DVS Breast Cancer Questions Flashcards
B. Intraductal papilloma
A. Punch biopsy of skin
Answer A
A diagnostic mammogram should be ordered in a woman over the age of 30 who presents with a new breast mass. Mammography helps to look for suspicious calcifications in other areas of the affected breast, characterize the mass, as well as evaluate the contralateral breast.
It is important to note that the mammogram may be normal despite the presence of a palpable breast cancer. For this reason, a tissue biopsy is recommended for palpable breast masses regardless of mammogram results. Tissue sampling is best performed via US-guided core needle biopsy. US also provides more information about the mass (cystic vs. solid).
Fine-needle aspiration (B) is rarely used as it relies on cytology rather than histology.
Answer D
The H&P is most consistent with a dx of fibrocystic changes of the breast. Pts will present with painful breast tissue before menses that improves during menstruation.
On exam, fibrotic tissue may be palpated and is generally found in the upper outer quadrants of teh breast. This patient should be counseled and instructed to look for these changes with a f/u appt in a month.
Persistent cystic breast lesions can be evaluated and treated with FNA (E) although this is not needed in children and adolescents. Cystic lesions that resolve with aspiration should be reevaluated with US 3 months after aspiration (C).
A 65 y/o woman returns to clinic for a 3-mo f/u. 3 months ago, she developed a pruritic, erythematous, ulcerated rash surrounding the areola of her right breast. She tried hydrocortisone 1% on the lesion at the recommendation of her PCP, but the lesion persisted. She has no hx of skin diseases in the family. She takes warfarin for afib. She started HCTZ for HTN about 3 months ago. Otherwise, she is healthy. What is the best next step in the mgmt of this patient?
a. Punch biopsy of skin lesion
b. Change hydrocortisone 1% to triamcinolone to treat eczema
c. Treat with abx
d. Oral steroid course to treat psoriasis
e. Inc. dose of hydrocortisone
Answer A
The presentation is concerning for Paget’s disease of the breast. This presents as an eczematous, scaling, and ulcerating lesion around the areola. Paget’s disease of the breast is a type of DCIS that extends into the ducts to involve the skin of the nipple.
Answer C
Routine mammography on a 52 y/o woman shows six stippled microcalcifications in a cluster in the upper outer quadrant of the L breast; this finding was not present 1 year ago. No lumps are palpable on exam of breasts. She has no hx of breast cancer. Which of the following is the most approrpiate next step in mgmt?
a. F/u mammography in 4 to 6 mo
b. L upper outer quadrantectomy
c. FNA of lesion
d. Needle-localized open biopsy
e. Thermography
d. Needle-localized open biopsy
Suspicious mammogram findings that can’t be palpated need needle localized biopsy
