Breast Flashcards
at what week of gestation does mammary ridges appear?
5th or 6th week of gestation
___ syndrome is associated with amastia
poland syndrome
the breast is composed of how many lobes?
15 to 20 lobes
this quadrant contains the greater volume of tissue compared to all other quadrants
upper outer quadrants
___ artery are the perforators of the breast
internal mammary artery
blood supply of the breast
internal mammary artery
posterior intercostal artery
branches from axillary artery
this provides a route for breast cancer metastatsis to the vertebra
batson vertebral plexus
batson vertebral plexus extends from the ___
base of the skull of the sacrum
What innervates the breast?
- lateral cutaneous branch from the 3rd to 6th intercostal nerves
- Intercostobrachial nerve (from the 2nd intercostal nerve)
- Supraclavicular nerve from the cervical plexus
Level I breast lymphatics are composed of
- Scapular group
- External mammary group
- Axillary vein grooup
Level II breast lymphatics are composed on
- central group
2. Interpectoral group
Rotter nodes are also called
interpectoral group
Level III breast lymphatics are composed of
Subclavicular group
Estrogen plays a role ____ development
ductal development
Progesterone plays a role in ____
lobular development
____ plays a role in lactogenesis
prolactin
___ syndrome predisposes a male to breast cancer
Klinefleter syndrome
[Gynecomastia Grading]
mild enlargement without skin redundancy
Grade I
[Gynecomastia Grading]
moderate breast enlargement without skin redundancy
Grade IIa
[Gynecomastia Grading]
moderate enlargement with skin redundancy
Grade IIb
[Gynecomastia Grading]
marked enlargement with skin redundancy and ptosis
Grade III
Drug treatment for gynecomastia
Danazol
[pharma]
drug of choice for gynecomastia with androgen deficiency
testosterone administration
Etiologic agent for epidemic puerperal mastitis via the suckling neonate
MRSA
Etiologic agent for non-epidemic mastitis
S. aureus.
___ is also called recurrent peri-ductal mastitis
Zuska Disease
Recurrent retroareaolar infections and abscesses of the periductal mastitits
zuska disease
Variant of thrombophlebitis that involves the superficial veins of the anterior chest wall and breast
mondor disease
[diagnose]
acute pain at the lateral aspect of the breast, tender, firm cord following the distribution of the veins
mondor disease
[Is there a risk for malignancy in this lesion?]
mild ductal epithelial hyperplasia
none
[Is there a risk for malignancy in this lesion?]
duct ectasia
none
[Is there a risk for malignancy in this lesion?]
sclerosing adenosis
no to slightly increased risk
[Is there a risk for malignancy in this lesion?]
florid ductal epithelial hyperlasia
no to slightly increased risk
[Is there a risk for malignancy in this lesion?]
intraductal papillomas
no to slightly increased risk
[diagnose]
well-defined mass, UO quadrant, enlarges before the onset of her period
fibrocystic disease of he breast
most common cause of bloody nipple discharge
intraductal papilloma
[diagnose]
well circumscribed painless rubbery movable discrete borders
fibroadenoma
Smoking ___ (is/ is not) a risk factor for breast CA
not a risk factor
At what age will you request for a baseline mammogram
35
annual mammogram shall be done beginning ___ age
40
[BRCA Mutations]
BRCA 1 is located in what chromosome?
Chr 17
[BRCA Mutations]
this is associated with poorly differentiated CA and hormone receptor negative
BRCA 1
[BRCA Mutations]
early onset, bilateral disease
CA at other sites
BRCA 1
[BRCA Mutations]
BRCA II is located in what chromosome?
Chromosome 13
[BRCA Mutations]
Associated with breast CA in men
BRCA II
[BRCA Mutations]
this is associated with well differentiated CA
and express hormone receptor
BRCA II
[BRCA Mutations]
Age at which mammogram should be done yearly
25
[BRCA Mutations]
age at which CA 125 yearly beginning at age 25
25 years old
If the mass is around 1cm, it has been present for how many years?
