Breast, Endocrine, Melanoma

Question 1

Which cell layer is breast formed from?

Answer 1

Ectoderm milk streak

Question 2

Esterogen vs. Progesterone vs. Prolactin in breast development

Answer 2

E: Duct development
P: Lobular development
Prolactin: Synergizes esterogen and progresterone

Question 3

Cyclic changes a/w estrogen and progesterone and breast tissue

Answer 3

Estrogen: breast swelling, growth of glandular tx
Progesterone: maturation of tissues, withdrawal causes menses

Question 4

Nerves a/w breast surgery: LTN

Answer 4

LTN (innervates serratus anterior) injury results in winged scapula

Question 5

What artery supplies the serratus anterior?

Answer 5

Lateral thoracic artery

Question 6

Nerves a/w breast surgery: TD nerve

Answer 6

Innervates LD; injury results in weak arm pull-ups and adduction

Question 7

What artery supplies the latissumus dorsi?

Answer 7

Thoracodorsal artery

Question 8

Medial vs. Lateral pectoral nerves

Answer 8

Medial: Pec major and minor
Lateral: Pec major only

Question 9

Nerves a/w breast surgery: Intercostobrachial nerve

Answer 9

Lateral cutaneous branch of the 2nd intercostal nerve; sensation to medial arm and axilla – just below the axillary vein when performing an axillary dissection

Question 10

Most common nerve injured with MRM or ALND

Answer 10

Intercostalbrachial nerve

* Can be transected without major consequence

Question 11

Which arteries supply the breast?

Answer 11

Internal thoracic, intercostal, thoracoacrominal, lateral thoracic

Question 12

What valveless venous plexus allows direct hematogenous mets of breast ca to the spine?

Answer 12

Batson’s plexus

Question 13

97% of breast lymph drainage is to…

Answer 13

Axillary nodes

2%: IM nodes

Question 14

Supraclavicular nodes is considered N1 N2 or N3 in BRCA

Answer 14

N3

Question 15

The number one cause of primary axillary adenopathy is…

Answer 15

Lymphoma

Question 16

What are the suspensory ligaments of the breast called?

Answer 16

Cooper’s ligaments – BRCA involving these strands can dimple the skin

Question 17

Most common cause of breast abscess

Answer 17

Staph, followed by Strep.
a/w breast feeding
Tx: perc/I+D, d/c breast feeding, breat pump, Abx
Failure to resolve in 2 weeks –> Bc to r/o necrotic breast ca

Question 18

Infectious mastitis

Answer 18

Most commonly a/w breastfeeding

Question 19

Malignant cells of the ductal epithelium without invasion of the basement membrane

Answer 19

DCIS; 50% get cancer if not resected (ipsilateral breast); 5% get cancer in contralateral breast

Question 20

Clusters of calcifications on mammography

Answer 20

DCIS

Question 21

Most aggressive type of DCIS

Answer 21

Comedo pattern: necrotic areas; high risk for multicentricity, microinvasion, recurrence

Question 22

Treatment of DCIS/comedo

Answer 22

Simple mastectomy

Question 23

Treatment of DCIS

Answer 23

Lumpectomy and XRT; need one cm margins, no ALND/SLNB; possibly tamoxifen/raloxifent

Question 24

When does DCIS get a simple mastectomy/SLNBx

Answer 24

High grade – comedo, multicentric, multifocal; a large tume not amenable to lumpectomy or not able to get good margins

Question 25

What percentage of LCIS goes onto cancer?

Answer 25

40% in either breast

Question 26

Is LCIS pre-malignant?

Answer 26

No – it’s a marker for the development of BRCA

Question 27

Is LCIS palpable?

Answer 27

No – no microcalcifications

Question 28

Is LCIS found in pre- or pos-menopausal women

Answer 28

Pre

Question 29

Patients with LCIS are more likely to develop what type of BRCA?

Answer 29

Ductal cancer

Question 30

Do you need negative margins in LCIS?

Answer 30

N – though you do need to excisional biopsy of the suspicious area

Question 31

Treatment LCIS

Answer 31

Nothing, Tamox/Ralox, b/L subcutaneous mastectomy, no ALND

Question 32

What percentage of breast cancer have negative mammogram and negative ultrasound

Answer 32

10%

Question 33

Workup of a symptomatic breast mass <40 y.o.

Answer 33

US, core needle bx, possible FNA (Mammogram if US indeterminate or suspicious)

Question 34

Workup of a symptomatic breast mass >40 y.o.

Answer 34

B/L Mammogram, u/s, core bxb

Question 35

IF core or FNA is indeterminate, non-diagnostic or non-concordant with exam findings, what is the next step

Answer 35

Excisional biopsy

Question 36

If cyst fluid is bloody

Answer 36

Need cyst excisional biopsy; if clear and recurs, need excisional biopsy. If complex cyst, need excisional biopsy

Question 37

CNBx vs. FNA

Answer 37

Architecture vs. Cytology