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OBGYN > Breast Disorders > Flashcards

Breast Disorders Flashcards

1
Q

What is the functional unit of the breast called and what does it consist of?

A

it is called the terminal duct lobular unit and it is composed of a lobule filled with glands, which drain into a common terminal duct

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2
Q

What happens to breast tissue as a woman ages?

A

the glands involute and are replaced by fat

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3
Q

In which layer of tissue is the breast located?

A

within the superficial fascia of the chest wall

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4
Q

Most glandular or lobular breast tissue is located where within the breast?

A

the upper outer quadrant

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5
Q

Describe the ductal epithelium within the breast.

A
  • there is the luminal cell layer, the inner layer which is responsible for milk production
  • and there is the myoepithelial layer, which has contractile ability and propels milk towards the nipple
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6
Q

What are “milk lines”?

A

an imaginary line between the axilla and groin, along which breast tissue can sometimes be found

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7
Q

Define polymastia and polythelia.

A
  • polymastia: true accessory breasts

- polythelia: extra nipples

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8
Q

To what lymph nodes does breast cancer most often spread?

A

the ipsilateral lymph node and the internal mammary nodes

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9
Q

The breasts receive blood supply from which arteries?

A
  • perforating branches of the internal mammary artery
  • lateral thoracic artery
  • thoracodorsal artery
  • thoracoacrimal artery
  • intercostal perforating arteries
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10
Q

What is the effect of estrogen and progesterone on breast tissue?

A
  • estrogen is responsible for growth of adipose tissue and lactiferous ducts
  • progesterone leads to lobular growth and alveolar budding
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11
Q

What risk factors exist for breast cancer?

A
  • age
  • personal history of breast cancer or atypical hyperplasia
  • BRCA mutations
  • high breast density
  • estrogen exposure
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12
Q

How much earlier is mammography typically able to detect breast lesions than palpation? What is the size threshold for detection with each method?

A
  • mammography is able to detect 1 mm lesions, meaning it typically detects lesions 2 years before they become palpable
  • palpation is typically only able to detect lesions 1 cm or larger
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13
Q

What is the BI-RADS system? What are the levels?

A

a standardized system to help communicate the final assessment and recommendations related to mammography findings

  • class 0: need additional imaging
  • class 1: negative
  • class 2: benign
  • class 3: probably benign
  • class 4 (A, B, C): low, intermediate, or moderate suspicion of malignancy
  • class 5: highly suggestive of malignancy
  • class 6: biopsy-proven malignancy
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14
Q

What role does ultrasonography play in evaluating breast lesions?

A

it is useful in evaluating inconclusive mammography findings, in evaluating breasts of young women and others with dense tissue, allowing better differentiation between solid and cystic masses, and in guiding tissue core-needle biopsy

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15
Q

What does an anechoic defect found on breast ultrasound suggest?

A

it is suggestive of a simple cyst which can be drained for symptomatic relief

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16
Q

What imaging modality should be used to screen women younger than 30 for breast cancer?

A

ultrasonography

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17
Q

What role does MRI play in evaluating breast lesions?

A

it is used as an adjunct for early detection of breast cancer in women at very high risk

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18
Q

If fine-needle aspiration biopsy of a breast lesions drains clear fluid what is the next step? What if it is bloody?

A
  • clear fluid does not require pathologic evaluation
  • bloody fluid should be sent for cytologic evaluation ad the patient should undergo diagnostic mammography and ultrasonography
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19
Q

In what circumstances are fine-needle aspiration and core-needle biopsies used to evaluation breast lesions?

A
  • fine-needle is used to obtain a fluid sample from a cystic lesions
  • core-needle is used to obtain samples from a larger, solid mass
20
Q

Contrast cyclic and noncyclic mastalgia.

A
  • cyclic begins during the luteal phase of the menstrual cycle and resolves after the onset of menses with bilateral pain, usually in the upper outer quadrants of the breast
  • noncyclic is not associated with the menstrual cycle and includes various etiologies including tumor, mastitis, cysts, or history of trauma
21
Q

What is the likely diagnosis for someone with cyclic breast pain, beginning in the luteal phase and resolving after the onset of menses, localized to the upper outer quadrant?

A

cyclic mastalgia

22
Q

What are the side effects of tamoxifen?

A
  • increased risk of endometrial hyperplasia
  • increased risk of DVT
  • hot flashes and vaginal bleeding
23
Q

How does raloxifen compare to tamoxifen with regards to the treatment of mastalgia?

A
  • both are SERMs used off-label for cases of refractory mastalgia
  • both are accompanied by a risk for DVT and menopausal symptoms like hot flashes and vaginal bleeding
  • however, raloxifen does not carry the same risk for endometrial hyperplasia as tamoxifen
24
Q

Name three medical therapies for mastalgia.