5 years
Nipple changes in breast CA is due to
shortening of coopers sensory ligament
it is the most important prognostic correlate of disease-free and overall survival
axillary lymph node status
Peau d orang e is due to
blockage of lymph node drainage
Metastatic foci occirs when the primary Ca exceeds in ___ cm
0.5
[Primary Breast CA]
originates from the terminal duct lobular units
(+) neighborhood calcifications
marker of increased risk for invasive CA
LCIS
[Primary Breast CA]
due to proliferation of the epithelium
calcification occurs in the areas of necrosis
DCIS
[Primary Breast CA]
a true anatomic precursor of invasive CA
DCIS
[Primary Breast CA]
paget disease is associated with this CA
DCIS
[Primary Breast CA]
In lobular CA, the subsequent cancers is located
bilaterally
[invasive breast CA]
large, pale, vacuolated cells in the rete pegs of epithelium
(+) CEA
(-) S-100
Paget disease
(+) S-100 - melanoma
most common type of invasive breast CA
invasive ductal CA
[diagnose]
central stellate configuration with chalky white or yellow streaks
invasive ductal CA
[invasive breast CA]
this is the frequent phenotype of BRCA1 cancers
medullary CA
[diagnose]
mass that is soft, hemorrhagic, bulky
dense lymphoreticular infiltrate of lymphocytes and plasma cells
large pleomorphic nuclei that are poorly differentiated sheet-like growth pattern
medullary CA
[invasive breast CA]
usually seen in elderly population
glistening and gelatinous mass
colloid CA
[invasive breast CA]
presents in 70 year old woman, small, rarely attain a size of 3cm
papillary CA
[invasive breast CA]
perimenopausal or early menopausal periods
distant metastasis are ra
haphazard array of small tubular elements
tubular CA
[invasive breast CA]
absence of E-cadherin
invasive lobular CA
[invasive breast CA]
small cells arranged in single file orientation
intracytoplasmic mucin that may display the nucleus (signet ring CA)
invasive lobular CA
Cite the risk factors of breast CA
- increased estrogen exposure
- Radiation exposure
- increased alcohol intake
- high fat diet
- prolonged OCP use
- Prolonged HRT use
- Family history
Cite the specific mammographic features of malignant breast CA
- Solid mass with or without stellate features
- Asymmetric thickening of tissues
- clustered microcaclficiations
[BIRADS Category]
probably benign
<2% risk of malignancy
BIRADS 3
[BIRADS Category]
Recommendation for BIRADS 3
short interval follow-up every 6 months, then every 6 to 12 months
What BIRADS category will you perform biopsy (needle)
BIRADS 4A, B, C
What is the primary indication for ductography
nipple discharge especially when the fluid contains blood
Imaging modality for younger females to screen for breast CA
UTZ
What is the screening modality for women with BRCA mutation?
MRI
diagnostic modality for premenopausal woman with a family history of breast CA
breast UTZ
ER/PR flow studies can be done in this type of breast biopsy technique
incisional biopsy
excisional biopsy
breast biopsy technique used for non-palpable masses
wire or needle directed excisional biopsy
[Breast CA Staging]
T2 N1 M0
T2: Tumor is greater than 2 cm but less than 5cm
N1 : mets movable ipsilateral ALN
[Breast CA Staging]
N3 means
mets in ipsilateral ALN and internal mammary LN or inflaclavicular LN or supraclavicular LN
[SLNB Recommendations]
SLNB negative
No further axillary dissection
[SLNB Recommendations]
SLNB positive
200 cells, larger than 0.2mm, but none larger than 2.0mm
no further LN dissection
[SLNB Recommendations]
SLNB positive
but T1 or T2, 1 or 2 positive sentinel LN
Breast conserving surgery, Whole-breast RT planned, no preopeartive chemo
No further LN dissection
[SLNB Recommendations]
SLNB not identified
do Axillary LN dissection
[Type of mastectomy]
Simple Mastectomy +
Removal of axillary LN
+ removal of pectoralis minor
MRM, Patey
[Type of mastectomy]
Simple Mastectomy +
Removal of axillary LN
+ preserve pectoralis minor
MRM, Madden and Auchinocloss
[Type of mastectomy]
Simple Mastectomy +
Removal of axillary LN
+ transect pectoralis minor then repair of transected muscle
MRM, scanlon
[Type of mastextomy]
Remove entire breast, axillary LN,
+ Pectoral Minor + Pectoral major
Radical Mastectomy
[complications of mastectomy]
Protraction of scapula: ___ nerve and muscle
Long thoracic, serratus anterior
[complications of mastectomy]
Extension and adduction of shoulder: ___ : _____
Thoracodorsal, latissimus dorsi
[complications of mastectomy]
The pectoralis minor and major are damaged. What nerve is affected?
lateral pectoral nerve
[complications of mastectomy]
loss of sensation of medial upper arm
intercostobrachial
[Advanced locoregional breast CA]
Neoadjuvant chemotherapy is indicated in what stages of CA
Stage IIIa, Stage IIIb
Most common site of breast CA metastasis
Liver, Lungs
Breast cancer treatment during the 1st and 2nd trimester
MRM
breast CA treatment in 3rd trimester?
BCS
[Follow-up after treatment]
In the first 2 years
every 4 months
[Follow-up after treatment]
In the next 3 years (after 2 years of treatment)
every 6 months
[Follow-up after treatment]
Mammogram of the contralateral breast is done every ____
yearly
[Type of mastectomy]
Modified radical mastectomy removes axillary LN level ___ and ____
Level I and II
[Type of mastectomy]
This type removes
ALL breast tissue, skin, NAC
pectoralis major
pectoralis minor
level I, II and III LN
Halsted Radical Mastectomy
___ drugs used for medical adrenalectomy
anastrazole
drug that inhibits production of adrenal steroids and conversion of androgens to estrogens in the adrenal gland and peripherally
anastrazole