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Year 2 OBGYN > Breast diseases benign and malignant > Flashcards

Breast diseases benign and malignant Flashcards

1
Q

what is the workup for a palpable mass?

A

should undergo diagnostic imaging prior to biopsy, since biopsy can alter mammographic / sonographic appearance

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2
Q

for women over 30 what is the imaging workup for a mass? under 30?

A
  • over 30 - start with mammo +/- US

- under 30 - start with US

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3
Q

what are the three categories of benign lesions as outlined by Dupont et al?

A
  • nonproliferative: no increased risk
  • proliferative: 1.5-2x risk
  • atypical hyperplasia: 3.5-5x risk
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4
Q

what are the proliferative benign breast lesions without atypia?

A
  • moderate ductal hyperplasia
  • intraductal papilloma
  • adenomas
  • fibroadenomas
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5
Q

what are the atypical hyperlasia benign breast lesions?

A
  • atypical ductal hyperplasia

- atypical lobular hyperplasia

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6
Q

what is duct ectasia?

A
  • dilated duct that widens and the duct walls thicken
  • duct fills with fluid
  • milk duct becomes clogged with a thick sticky substance
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7
Q

breast cysts are derived from what structural unit?

A

terminal ductal lobular unit

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8
Q

if not clear if mass is cystic or solid, what test do you order?

A

FNA

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9
Q

if no fluid can be obtained from a breast mass, what test ido you order?

A

biopsy

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10
Q

if there is a discordance between imaging and path results, what do you do?

A

surgical excision with needle localization

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11
Q

what is the most common organism responsible for infections of the breast? what is the treatment?

A

s. aureus

dicloxacillin or 1st gen ceph

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12
Q

what are the proliferative lesions of the breast?

A
  • fibroadenoma
  • fibromatosis
  • adenomas
  • intraductal papillomas
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13
Q

what is a fibroadenoma? what cell components are present? what is the exam presentation?

A
  • pseudoencapsulated, sharply delimited from surrounding breast tissue
  • contain both epithelial (organized and columnar to cuboidal with uniform nuclei) and stromal components
  • firm, rubbery
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14
Q

what is the most common benign breast tumor?

A

fibroadenoma

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15
Q

a giant fibroadenoma must be differentiated from what other condition?

A

phyllodes tumor

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16
Q

what is a lactating adenoma? what is the PE appearance? what is used to shrink it?

A
  • 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
17
Q

what should be obtained for bloody nipple discharge?

A

cytology

18
Q

what are the causes of bloody nipple discharge (4)? what is the most common cause?

A
  • solitary intraductal papilloma
  • intraductal papillomatosis
  • ductal hyperplasia
  • malignancy

MOST COMMON: intraductal papilloma

19
Q

are intraductal papillomas premalignant? what is the treatment?

A

no

excision

20
Q

what is the treatment recommendation for atypical ductal hyperplasia? why?

A

complete excisional biopsy

stronger risk to breast cancer progression (3.5-5x)

21
Q

fibrocystic disease (could be) a result of what process?

A

normal physiologic changes in breast related to menstrual hormonal cycles

22
Q

what is the treatment for fibrocystic disease? what exacerbates it?

A

reduction in estrogen, which exacerbates it

23
Q

what is mondor’s disease?

A

phlebitis of thoraco-epigastric vein

24
Q

most breast cancers are carcinomas arising from what structural unit?

A

terminal duct lobular unit

25
Q

is breast cancer primarily sporadic or genetic?

A

sporadic

26
Q

what is the cellular origin of breast cancers?

A

terminal duct lobular unit

27
Q

what is the pathogenesis of atypical hyperplasia?

A

alterations of cell adhesion and polarity as the epithelium begins to pile up and distend the acini

28
Q

what is the most common type of breast cancer, by far?**

where does it start?

A

invasive ductal carcinoma**

starts in milk duct epithelium of terminal duct lobular unit

29
Q

HER2/neu breast cancers are treated with which drugs?

A
  • trastuzumab (herceptin)

- iapatinib (tykerb)

30
Q

the majority of breast cancers have what receptor profile?

A

ER/PR +

HER2/neu -

31
Q

what are the special types of invasive breast cancer?

A
  • medullary
  • mucinous
  • papillary
  • tubular
32
Q

where does paget disease of the nipple start? where does it spread?

A

breast ducts and spreads to skin of nipple and then to areola

33
Q

what is BIRADS?

A

breast imaging reporting and data system

34
Q

which BIRADS rating is suspicious of malignancy?

A

BIRADS 4

35
Q

what is the sentinel lymph node?

A

first lymph node in the chain of drainage

36
Q

how does lumpectomy + radiation compare to mastectomy for overall survival?

A

same

37
Q

what test is performed for nonpalpable abnormalities?

A

image guided biopsy

Year 2 OBGYN (33 decks)

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