Breast Flashcards
LCIS on biopsy. Next step?
Excisional biopsy.
[Does NOT need clear margins.]
What is the relative risk increase for cancer in a patient with biopsy showing:
- Proliferative lesion without atypia?
- Proliferative lesion with atypia?
- Proliferative lesion with atypia and first degree relative with breast cancer?
Proliferative lesion without atypia: 1.5 to 2.0x
Proliferative lesion with atypia: 4.0 - 5.0x
Proliferative lesion with atypia and first degree relative with breast cancer: 9.0
45-year-old woman with new-onset nipple discharge - intermittent, bloody, and spontaneous. Small amount of discharge that appears to be coming from a single duct. What initial imaging workup should be obtained for this patient?
What do you if that imaging is negative?
Breast ultrasound and diagnostic mammogram
If above is WNL –> then get MRI or ductography.
If MRI/ductography is WNL –> possible excision or follow up exam within 6 months.
If abnormal –> biopsy (if biopsy WNL.. then excision)
What are the pathology slide findings for Inflammatory Breast Cancer (and in what layers of the skin?)
dermal tumor emboli in the papillary and reticular dermis of the skin
Which factor most significantly impacts the surgical treatment options for patients with Paget disease of the nipple
Multicentricity
Paget disease of the nipple who have multicentric disease are limited to a mastectomy. Surgical treatment decisions do not depend on tumor biology. Surgical decision making for Paget disease is not dependent on the status of the axillary nodes and should be considered independently of axillary lymph node involvement.
52-year-old woman is 8 hours postoperative after a left total mastectomy with an axillary lymph node dissection. She has an output of 400 mL of sanguineous fluid from the Jackson-Pratt drain overlying her breast and has felt lightheaded when she ambulates to the bathroom. The drain output is dark red while previously primarily serous in nature. Vitals WNL. A small amount of swelling is present over the superior portion of the upper mastectomy flap but no palpable hematoma is felt. The dressing over the incision is without strikethrough. What is the most appropriate next step in management?
Compression wrapping with axillary padding
What are the five indications for annual magnetic resonance imaging screening in women?
1) Lifetime risk of breast cancer greater than 20%
2) Known BRCA1 or BRCA2 gene mutation
3) Untested woman with a first-degree relative with a BRCA mutation
4) Prior chest radiation therapy between the ages of 10 and 30 years
5) Genetic diseases such as Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome (or existence of one of these syndromes in first-degree relatives)
26 week pregnant female has a 2-cm estrogen receptor–positive, progesterone receptor–positive, and HER2-positive infiltrating ductal breast cancer. She desires breast-conserving surgery. What is the appropriate initial management?
Chemotherapy, then lumpectomy and adjuvant radiation after delivery
[Chemotherapy is safe during the second and third trimesters with the exception of folate scavenging drugs like methotrexate.]
56-year-old, obese man presents with a 3-cm left breast mass. Core biopsy reveals invasive ductal cancer, which is ER/PR+, HER2 negative. On physical examination, the mass is mobile and his ipsilateral axilla is indeterminate. Which of the following is your next best step?
Ultrasound of the axilla with fine needle aspiration (FNA) of any suspicious nodes
[Additional imaging and FNA as indicated would help determine whether this or sentinel lymph node biopsy would be appropriate. Simple mastectomy and sentinel lymph node biopsy would be correct if the lymph nodes were clinically negative by examination and/or imaging if indeterminate. If nodes were positive, however, an axillary dissection would be indicated. Lumpectomy and sentinel lymph node biopsy followed by radiation in that breast conservation is not normally performed in men.]
Associated with HIGHER tumor grade and cell proliferation, LESS in situ carcinoma associated with invasive cancer (compared to the general population), a HIGHER occurrence of medullary carcinoma, and a LOWER frequency of hormone receptor–positive tumors (more commonly triple-negative). BRCA1 or BRCA2?
BRCA1
Associated with LOWER tumor grade and cell proliferation, a HIGHER occurrence of tubulolobular invasive carcinoma and invasive cribriform carcinoma, and a higher frequency of hormone receptor–positive tumors. BRCA1 or BRCA2?
BRCA2
=60-year-old man presents with a 3.5-cm–fixed periareolar breast lesion and a palpable ipsilateral axillary lymph node. The mass is invasive ductal carcinoma, and ultrasound-guided biopsy of the lymph node is positive for cancer. What is your next best step
Chemotherapy, followed by Modified Radical mastectomy
47-year-old woman is diagnosed with inflammatory breast cancer. She is treated with neoadjuvant chemotherapy with a good response. What surgical procedure would you recommend?
Total mastectomy and axillary lymph node dissection
What are the five screening recommendations for patient with known or suspected BRCA mutation?
1) Annual MRI starting at age 25
2) Annual mammogram starting at age 30
3) Annual ovarian cancer screening (including transvaginal ovarian ultrasounds, cancer antigen-125 [CA-125], pelvic examinations) starting at age 30
4) Biannual clinical breast examination beginning at age 25
5) Monthly self-breast examination starting at age 18
True or False:
Skin punch biopsy is not required for a diagnosis of IBC as a negative biopsy does not exclude the diagnosis of IBC
True! IBC can be a clinical diagnosis based on skin presentation.
