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women's health > breast disorders > Flashcards

breast disorders Flashcards

1
Q

inspection of breasts involves

A
  • examines sitting upright and in the supine position
    • both arms relaxed, raised, and body leaning forward, hands on hips
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2
Q

list the concerning physical exam findings of breast mass

A
  • hard, gritty texture of breast mass
  • immobile
  • irregular borders
  • > 2 cm
  • new or growing
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3
Q

concerning finding on breast exam of nipple discharge

A
  • unilateral
  • bloody
  • spontaneous discharge
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4
Q

what imaging modalities are used to evaulate breast mass

A
  • mammography -> most useful in women >35
  • ultrasound -> most useful in women < 35
    • adjunct ot mammo
  • MRI
    • adjunct to mammo and US
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5
Q

What are the normal views taken with mammograms

A
  • CC = cranial cadual view: top to bottom
  • MLO = medial lateral oblique
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6
Q

What are concerning findings on mammogram considering a mass

A
  • increased density
  • irregular border
  • spiculation: lump of tissue with spikes or points on the surface
  • clustered irregular microcalcifications
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7
Q

if have clinically suspicious lump, does a negative MRI r/o cancer

A

No

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8
Q

What is US used for in evaluation of breast cancer

A
  • adjunct to mammogram
  • mass cystic or solid
  • guide core needle biopsies
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9
Q

what are concerning findings of US for a breast mass

A
  • hypoechoic lesion with ill-defined borders
  • mass that is taller than wide
  • spiculated margins
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10
Q

what imaging modality is best at demonstrating ductal carcinoma in situ (DCIS)

A

MRI

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11
Q

biopsies help to determine presence of malignant cells and determine if mass has what receptors

A

estrogen and progesterone

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12
Q

Fine needle aspiration is ued to aspirate palpable mass/suspected cyst. Is follow up indicated after procedure?

A
  • follow-up 4-6 weeks after aspiration
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13
Q

concerning findings in Fine needle aspiration of breast mass

A
  • recurrence of mass after aspiration
  • bloody aspirate
  • no fluid is obtained
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14
Q

use of core needle biopsy

A
  • obtain pathologic diagnosis of breast mass
    • large 14-18 gauge needle
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15
Q

concerning findings on core needle biopsy and/or sterotactic biopsy on breast mass

A
  • carcinoma
  • atypia: abnormal cells
  • insufficient specimen
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16
Q

what is a sterotactic biopsy

A
  • provides 3 dimensional view
  • evaluate
    • microcalcifications, densities, masses
  • multiple passes for tissue sampling
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17
Q

differentiate between incisional and excisional biopsies

A
  • incisional: portion of mass removed
  • excisional: entire mass removed
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18
Q

what is mastalgia

A

breast pain

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19
Q

what is the common presentation of benign mastalgia

A
  • cyclic
  • mild
  • bilat tenderness and swelling
  • common few days preceeding menstrual cycle
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20
Q

what is the concerning findings associated with mastalgia

A
  • persistent
  • unilateral pain
  • tenderness
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21
Q

What is a ductogram

A
  • used in evaluation of nipple discharge
  • cannulation of a single duct with catheter and injection of contrast solution
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22
Q

What are concerning findings regarding nipple discharge

A
  • unilateral
    • spontaneous
    • localized to single duct
    • > 40 yo
    • bloody
    • associated with a mass
23
Q

managment of patient with concerning findings regarding nipple discharge

A
  • excisional biopsy of offending duct and mass
  • referral to breast specialist
24
Q

What is Duct Ectasia

A
  • most common cause of nipple discharge
  • benign
  • multiple dilated ducts in the subareolar space
25
Q

what nipple discharge would you expect with Duct Ectasia

A
  • clear, milky or green-brown
26
Q

tx of Duct Ectasia

A

duct exciosion if definitive histological diagnosis

27
Q

What is Intraductal papilloma?

