Breast cancer

Question 1

Most important prognostic consideration in tx of patients with breast cancer

Answer 1

TNM staging. Additionally, overexertion of Her-2/neu oncogene is related to a worse prognosis. However, ER+ and PR+ are good prognostic features.

Question 2

Rash localized to the nipple with an ulcerating eczematous appearance

Answer 2

Pages disease. 85% have underlying breast CA. Skin bx will typically demonstrate large cells that appear to be surrounded by clear halos because the cancer cells become retractd from adjacent keratinocytes. Underlying adenoma with changes of Pagets disease thought to be caused by migration of neoplastic cells through the mammary ducts to the nipple surface.

Question 3

Elderly woman that presents with a palpable mass in the breast; less commonly, young permpartum patients with skin changes

Answer 3

Breast lymphoma

Question 4

Peau d’orange

Answer 4

Severe ductal CA tha t infiltrated into the dermal lymphatics with resulting edema, erythema, and warmth of the entire breast (inflammatory CA)