A
  • danazol
  • tamoxifen
  • raloxifen
25
Q

Mammary Duct Ectasia

A
  • chronic inflammation with dilation of the subareolar ducts
  • classically arises in multiparous postmenopausal women
  • presents as a periareolar mass with a green-brown nipple discharge composed of inflammatory debris
26
Q

Fibrocystic Change

A
  • development of fibrosis and cysts in the breast; thought to be hormone driven
  • lobules dilate and form cysts; the cyst walls are lined by flattened atrophic epithelium or may be modified through apocrine metaplasia; if the cysts rupture, the resulting scarring and inflammation may lead to fibrotic changes
  • the most common change in the premenopausal breast
  • presents as vague irregularity of the breast tissue bilaterally, usually in the upper outer quadrant, and cysts have a blue-dome appearance on gross exam
  • benign but associated with an increased risk for invasive carcinoma IN BOTH BREASTS
27
Q

Intraductal Papilloma

A
  • a papillary growth into a large duct
  • characterized by fibrovascular projections lined by luminal and myoepithelial cells
  • classically presents as a bloody nipple discharge in premenopausal women
  • must be distinguished from papillary carcinoma, which also presents with a bloody nipple discharge; this is done on the basis that papillary carcinoma has fibrovascular projections lined with luminal but not myoepithelial cells
28
Q

List possible characteristics of breast masses that suggest malignancy rather than benign processes.

A
  • size greater than 2 cm
  • immobility
  • poorly defined margins
  • firmness
  • skin dimpling or color changes
  • retraction or change in the nipple
  • bloody nipple discharge
  • ipsilateral lymphadenopathy
29
Q

What is the estimated time it takes for a breast tumor to become palpable?

A

5 years

30
Q

Describe the pathogenesis of fibrocystic changes of the breast.

A
  • lobules may dilate and form cysts
  • these cysts are lined by flattened, atrophic epithelium or epithelium modified through apocrine metaplasia
  • if the cysts rupture, the resulting scarring and inflammation may lead to fibrotic changes
31
Q

Define adenosis.

A

an increase in the number of glands with associated lobular growth in the breast without a change in the architecture of the lobule

32
Q

Fibroadenoma of the Breast

A
  • a tumor of fibrous tissue and glands
  • the most common benign neoplasm of the breast
  • presents in premenopausal women as a well-circumscribed, mobile, marble-like mass
  • estrogen sensitive so it grows during pregnancy and may be painful during the menstrual cycle
  • carries no risk for carcinoma
33
Q

Define epithelial hyperplasia and sclerosing adenosis of the breast.

A
  • epithelial hyperplasia is when more than the typical two cell layers in the epithelium
  • sclerosing adenosis is when there is increased fibrosis within the expanded lobule which distorts and compresses of the epithelium
34
Q

What is a radial scar of the breast?

A

also known as a complex sclerosing lesion, it is a proliferative lesion without atypia defined as a nidus of tubules entrapped in a densely hyalinized stroma surrounded by radiating arms of epithelium

35
Q

Lobular Carcinoma In Situ

A
  • a malignant proliferation of cells in lobules with no invasion of the basement membrane
  • does not produce a mass or calcifications and is usually discovered incidentally on biopsy
  • characterized by dyscohesive cells lacking the E-cadherin adhesion protein
  • often multifocal and bilateral
  • it has a low risk of progressing to invasive carcinoma but treat with tamoxifen and close follow up
  • managed with excision biopsy
36
Q

Ductal Carcinoma In Situ

A
  • a malignant proliferation of cells in ducts without invasion of the BM
  • often detected as calcification on mammography, but does not usually produce a mass
  • histologic subtypes are based on architecture, and the most important one is comedo type
  • comedo type is characterized by high-grade cells with necrosis and dystrophic calcification in the center of ducts
  • Paget disease of the breast is another form of DCIS
  • patients are at increased risk for invasive cancer or a recurrence of the DCIS lesion
  • diagnosed with core-needle biopsy, which is followed with surgical biopsy or excision and finally with tamoxifen
37
Q

What is the most significant risk factor for developing breast cancer?

A

advancing age

38
Q

What risks do BRCA1 and BRCA2 mutations carry?

A
  • BRCA1 has a high risk for both breast and ovarian cancer

- BRCA2 has a high risk for breast cancer but does not carry as much risk for ovarian cancer compared to BRCA1

39
Q

Describe some risk factors for breast cancer.

A
  • advancing age is the most important
  • family history, especially of BRCA mutations
  • greater estrogen exposure
  • radiation exposure
  • dense breast tissue or history of typical hyperplasia or LCIS
40
Q

Describe the Gail model.

A
  • used to estimate a woman’s risk of developing invasive breast cancer over the next 5 years and in their lifetime
  • uses history of LCIS/DCIS, age, age at onset of menstruation, age at the time of the first live birth, number of first-degree relatives with breast cancer, history of breast biopsy, and race
  • the strongest predictive factor in this assessment is family history
41
Q

What aspect of the Gail model is the strongest predictive factor for breast cancer?

A

a family history of breast cancer

42
Q

Compare LCIS and DCIS.

A
  • LCIS is often bilateral, multi centric, and increases the risk for invasive cancer in both breasts
  • DCIS is unilateral, unicentric, and increases the risk for invasive cancer in the ipsilateral breast
43
Q

What does a mastectomy involve?

A

removal of all breast tissue and the nipple areolar complex with preservation of the pectoralis

44
Q

Lumpectomy should always be supplemented with what other form of therapy?

A

radiation, when this is used in conjunction with lumpectomy, it has outcomes equal to those of radical mastectomy

45
Q

What is the mechanism of action of trastuzumab?

A

it acts on membrane-bound proteins produced by Her2/neu

46
Q

Most breast cancer recurrences occur within what time period?

A

five years

47
Q

What forms of primary prevention are recommended for BRCA mutation carriers?

A
  • monthly breast-self exams beginning at age 18
  • annual CBEs
  • screening mammograms beginning at age 25 or 5-10 years before the age of diagnosis in the affected relative

OBGYN (21 decks)

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