A
  • Benign
  • solitary lesion on the inside of the duct
28
Q

what nipple discharge would you expect with Intraductal papilloma

A
  • reproducible, bloody nipple discharge
29
Q

what is the problem with Intraductal papilloma

A
  • there is a malignant version: invasive papillary carcinoma
30
Q

if patient presents with bilat milky nipple discharge and is not lactating, suspect what condition

A
  • pituitary adenoma
    • excess prolactin
31
Q

Etiology of mastitis

A
  • breast infection, usually bacterial
    • S. aureus, S. epidermidis
32
Q

when is mastitis most commonly seen

A
  • after 3rd week of breastfeeding
    • possibly due to inspissation of mild, obstruction and secondary infection
    • progress to abscess in 5-10%
33
Q

treatment of mastitis with abscess

A
  • abx
  • I&D (surgery consult)
    • **beware of “mastitis” that doesn’t improve with tx -> inflammatory carcinoma
34
Q

breast cyst have highest incidence in what patient population

A

females 30-40 yo

35
Q

what is most likely diagnosis

  • firm, mobile, slightly tender mass
  • well-defined border, smooth
  • echo-free center on US
A

breast cyst

36
Q

how is breast cyst diagnosed and treated

A
  • aspiration : diagnostic and therapeutic
  • re-image in 4-6 weeks
37
Q

Fibroadenomas are most common in what age group? what causes them to enlarge

A
  • females < 30 yo
  • pregnancy, OCP use, menses
    • changes in size with menstrual cycle
38
Q

what is most likely diagnosis

  • discrete, smooth, firm, rubbery, mobile, non-tender mass
  • well circumscribed borders
  • weak internal echoes
A

Fibroadenomas

39
Q

when is surgery indicated for Fibroadenomas

A
  • mass increases in size
  • > 3 cm
  • symptomatic
  • planning a pregnancy
40
Q

What are Phyllodes tumors ? benign?

A
  • similar to fibroadenomas but grow rapidly
  • 90% are benign
41
Q

management of Phyllodes tumors

A
  • wide local excision to tumor-free margins
  • total mastectomy sometimes required
42
Q

is there a risk of recurrence with Phyllodes tumors

A
  • yes
    • radiation on tumors > 5 cm
    • chemotherapy on tumors > 5 cm and evidence of stromal overgrowth
43
Q

What are some risk factors for breast cancer

A
  • nulliparity
  • late first pregnancy
  • early menarche
  • late menopause
    • FH
44
Q

clinical presentation

  • superficial irritation and itching sensation
  • itching, burning, sticking pain in the nipple
  • nipple appears erosive and thickened
A
  • Paget’s disease
45
Q

What are the two types of noninvasive (in situ) breast carcinomas

A
  • Lobular (LCIS)
  • Ductal (LCIS)
46
Q

What defines a Lobular (LCIS)

A
  • a preinvasive lesion -> not a cancer
  • indicator for increased risk: 1% per year
47
Q

What defines Ductal (DCIS)? What results are expected on mammography?

A
  • treated as malignancy because can develop into invasive cancer
  • on mammography -> clustered pleomorphic calcifications
48
Q

Differentiate between the two types of infiltrating (invasive) carcinomas

A
  1. infiltrating ductal carcinoma
    • 80%
  2. infiltrating lobular carcinoma
    • 10%
    • higher incidence of multicentricity
    • more likely to be bilateral
49
Q

clinical presentation

  • diffuse induration, erythema, warmth, edema, peau d’orange of the skin of the breast with/without palpable mass
  • axillary lympadenopathy
A
  • inflammatory breast cancer
    • the most rapidly lethal malignancy of the breast
50
Q

Where are the common locations of metastasis in breast cancer

A
  • lung
  • liver
  • bone
  • ovaries
  • brain
51
Q

What type of mastectomy is this: entire breast including pectoralis major fascia, nipple, and areola

A

simple (aka total)

52
Q

What type of mastectomy is this: entire breast including nipple and areola + axillary lymph nodes

A

modified radical mastectomy

53
Q

What type of mastectomy is this: entire breast, lymph nodes, pectoralis muscle

A

radical mastectomy

54
Q

screening guidelines for mammography

A
  • start age 40
  • then every 1-2 years

women's health (5 decks)

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