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Breast-endocrine Flashcards

1
Q

Fibroadenoma definition

A

Proliferation of stromal and epithelial tissue of the duct lobules

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2
Q

The most common breast tumour in women <35 years of age is:

A

fibroadenoma

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3
Q

Fibroadenoma development may be associated with:

A

increased levels of oestrogen

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4
Q

Clinical features of fibroadenoma include:

A

Well-defined, mobile mass that is most commonly solitary. Non-tender and rubbery in consistency.

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5
Q

Triple assessment of a breast lump includes:

A

Physical examination, imaging (mammography and/or ultrasound) and biopsy (FNA or CNB)

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6
Q

Ultrasound findings consistent with a fibroadenoma include:

A

A well-circumscribed oval or round hypoechoic solid mass

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7
Q

Mammography findings consistent with a fibroadenoma include:

A

A round mass with a well-defined border. May have popcorn-like calcifications.

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8
Q

Findings associated with fibroadenoma on biopsy include:

A

Fibrous and glandular tissue proliferation

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9
Q

Management of new palpable fibroadenomas in women >40yo:

A

Excisional biopsy even if benign on triple testing

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10
Q

Management of new palpable fibroadenomas in women <40yo that are benign on triple assessment:

A

Managed with either surgical excision or regular clinical and ultrasound review (according to patient preference)

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11
Q

Management of impalpable fibroadenomas that are benign on triple assessment:

A

Imaging surveillance (6-12 monthly)

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12
Q

Fibroadenomas greater than __-__cm in diameter should be considered for excisional biopsy regardless of patient age and triple testing results.

A

3-4cm

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13
Q

Indications for repeat biopsy on surveillance of a fibroadenoma include:

A

significant increase in size or development of atypical features

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14
Q

Prognosis of fibroadenoma

A

Most fibroadenomas are benign and have an excellent prognosis.

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15
Q

Intraductal papilloma definition

A

A tumour that arises from the epithelium of the lactiferous ducts

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16
Q

Intraductal papilloma has a peak incidence in which age range?

A

30-50 years old

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17
Q

The most common cause of bloody or serous nipple discharge is:

A

intraductal papilloma

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18
Q

Clinical features of intraductal papilloma include:

A

Bloody or serous nipple discharge. Palpable retro-areolar mass.

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19
Q

What region are intraductal papillomas most commonly found in?

A

The sub-areolar region, usually <1cm away from the nipple

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20
Q

Features of intraductal papilloma on breast ultrasound include:

A

A well-defined solid nodule or mass within a dilated lactiferous duct

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21
Q

Features of intraductal papilloma on core needle biopsy include:

A

Papillary structure with fibrovascular core covered by both epithelial and myoepithelial calls.

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22
Q

Peripheral intraductal papillomas may be associated with:

A

cellular atypia, DCIS or invasive breast cancer

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23
Q

Most intraductal papillomas are treated with:

