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REPRO II Exam 1 > Breast Disease - Tieman > Flashcards

Breast Disease - Tieman Flashcards

1
Q

most common breast mass in young women

A

fibroadenoma

<30yo

benign

firm, moveable, non-tender

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2
Q

fibroadenoma diagnosis

A

U/S

FNA helpful - but can’t distinguish from phyllodes

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3
Q

giant fibroadenoma

A

> 5cm

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4
Q

tx of fibroadenoma

A

may be watched, excised, or treated with cryoablation

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5
Q

phyllodes tumor

A

stroma grows rapidly and tumor becomes large

may be benign or malignant - depends on mitotic rate and histo

malignant - tx - wide local excision or mastectomy

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6
Q

fibrocystic breast disease

A

cyst may be painless - multiple painful are common

35-55yo

fluctuate with menstrual cycle

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7
Q

fluctuate with menstrual cycle

A

fibrocystic breast disease

areas of fibrosis in ducts with destruction and dilation of terminal ductules and lobules

fill with cystic fluid

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8
Q

tx fibrocystic breast disease

A

aspiration

if recur - may be reaspirated

bloody aspirate - examine it

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9
Q

bilateral diffuse cyclical breast pain

A

fibrocystic breast disease

U/S - multiple small cysts

mammography - dense tissue - without mass

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10
Q

increased risk of fibrocystic breast disease

A

caffeine
chocolate
alcohol

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11
Q

tx of fibrocystic breast disease

A 
support bra
analgesica
avoid trauma
danazol, tamoxifen - if severe
primrose oil
low fat diet
vit E
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12
Q

sclerosing adenosis

A

proliferation of fibrous stroma and terminal ductules with deposition of calcium

mammogram - look like microcalcifications of breast ca

no malignant potential

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13
Q

radial scar

A

complex sclerosing lesion

microcyst, epithelial hyperplasia, adenosis, central sclerosis

need bx - to distinguish from breast cancer**

slight increased risk to develop breast cancer

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14
Q

expressed nipple discharge

A

goes away when manipulation stopped

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15
Q

spontaneous nipple discharge

A

needs evaluated if serous/blood discharge

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16
Q

evaluation of nipple discharge

A

mammogram, cytology, U/S

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17
Q

unilateral, spontaneous, bloody/serous nipple discharge

A

duct excision required

95% benign papilloma
5% papillary carcinoma

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18
Q

bilateral nipple discharge

A

fibrocystic disease with duct ectasia

if not lactating - hyperPRL, hypothyroid, drug induced

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19
Q

lactational mastitis

A

younger
breast feeding women with fever
breast erythema and tenderness

staph aureus - tx antibiotics

may form abscess

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20
Q

chronc sub-areolar mastitis with duct ectasia

A

older women
diabetics who smoke

mixed flora

tx - antibiotics

may form abscess

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21
Q

non-resolving mastitis

A

requires biopsy*

bc looks like inflammatory breast cancer

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22
Q

fat necrosis

A

scarring folowing trauma, surgery, radiation

scar tissue, chronic inflammatory cells, and macrophages

often with calcifications

no malignant potential

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23
Q

male gynecomastia

A

diffuse male hypertrophy

pubertal - adolescent boys - rarely requires tx

senescent - males >50, medication associated - digoxin, thiazide, estrogens, phenothiazines, theophylline

must rule out underlying medical condition (cirrhosis, renal failure, malnutrition)

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24
Q

male breast cancer

A

harder, non-tender, fixed to surrounding sructure

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25
Q

lobes of breast

A

15-20

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26
Q

estrogen

A

ducts

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27
Q

progesterone

A

lobules

28
Q

nipple openings

A

15-20

29
Q

age <30

A

fibroadenoma

30
Q

age 30-50

A

fibrocystic mass

31
Q

age >60

A

majority of breast cancers

but cancer can happen at any age

32
Q

social hx for breast ca

A

smoking, ETOH, occupation

33
Q

family hx for breast ca

A

first degree relative - 2-3x risk increase

BRCA1 and 2 - 80% lifetime risk

endocrine disease

34
Q

estrogen window

A

menarche to menopause

35
Q

age of 1st pregnancy >35yo

A

1.5-3x increase risk of breast cancer

36
Q

GAIL model

A

risk assessment for breast cancer

age, menarche age, age 1st birth, 1st relative with breast cancer, number of biopsies, race

37
Q

patient <40yo with benign breast mass desiring excision

A

surgical biopsy

38
Q

benign breast mass >40yo

A

mammogram
ultrasound
FNA
excise if malignant - repeat 3 months if benign

39
Q

MRI of breast

A

high sensitivity
low specificity

more false positive readings and bx expenses

screening for high risk BRCA patients, dense breasts, small lesions, implants

40
Q

FNA

A

minimally invasive
can be done in office

requires skilled cytopathologist

41
Q

core needle biopsy

A

obtain tissue
ER/PR analysis

doesn’t interrupt lymphatics

42
Q

atypia on FNA or core needle bx

A

requires excision of entire lesion - to rule out malignancy

43
Q

atypical hyperplasia on biopsy

A

3-6x increased risk of later invasive cancer

44
Q

LCIS

A

tx as risk factor
15-20x increased risk of DCIS bilaterally**

excisional biopsy with clear margins

45
Q

DCIS

A

tx with lumpectomy/radiation

46
Q

most common invasive breast cancer

A

ductal

-favorable - medullary, tubular, mucinous, papillary

47
Q

lobular carcinoma of breast

A

bilateral

slightly better prognosis than ductal

48
Q

peau d’orange

A

inflammatory cancer of beast

49
Q

breast cancer staging

A

T1 - 5cm
T4 - wall fixation or skin involved

N0 - no nodes
N1 - mets to ipsilateral nodes
N2 - mets to fixed or matted axillary nodes

50
Q

stage 0 prognosis

A

Tis, N0, M0 - 95% 5 year

51
Q

stage 1 prognosis

A

T1, N0, M0 - 85% 5 year

52
Q

BI-RADS 0

A

requires additional studies

53
Q

BI-RADS 1

A

no abnormal findings

-routine screening

54
Q

BI-RADS 2

A

benign findings

-routine screening

55
Q

BIRADS 3

A

probably benign

-6 month follow up

56
Q

BIRADS 4

A

suspicious abnormality

-image guided bx

57
Q

BIRADS 5

A

highly suggestive of malignancy

-image guided bx

58
Q

mammotome biopsy

A

image guided

59
Q

radical mastectomy

A

removal of breast, pec muscles, axillary nodes

rarely used - only if invades pectoralis muscles

60
Q

modified radical mastectomy

A

remove breast, axillary nodes

61
Q

partial mastectomy

A

remove part of breast

breast ca with negative axillary nodes

62
Q

ALND

A

axillary lymph node dissection
-preferred tx if lymph node positive for cancer or patient doesn’t want to risk having two procedures

complications - numbness - lymphedema

63
Q

neoadjuvant therapy

A

chemo/rad before surgery

to down size and down stage tumors

64
Q

anastrazole

A

aromatase inhibitor

65
Q

breast cancer follow up

A

6-12 months

look for recurrence/mets

mammograms - yearly bilateral

REPRO II Exam 1 (14 decks)

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