Breast diseases benign and malignant Flashcards
what is the workup for a palpable mass?
should undergo diagnostic imaging prior to biopsy, since biopsy can alter mammographic / sonographic appearance
for women over 30 what is the imaging workup for a mass? under 30?
- over 30 - start with mammo +/- US
- under 30 - start with US
what are the three categories of benign lesions as outlined by Dupont et al?
- nonproliferative: no increased risk
- proliferative: 1.5-2x risk
- atypical hyperplasia: 3.5-5x risk
what are the proliferative benign breast lesions without atypia?
- moderate ductal hyperplasia
- intraductal papilloma
- adenomas
- fibroadenomas
what are the atypical hyperlasia benign breast lesions?
- atypical ductal hyperplasia
- atypical lobular hyperplasia
what is duct ectasia?
- dilated duct that widens and the duct walls thicken
- duct fills with fluid
- milk duct becomes clogged with a thick sticky substance
breast cysts are derived from what structural unit?
terminal ductal lobular unit
if not clear if mass is cystic or solid, what test do you order?
FNA
if no fluid can be obtained from a breast mass, what test ido you order?
biopsy
if there is a discordance between imaging and path results, what do you do?
surgical excision with needle localization
what is the most common organism responsible for infections of the breast? what is the treatment?
s. aureus
dicloxacillin or 1st gen ceph
what are the proliferative lesions of the breast?
- fibroadenoma
- fibromatosis
- adenomas
- intraductal papillomas
what is a fibroadenoma? what cell components are present? what is the exam presentation?
- pseudoencapsulated, sharply delimited from surrounding breast tissue
- contain both epithelial (organized and columnar to cuboidal with uniform nuclei) and stromal components
- firm, rubbery
what is the most common benign breast tumor?
fibroadenoma
a giant fibroadenoma must be differentiated from what other condition?
phyllodes tumor
what is a lactating adenoma? what is the PE appearance? what is used to shrink it?
- benign stromal tumor that occurs only in association with gestation and is typically seen from third trimester through period of lactation
- firm, mobile, nontender
- bromocriptine
what should be obtained for bloody nipple discharge?
cytology
what are the causes of bloody nipple discharge (4)? what is the most common cause?
- solitary intraductal papilloma
- intraductal papillomatosis
- ductal hyperplasia
- malignancy
MOST COMMON: intraductal papilloma
are intraductal papillomas premalignant? what is the treatment?
no
excision
what is the treatment recommendation for atypical ductal hyperplasia? why?
complete excisional biopsy
stronger risk to breast cancer progression (3.5-5x)
fibrocystic disease (could be) a result of what process?
normal physiologic changes in breast related to menstrual hormonal cycles
what is the treatment for fibrocystic disease? what exacerbates it?
reduction in estrogen, which exacerbates it
what is mondor’s disease?
phlebitis of thoraco-epigastric vein
most breast cancers are carcinomas arising from what structural unit?
terminal duct lobular unit
is breast cancer primarily sporadic or genetic?
sporadic
what is the cellular origin of breast cancers?
terminal duct lobular unit
what is the pathogenesis of atypical hyperplasia?
alterations of cell adhesion and polarity as the epithelium begins to pile up and distend the acini
what is the most common type of breast cancer, by far?**
where does it start?
invasive ductal carcinoma**
starts in milk duct epithelium of terminal duct lobular unit
HER2/neu breast cancers are treated with which drugs?
- trastuzumab (herceptin)
- iapatinib (tykerb)
the majority of breast cancers have what receptor profile?
ER/PR +
HER2/neu -
what are the special types of invasive breast cancer?
- medullary
- mucinous
- papillary
- tubular
where does paget disease of the nipple start? where does it spread?
breast ducts and spreads to skin of nipple and then to areola
what is BIRADS?
breast imaging reporting and data system
which BIRADS rating is suspicious of malignancy?
BIRADS 4
what is the sentinel lymph node?
first lymph node in the chain of drainage
how does lumpectomy + radiation compare to mastectomy for overall survival?
same
what test is performed for nonpalpable abnormalities?
image guided biopsy
