breast disorders

Question 1

What are the key findings in fibrocystic change in the breast?

Answer 1

-multiple bilateral small tender breast masses, possible mild breast pain, sx improvement after menses, mobile masses that vary in size during the menstrual cycle

Question 2

What would a biopsy of fibrocycstic change of the breast show?

Answer 2

epithelial hyperplasia

Question 3

What is the history of fibroadenoma>

Answer 3

most common benign breast tumor, esp. in women under 30. typically a proliferative process of a single duct. pts have a solitary solid mobile mass with well-defined edges; size may vary with menstrual cycle

Question 4

What causes breast abscesses?

Answer 4

S aureus mos common, may be strep or anaerobic bacteria

Question 5

How are breast abscessed diagnosed?

Answer 5

FNA confirms the dx

Question 6

What are the complications of breast abscesses?

Answer 6

fistula formation with recurrent abscess, recurrence is common

Question 7

What is the history and definition of an intraductal papilloma?

Answer 7

-benign lesion of ductal tissue that may have malignant potential. will show bloody or nonbloody discharge from nipple on stimulation, breast pain, and palpable mass behind the areola

Question 8

What labs are done for an intraductal papilloma?

Answer 8

excisional biopsy, ductal lavage by microcatheter may be used to test for abnomral intraductal cells

Question 9

What is the most common site for breast cancer?

Answer 9

upper outer quadrant

Question 10

What percentage of breast cancers are not detected through screening mammogram, and where are they usually located?

Answer 10

-20%; usually in upper outer quadrant

Question 11

What is the disadvantage of FNA for suspicious breast masses?

Answer 11

can’t distinguish btw invasive or in situ CA; core biopsy is better at this

Question 12

When is radiation performed in breast cancer?

Answer 12

tumors greater than 5 cm; after lumpectomy

Question 13

When must you do a mastectomy instead of a lumpectomy?

Answer 13

multiple tumors, prior breast irradiation,

Question 14

What is the next step after a negative FNA in a solid breast mass?

Answer 14

more definitive biopsy- there is a 20% false negative rate for FNA

Question 15

When is hormone or chemo indicated in breast cancer?

Answer 15

node positivity, tumors >1 cm, tumors with aggressive histology.

Question 16

To what other organs does breast cancer metastasize?

Answer 16

bone, thoracic cavity, brain, liver

Question 17

What should you do if there is palpable mass but low suspicion of malignancy on mammogram?

Answer 17

• ultrasound. if asymptomatic simple cyst, repeat mammogram in 6 months
• If solid mass or symptomatic complex cyst, doa biopsy

Question 18

What is the “next step” algorithm for breast biopsy?

Answer 18

1. If nonbloody cystic fluid or complete resolution with aspiration, observe
2. If bloody aspirate or residual mass after aspiration, need a more definitive biopsy
3. if malignant, proceed with cancer treatments

Question 19

What is medullary carcinoma?

Answer 19

well circumscribed mass with rapid growth. better prognosis than ductal carcionma

Question 20

What is tubular carcinoma?

Answer 20

slow growing malignancy of well formed tubular structures invading the stroma. pts usually in late 40s with excellent prognosis