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Surgery > Fiser ABSITE Ch. 24 Breast > Flashcards

Fiser ABSITE Ch. 24 Breast Flashcards

1
Q 
What hormone?
duct development (double layer of columnar cells)
A

Estrogen

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2
Q

What hormone?

lobular development

A

Progesterone

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3
Q

What hormone?

synergizes estrogen and progesterone

A

Prolactin

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4
Q

What hormone?

breast swelling, growth of glandular tissue

A

Estrogen

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5
Q

What hormone?

maturation of glandular tissue; withdrawal causes menses

A

Progesterone

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6
Q

What hormone?

cause ovum release

A

FSH, LH surge

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7
Q

innervates serratus anterior; injury results in winged scapula

A

Long thoracic nerve

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8
Q

innervates latissimus dorsi; injury results in weak arm pullups and adduction

A

Thoracodorsal nerve

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9
Q

innervates pectoralis major and pectoralis minor

A

Medial pectoral nerve

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10
Q

innervates pectoralis major only

A

Lateral pectoral nerve;
lateral cutaneous branch of the 2nd intercostal nerve; provides sensation to medial arm and axilla; encountered just below axillary vein

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11
Q

when performing axillary dissection

• Can transect without serious consequences

A

Intercostobrachial nerve

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12
Q

List arterial supply to the breast

A

Branches of internal thoracic artery, intercostal arteries, thoracoacromial artery; and lateral thoracic artery

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13
Q

valveless vein plexus that allows direct hematogeous metastasis of breast CA to spine

A

Batson’s plexus

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14
Q

Primary axillary adenopathy

A

1 lymphoma

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15
Q

Supraclavicular pos lymph nodes are considered ? in TMN staging

A

considered M1 disease

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16
Q

Most common organisms with breast abscess

A

S. aureus

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17
Q

Dilated mammary ducts, inspissated secretions, marked periductal inflammation; • Symptoms: noncyclical mastodynia, nipple retraction, creamy discharge from nipple; can have sterile subareolar abscess

A

Periductal mastitis (mammary duct ectasia or plasma cells mastitis)

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18
Q

hypoplasia of chest wall, amastia, hypoplastic shoulder, no pectoralis muscle

A

Poland’s syndrome

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19
Q

superficial vein thrombophlebitis of breast; feels cord Like, can be painful; • Associated with trauma and strenuous exercise; • Usually occurs in lower outer quadrant; • Tx: NSAIDs

A

Mondor’s disease

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20
Q

can manifest as a cluster of calcifications on mammogram; with out a mass or pain, can look like breast CA; • Is differentiated from breast CA by regularity of nuclei and absence of mitosis

A

Sclerosing adenosis

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21
Q

Most common cause of bloody discharge from nipple

A

Intraductal papilloma

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22
Q

What test can be used to dx Intraductal papilloma?

A

contrast ductogram

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23
Q

What is the tx for Intraductal papilloma?

A

resection (subareolar resection usually curative)

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24
Q

Most common breast lesion in adolescents and young women;

A

Fibroadenoma; 10% multiple; Usually painless, slow growing, well circumscribed, firm, and rubbery

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25
Q

tx of Fibroadenoma >30yr

A

excisional biopsy to ensure diagnosis

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26
Q

Green nipple discharge indicates?

A

Fibrocystic disease

Tx: if cyclical and nonspontaneous, reassure patient

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27
Q

Bloody nipple discharge indicates

A

most commonly intraductal papilloma; occasionally ductal CA; Tx: need galactogram and excision of that ductal area

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28
Q

Serous nipple discharge indicates?

A

worrisome for cancer, especially if coming from only 1 duct or spontaneous; Tx: excisional biopsy of that ductal area

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29
Q

Tx for Spontaneous nipple discharge

A

no matter what the color or consistency is worrisome for cancer; • All these patients need some sort of biopsy in the area of the duct causing the discharge

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30
Q

Affects multiple ducts of both breasts
• Are larger than when they occur solitarily
• Usually have serous discharge
• Mammogram shows Swiss cheese appearance
• increased risk of breast CA (40% get breast CA)

A

DIFFUSE PAPILLOMATOSIS

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31
Q

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

A

DCIS; Usually not palpable and presents as a cluster of calcifications on mammography; • Need a 2-3 mm margin with excision

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32
Q

most aggressive subtype of ductal carcinoma in situ; has necrotic areas; • High risk for multicentricity, microinvasion, and recurrence; • Tx: simple mastectomy

