Breast Disorders Flashcards
0
Q
Fibrocystic Disease
A
- Most common lesion of the breast
- Benign
- RFs: estrogen, alcohol
- Sx: fibrous/cystic changes in the breast, breast pain/tenderness that varies with the menstrual cycle, fluctuate in size.
- Dx: breast exam, hx, aspirated cysts through FNA
- Tx: stop caffeine, NSAIDs, primrose oil, Vit E, drainage of cyst. If recurs, second aspiration. If recurs again, open bx needed.
- Most common cause of green, straw, or brown colored discharge.
1
Q
Fibroadenoma
A
- Most common breast tumor in women <30yo.
- Benign
- Stromal overgrowth, collagen arranged in swirls
- Sx: solid, mobile, well circumscribed, round
- Dx: US, FNA(will be negative), excision
- Tx: resection if large or growing, observation if small.
2
Q
Breast Cancer
A
- 12% lifetime risk.
- Most common type is Infiltrating ductal carcinoma (75%).
- Most common site is upper outer quadrant.
- RFs: nulliparity, menarche 55yo, hx or FH of breast cancer, pregnancy with first child >30yo, hyperplasia in breast, elderly, DCIS or LCIS, papilloma, sclerosing adenosis.
- Sx: asx, mass, pain (but most are painless), nipple discharge(bloody), local edema, nipple retraction, dimple, nipple rash, skin retraction, axillary/supraclavicular LNs.
-Invasive Breast Cancer Types:
-Infiltrating ductal carcinoma (most common)
-Medullary carcinoma, Infiltrating lobular carcinoma, tubular
carcinoma, mucinous carcinoma, inflammatory breast cancer.
- Radiographic tests: mammogram (may see spiculated mass, microcalcifications), breast US (use this in younger women), MRI.
- Bx: FNA, core bx, mammotome sterotactic bx, open bx. Need to check the specimen for estrogen and progesterone receptors; will determine if the tumor will respond to hormonal therapy (tamoxifen). Also look for HER2 oncogene-can use trastuzumab to treat.
- Workup for a breast mass: CBE, mammogram/US, FNA/core bx/open bx.
- Pre-op staging workup: B/L mammogram, CXR, CBC, LFTs, serum Ca level, alkaline phosphatase
- Sites of Mets: LNs, lung, liver, bones, brain
- Tx: modified radical mastectomy(breast, axillary LNs, and nipple/areolar complex are removed, drains are placed in axilla and chest wall), lumpectomy and radiation + sentinel LN dissection. Use radiation if the pt has undergone breast conservation surgery.
- Tamoxifen-binds estrogen receptors, can help prevent cancer in pts at risk. s/e= endometrial cancer, DVT, pulmonary emboli, cataracts, hot flashes, mood swings.
- Premen, node +, ER- = Chemo
- Premen, node +, ER+ = Chemo and tamoxifen
- Premen, node -, ER+ = Tamoxifen
- Postmen, node +, ER+ = Tamoxifen, +/- chemo
- Postmen, node +, ER- = Chemo, +/- Tamoxifen.
- Chemo used: Cyclophosphamide + 5-Fluorouracil + MTX/Adriamycin
- Breast reconstruction: TRAM flap, implant, latissimus dorsi flap.
3
Q
Breast Abscess
A
- Etiology: mammary ductal ectasia, mastits. Most common bacteria are staph aureus in nursing women and mixed infections in nonlactating women.
- Periareolar (nonlactating): need to r/o cancer, tends to recur until the duct is excised.
- Puerperal (lactating): can continue breast feeding.
-Tx: Abx, needle or open drainage with cultures taken, resection if recurrent.
4
Q
Mastitis
A
- Superficial infection of the breast
- Most often caused by Staph aureus
- Typically occurs at onset of breast feeding.
- Sx: erythema, pain, edema, fever, chills, malaise
- Tx: Abx, heat applications
- Need to make sure that it is not inflammatory breast cancer.
5
Q
Gynecomastia
A
- Etiology: medications, ilicit drugs, liver failure, increased estrogen, decreased testosterone, hyperthyroidism, prolactin secreting tumor, acromegaly, testicular tumor, adrenal tumor, alcoholism
- Tx: stop or change meds, correct underlying cause, bx, liposuction, mastectomy
6
Q
Poland syndrome
A
- Congenital abnormality
- Breast is tuberous and asymmetric
- More common in males
- Right side affected more often
7
Q
Cysts and Apocrine Metaplasia
A
- Palpable mass, tends to recur, multiple
- Dx: US, FNA, cytology of aspirate
- Tx: aspiration
- Apocrine metaplasia: transition of ductal epithelium to tall columnar type with rounded apical aspect. Commonly seen in cysts. NO increased incidence of cancer.
8
Q
Duct ectasia
A
- Benign
- Dilation, periductal inflammation and fibrosis of the retroareolar ducts beneath the nipple.
- Sx: nipple discharge, pain, inflammation, fibrosis, nipple retraction, mass behind nipple, skin fixation, discharge.
- Dx: US, mammogram
- Tx: usually need no tx, abx for infection, duct excision if recurrent.
9
Q
Mild Epithelial hyperplasia
A
- Increase in the number of cells in relation to the basement membrane.
- Moderate = >5 layers of cells.
- Florid= ducts are packed with solid sheets of cells
- Increased risk of breast cancer.
10
Q
Calcifications
A
- Ca deposits can occur in the ducts or lobules, int he stroma, or in the epithelium.
- 90-95% are benign.
- Benign: long parallel lines, burst or popcorn pattern, radiolucent(dark), uniform size, widely dispersed, no spicules.
- Malignant: irregular, branches, spicules, comma shaped, clustered.
- Tx: bx
11
Q
Sclerosing Adenoma
A
- May look like cancer. Distinguished by electron microscopy.
- Sx: painful mass, or asx.
- Dx: opacity on mammogram
- Increased risk for developing breast cancer
12
Q
Radial scar and complex sclerosing lesion
A
- Central scar with proliferating epithelial elements emanating from the center in a stellate pattern.
- Radial scar= up to 1cm
- Complex sclerosing lesion= >1cm
- Dx: mammogram (may look like cancer)
- Increased risk or breast cancer
13
Q
Intraductal papilloma
A
- Most common cause of bloody discharge in a young woman.
- Sx: bloody discharge, possible palpable mass
- Tumor is attached to the duct by a stalk of connective tissue
- Dx: mammogram
- Increased risk of breast cancer.
14
Q
Atypical lobular hyperplasia
A
- Less than half of the acini are completely distended and/or less than half of the acini are filled by a uniform population of cells. (if more than half=LCIS)
- Increased risk of breast cancer.