A

microdochectomy

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24
Q

Microdochectomy definition

A

Removal of one or more of the lactiferous ducts of the breast

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25
Risk of breast cancer is only increased with ____________ papilloma
multi-ductal
26
Lipoma definition
A soft and mobile benign adipose tumour with low malignant potential.
27
Clinical features of lipoma
Slow-growing, round, soft, rubbery lump. Non-tender.
28
Surgical excision of a lipoma can be considered in the following cases:
If the tumour causes pain, cosmetic reasons, if the tumour is rapidly-growing or firm on palpation
29
Phyllodes tumour definition
Rare fibroepithelial tumours that are comprised of both epithelial and stromal tissue.
30
Peak incidence of phyllodes tumour is in which age group?
40-50yo
31
Clinical features of phyllodes tumours
Painless, multinodular lump with an average size of 4-7cm. Variable growth rate.
32
Ultrasound findings in phyllodes tumours
Hypoechoic solid mass that may contain cysts
33
Biopsy findings in phyllodes tumours
Leaf-like architecture with papillary projections of epithelium-lined connective tissue (stroma)
34
Phyllodes tumours can be histologically classified as:
Benign, borderline or malignant
35
Management of benign phyllodes tumour
Surgical excision
36
Management of borderline or malignant phyllodes tumour
Wide excision
37
Phyllodes tumour prognosis
High risk of recurrence after excision. Borderline and malignant phyllodes tumours can metastasis haematogenously. Metastatic phyllodes tumour has a poor prognosis.
38
Mastitis definition
Acute or chronic inflammation of the breast tissue
39
Mastitis can be classified into:
Lactational and non-lactational mastitis
40
The most common causative pathogen of mastitis is:
Staphylococcus aureus
41
Risk factors for lactational mastitis include:
First child, poor feeding technique
42
Lactational mastitis usually presents within which time period?
Within the first 3 months of breastfeeding or during weaning.
43
Risk factors for non-lactational mastitis include:
Duct ectasia, tobacco smoking
44
Tobacco smoking can predispose to non-lactational mastitis by:
Causing damage to the sub-areolar duct walls and predisposing to bacterial infections
45
Clinical features of mastitis
Tender, firm, swollen, erythematous breast (generally unilateral). Systemic symptoms. Pain during breastfeeding. Reduced milk secretion. Possible reactive axillary lymphadenopathy.
46
Breast milk culture is only indicated in patients with mastitis if:
there is an inadequate response to empiric antibiotic therapy or signs of severe infection.
47
Imaging is only indicated in patients with mastitis if:
There is a poor response to empiric antibiotic therapy, for the exclusion of alternative diagnoses and for evaluation of complications
48
The first line empiric antibiotic used for mastitis is:
An oral penicillinase-resistant penicillin such as dicloxacillin OR cephalexin
49
Empiric antibiotic therapy for mastitis with risk factors for MRSA infection is:
Clindamycin OR trimethoprim-sulfamethoxazole
50
Empiric antibiotic therapy for severe mastitis is:
IV vancomycin
51
Pheochromocytoma definition
A catecholamine-secreting tumour that typically develops in the adrenal medulla
52
Pheochromocytoma rule of 10s
10% are malignant, 10% are extra-adrenal, 10% are bilateral and 10% affect children
53
The most common tumour of the adrenal medulla in adults is:
pheochromocytoma
54
Pheochromocytoma is most common in which age group?
30-50yo
55
Pheochromocytomas arise from:
chromaffin cells, which are derived from the neural crest
56
Pheochromocytomas are characterised by excessive secretion of:
adrenaline and noradrenaline
57
What percentage of pheochromocytomas are hereditary?
25%
58
Which genes are implicated in formation of pheochromocytomas?
MEN2, NF1, VHL
59
5 Ps of pheochromocytoma
Increased blood Pressure, head Pain, Perspiration, Palpitations, Pallor
60
Triggers of episodic hypertension associated with pheochromocytoma include:
Foods high in tyramine and pressure on the tumour
61
Starting beta-blockers before alpha-blockers in the setting of pheochromocytoma is contraindicated because:
doing so can trigger a life-threatening hypertensive crisis. Beta-blockers cancel out the vasodilatory effect of peripheral beta-2 adrenoreceptors, potentially leading to unopposed alpha-adrenoreceptor stimulation and thereby causing vasoconstriction and increased blood pressure
62
Surgical management of pheochromocytoma
Laparoscopic adrenalectomy
63
Conn syndrome is also known as
primary hyperaldosteronism
64
Conn syndrome definition
An excess of aldosterone caused by autonomous overproduction, typically due to adrenal hyperplasia or adrenal adenoma
65
Conns syndrome has a prevalence of __-__% in hypertensive patients
5-12%
66
Aldosterone is produced in which zone of the adrenal glands?
Zona glomerulosa
67
Conn syndrome is most commonly due to the following conditions:
Bilateral idiopathic hyperplasia of the adrenal glands or aldosterone-producing adrenal adenoma
68
Physiological aldosterone secretion is regulated by:
RAAS
69
Physiological aldosterone secretion occurs in response to:
detection of low blood pressure in the kidneys
70
Hyperaldosteronism results in hypertension via the following mechanism:
Elevated aldosterone → opens Na+ channels in the principal cells of the luminal membrane at the cortical collecting ducts of the kidneys → Na+ reabsorption and retention → water retention → hypertension
71
Conns syndrome causes hypokalaemia via the following mechanism:
↑ Na+ reabsorption → electronegative lumen → electrical gradient through open K+ channels → ↑ K+ secretion → hypokalaemia
72
Clinical features of Conns syndrome include:
Drug-resistant hypertension, fatigue, muscle weakness/cramping and headaches
73
Indications for diagnostic evaluation of Conns syndrome include:
Resistant hypertension despite combination therapy with 3 antihypertensives and/or hypokalaemia
74
The preferred screening modality for Conns syndrome is:
Aldosterone-to-renin ratio (ARR)
75
Diagnostic testing for Conns syndrome includes:
Oral sodium loading test or saline infusion test (non-suppressible aldosterone is diagnostic)
76
Imaging is indicated in Conns syndrome to:
exclude large tumours and help differentiate possible surgical candidates from non-surgical candidates.
77
Indications for surgical management of Conns syndrome include:
Confirmed unilateral adrenal hyperaldosteronism
78
If considering a laparoscopic unilateral adrenalectomy for management of Conns syndrome, the following should be considered:
Correction of hypokalaemia prior to surgery and monitoring for hyperkalaemia immediately following the surgery
79
First-line medical management for Conns syndrome is:
Aldosterone receptor antagonists e.g. spironolactone
80
The diagnostic tests for pheochromocytoma include:
Plasma free metanephrines or urinary fractionated metanephrines

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