what?
A cyst
What is the difference in biopsy size for lumps v calcification?
14G for lumps
11G for calcification
Common sites of mets from breast cancer are…
Brain Bones Liver Lung Pleura
