Breast disorders Flashcards
a benign condition with clinical and radiographic findings similar to that of breast cancer, including firm/fixed, non-tender mass, skin or nipple retraction, and calcifications on mammography.
Biopsy will reveal fat globules and foamy histiocytes
Fat necrosis of the breast
No further work-up is indicated for excised lesions.
Diagnosis
Solitary, well-circumscribed & mobile mass
± Tenderness
Benign
Breast Cyst
Diagnosis
Multiple, diffuse nodulocystic masses
Cyclic premenstrual tenderness
Benign
Fibrocystic Changes
Diagnosis
Solitary, firm, well-circumscribed & mobile mass
Cyclic premenstrual tenderness
Benign
Fibroadenoma
usually young women/teens
Diagnosis
Unilateral, firm, well-circumscribed & mobile mass
±Upper Outer quadrant
Cyclic premenstrual tenderness (eg, premenstrual breast tenderness, size change)
Benign
Fibroadenoma
usually young women/teens
Observation & repeat examination in adolescents
Ultrasound in adults (<30) or patients with persistent mass
Diagnosis
After trauma/surgery
Firm, irregular mass
± Ecchymosis, skin/nipple retraction
Benign
Fat Necrosis
of breast tissue
Trastuzumab is used for the treatment of patients with **HER2-positive **breast carcinoma and is associated with a risk of what?
cardiotoxicity
Cardiac function should be assessed with ECHO at baseline and at regular intervals
What medication is used in the treatment of estrogen receptor-positive breast cancer and increases the risk of venous thromboembolism?
Pts w/ factor V Leiden mutation are at ↑ risk of venous thromboembolism
testing for the mutation is sometimes indicated prior to initiation of medication
Tamoxifen
What medication is used in the treatment of postmenopausal estrogen receptor-positive breast cancer and increase the risk of osteoporosis?
Aromatase inhibitors (eg, anastrozole, letrozole)
Baseline bone density scans should be obtained prior to treatment.
Diagnosis
Engorgement & inadequate milk drainage in breastfeeding patients
Presents with Fever ± Myalgia, chills, malaise
Firm, red, tender, swollen quadrant of unilateral breast
Lactational Mastitis
Tx: Antibiotics & Frequent breastfeeding or pumping
Antibiotic therapy against MSSA (dicloxacillin, cephalexin), analgesics, and continued breastfeeding.
If pre-menopausal pt with hx of breast cancer s/p partial masectomy has negative axillary sentinel LN, but a positive lateral margin on pathology what is the next best step in management.
path reveals ER,PR, HER-2 negative tissue
Continue Breast conserving therapy (consisting of partial mastectomy, axillary sentinel LN biopsy, & whole breast radiation therapy) and reexcise the lateral margins.
Adequate surgical excision of the cancer requires negative margins.
Next Best Step In Management:
Bilateral non-bloody nipple discharge with a normal breast exam
no masses, skin changes, or lymphadenopathy
Obtain:
* HCG (r/o pregnancy)
* TSH
* Prolactin
Next Best Step In Management:
Unilateral non-bloody nipple discharge with a normal breast exam
no masses, skin changes, or lymphadenopathy
<30: Ultrasound
≥30: Mammography (+u/s, if negative)
Diagnosis
Unilateral bloody nipple discharge with a normal breast exam
no masses, skin changes, or lymphadenopathy
Intraductal papilloma
Benign
Diagnosis
Unilateral bloody nipple exam with an abnormal breast exam
+ breast mass, + overlying skin changes or + lymphadenopathy
Invasive Ductal Carcinoma
Cancerous
Diagnosis
Pt presents with green-brown (nonbloody/nonmilky) nipple discharge
with a palpable subareolar (under nipple) breast mass
no overlying skin changes noted
Mammary duct ectasia
subareolar ductal dilation, inflammation, and fibrosis
Diagnosis & NBSIM
Teenage boy presents with a small (<4 cm) firm, unilateral or bilateral, subareolar mass
No pathologic features (nipple discharge, axillary lymphadenopathy, systemic illness)
may be tender to palpation or feel glandular
Pubertal gynecomastia
Reassurance and observation
resolves in a year
Diagnosis and NBSIM:
Young woman presents with a painful, mobile and well-circumscribed breast mass
Ultrasound reveals a thin-walled, anechoic (ie, fluid-filled), and without echogenic debris or solid components.
Simple Breast Cyst
if no sxs observe
NBSIM: Fine-needle aspiration bc symptomatic (painful)
Patients with nonbloody fluid on aspiration and complete resolution of both the mass and symptoms require no additional management.
Recurrent mass or bloody aspirate require a biopsy.
A breast mass that is complex-appearing (thick-walled, septated, solid and cystic components) are suspicious for cancer and automatically require what intervention?
core needle biopsy
Patients with lactational mastitis who do not improve with antibiotic therapy require ____ to evaluate for breast abscess.
breast ultrasound
Tx: abscess drainage (via ultrasound-guided needle aspiration)
Inflammatory breast carcinoma (IBC) is an aggressive breast cancer that classically have symptoms of mastitis that do not improve (or only initially improve) with antibiotics. Features include unilateral breast pain, erythema, and swelling. It may also present with a puritic rash or skin thickening and dimpling (peau d’orange appearance).
What is necessary for diagnosis?
Metastatic disease (axillary lymphadenopathy) is common on initial presentation.
Core needle breast biopsy and full-thickness skin punch biopsy
Due to high rates of metastasis, treatment for IBC is typically aggressive (eg, chemotherapy, mastectomy, radiation).
Presents just like** breast abscess **however, in IBC peau d’orange skin thickening and a solid (rather than fluctuant) mass.
The greatest risk of breast cancer in women is what?
Age
(thus routine screening mammography is age based at ≥50 years)
other risk factors: Family History or Increased estrogen exposure (nulliparity, early menarche, and late menopause)
Selective estrogen receptor modulators (Mixed agonist/antagonist action)
Which one is an adjuvant treatment of breast cancer and which one helps with postmenopausal osteoporosis?
Tamoxifen: adjuvant treatment of breast cancer
Raloxifene: postmenopausal osteoporosis
Which selective estrogen receptor modulator carries increased risk for Endometrial hyperplasia/carcinoma & Uterine Sarcoma?
Tamoxifen
other side effects: Hot flashes (most common), VTE, endometrial polyps
