breast disorders

Question 1

lactaceles

Answer 1

milk producing cells

Question 2

oxytocin

Answer 2

milk excretion and bonding

Question 3

prolactin

Answer 3

milk secreting

Question 4

mastalgia

Answer 4

breast pain that can be cyclical or non-cyclical

Question 5

galactorrhea

Answer 5

milk discharge due to either excessive breast stimulation, prolactinoma, hypothyroid or dopamine antagonist medications

Question 6

bloody nipple discharge

Answer 6

can be due to intraductal papilloma or breast cancer

Question 7

• Arise in a lactiferous duct, usually 2-4mm and solitary
• Discharge can be bloody and/or clear
• Most commonly in women 30-50yo
• If multiple or with atypia, can be associated with underlying cancer

Answer 7

intraductal papilloma

Question 8

DCIS (intraductal carcinoma) more commonly detected via screening rather than symptoms

Answer 8

yep

Question 9

Paget’s

Answer 9

skin involvement with underlying breast cancer

Question 10

Gail model

Answer 10

5 year risk of breast cancer assessment to help guide decision-making

Question 11

Fibrocystic Breast Disease

Answer 11

lumpy dumpy breasts: usually a benign process but there is some tenderness and symptoms fluctuate

**reduces reliability of screening with mammogram due to visibility and thus an ultrasounds is used instead

Question 12

Fibroadenomas

Answer 12

most common cuase of breast masses in younger women and uncommon post-menopausal

• firm, well-circumscribed, mobile and non-tender mass

Question 13

Benign Cysts

Answer 13

• 1/3 of women age 35-50yo will have a breast cyst
• Varies in size, typically solitary or a few, well-circumscribed, mobile, +/- tenderness
• Almost always benign
  Fluid accumulation within glands
  Can aspirate if bothersome and/or to confirm dx

Question 14

breast cancer

Answer 14

1 in 8 will be diagnosed

** shape is irregular and stellate

Question 15

• Rare; <1% of all breast tumors
• Range from benign to malignant
• More common in younger women (40s)
• Usually single breast, large and firm
• Progress rapidly, but rarely metastasize

Answer 15

phyllodes tumor

Question 16

mastitis

Answer 16

infection that is lactational almost always and it is diagnosed clinically with fever, systemic symptoms and localized erythema, warmth and pain

• treatment: dicloxacillin QID and continued breastfeeding /pumping

Question 17

breast abcess

Answer 17

progression of a mastitis

Question 18

Malignant phyllodes is a _________

Answer 18

sarcoma.

Question 19

no increased risk for breast cancer

Answer 19

benign non-proliferative disease

Question 20

slight increased risk for breast cancer

Answer 20

benign proliferative disease, without atypia

Question 21

fibroadenoma

Answer 21

non or slight increased risk for breast cancer

Question 22

benign breast lesions

Answer 22

fibrocystic changes that is common esp. in 25-45 yr of age

** can stimulate breast carcinoma on imaging

Question 23

moderatly increased risk of breast cancer

Answer 23

benign proliferative disease with atypia

Question 24

high risk for breast cancer

Answer 24

carcinoma in situ (non malignant)

Question 25

usually non-palpable, associated with microcalcifications and up to 25% develop ipsilateral invasive carcinoma

Answer 25

in situ intraductal carcinoma

Question 26

DCIS spread?

Answer 26

no stays within the ducts

Question 27

outcome of invasive ductal carcinoma and invasive lobular carcinoma (unique pathology; tumor cells in strands and cords)

Answer 27

good prognosis

Question 28

(Nottingham) Scarf-Bloom-Richardson

Answer 28

Breast Carcinoma Grading

Question 29

tumor histologic grading criteria (3)

Answer 29

1. tubule formation
2. nuclear size
3. mitotic count

Question 30

independent varial for correlation with survival

Answer 30

tumor size

Question 31

Breast Cancer Predictive Marker Studies:What is the Objective?

Answer 31

Predict response to various therapeutic agents in individual patients and Select patients with higher likelihood of response Avoiding potential toxicity in those who are unlikely to respond to a particular drug

Question 32

Estrogen and progesterone receptor expression

Answer 32

Predicts response to hormonal therapy

Question 33

1. ER Modulation:
2. Estrogen Synthesis Inhibition:
3. ER Degradation:

Answer 33

1. ER Modulation: Tamoxifen
2. Estrogen Synthesis Inhibition: Aromatase inhibitors
3. ER Degradation: Fulvestrant

Question 34

HER2 oncoprotein/oncogene status

Answer 34

Predicts response to targeted therapy to trastuzumab

Question 35

Gene expression profile analysis

Answer 35

• Performed on selected cases

- Predicts benefit from chemotherapy

Question 36

15 - 20% of invasive breast carcinomas are ___________.
__________ tumors have a worse prognosis

Positive result predicts response to anti-_______ therapy

Answer 36

HER2 positive

Question 37

RS an independent/dependent predictor of disease recurrence

Answer 37

independent

Question 38

RS predictive of response to chemotherapy

1. High RS:
2. Low RS:

Answer 38

1. High RS: benefit from chemotherapy

2. Low RS: greatest benefit from hormonal therapy

Question 39

staging is unique to each tumor type

Answer 39

yep

Question 40

assessment for met carcinoma

Answer 40

lymph node involvement where 2/10 of a milimeter is positive

Question 41

Peau d’orange skin change

Answer 41

inflammatory breast carcinoma

Question 42

inflammatory breast carcinoma is where the tumor is present in

Answer 42

dermal lymphatics and shows poor prognosis

** underlying mass not always palpable

Question 43

flaky irritation around nipple, some oozing and biopsy shows infiltrate within the epidermis

Answer 43

mammary paget disease

** underlying DCIS