A

Comedo pattern; increased recurrence risk with comedo type and lesions > 2.5 cm

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33
Q

Tx for DUCTAL CARCINOMA IN SITU

A

lumpectomy and XRT; possibly tamoxifen; • Simple mastectomy if high grade (i.e., comedo type, multicentric, multifocal ), if a large tumor not amenable to lumpectomy, or if not able to get good margins; no ALND

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34
Q

40% get cancer (either breast)
• Considered a marker for the development of breast CA, not premalignant itself
• Has no calcifications; is not palpable
• Primarily found in premenopausal women
• Patients who develop breast CA are more likely to develope ductal CA (70%)
Do not need negative margins

A

LCIS

35
Q

Tx for LOBULAR CARCINOMA IN SITU

A

Tx: nothing, tamoxifen, or bilateral subcutaneous mastectomy (no ALND )

36
Q

Symptomatic breast mass workup

A
  • ultrasound
  • If solid FNA; excisional biopsy if FNA is non diagnostic
  • These patients most commonly have fibroadenomas that can be left alone if FNA is diagnostic. However, if the fibroadenoma enlarges, need excisional biopsy
37
Q

Symptomatic breast mass workup

30-50 years

A

bilateral mammograms and FNA; excisional biopsy if FNA; nondiagnostic

38
Q

Symptomatic breast mass workup

>5O years

A

bilateral mammograms and excisional or core needle biopsy

39
Q

What is the sensitivity/ specificity of a mammogram? How large does that mass need to be?

A

90%, 5mm

40
Q

What is the next step? Suspicious calcifications or architecture on mammography

A

perform localized stereotactic needle excisional biopsy

41
Q

What is the next step? Indeterminate calcifications or architecture on mammography

A

can perform core needle biopsy; if indeterminate, perform localized stereotactic needle excisional biopsy

42
Q

BI-RADS Classification of Mammographic Abnormalities

category 1

A

negative, routine screening

43
Q

BI-RADS Classification of Mammographic Abnormalities

category 2

A

Benign finding, routine screening

44
Q

BI-RADS Classification of Mammographic Abnormalities

category 3

A

Probably benign finding, Short-interval follow- up

45
Q

BI-RADS Classification of Mammographic Abnormalities

Category 4

A

Suspicious abnormality; Definite probability of malignancy consider biopsy

46
Q

BI-RADS Classification of Mammographic Abnormalities

Category 5

A

Highly suggestive of malignancy; High probability of cancer; appropriate action should be taken.

47
Q

List Node levels

A

I - lateral to pectoralis minor muscle
II - beneath pectoralis minor muscle
Ill- medial to pectoralis minor muscle

48
Q

node between the pectoralis major and pectoralis minor muscles

A

Rotter’s nodes

49
Q

most common distant metastasis of breast cancer

A

Bone

50
Q

tumors that have increased risk of multicentricity

A

Central and subareolar tumors

51
Q

TNM STAGING SYSTEM FOR BREAST CANCER

List the T

A

Tl : 5 cm

T4: skin or chest wall involvement

52
Q

TNM STAGING SYSTEM FOR BREAST CANCER

List N

A

N1: ipsilateral axillary nodes. N2: fixed ipsilateral axillary nodes. N3: ipsilateral internal mammary nodes

53
Q

TNM STAGING SYSTEM FOR BREAST CANCER

list the stages

A 
I:T1 , NO , 
IIA: TO-1, N1, or T2, NO, 
IIB:T2, N1, or T3, NO,
IIIA: TO-3, N2, or T3, N1-2 
IIIB:Any T4 or N3 tumours
IV:M1
54
Q

Gene mutation associated with ovarian (50%), endometrial CA

A

BRCA I; Consider TAH and bilateral oophorectomies in BRCA I families

55
Q

Gene mutation associated with male breast CA

A

BRCA II

56
Q

Types of Ductal CA

A
  1. Medullary breast CA
  2. Tubular CA
  3. Mucinous CA (colloid)
  4. Scirrhotic CA
57
Q

Type of ductal Ca smooth borders, increased lymphocytes, ductal type cancer with bizarre cells
• Vast majority are estrogen- and progesterone receptor-positive
• More favorable prognosis

A

Medullary breast CA

58
Q

Tx for ductal Ca

A

MRM or lumpectomy with ALND (or SLNB); postop XRT

59
Q

10% of all breast CAs
• Does not form calcifications; extensively infiltrative; increased bilateral, multifocal, and multicentric disease
• Signet ring cells confer worse prognosis
• Tx: MRM or lumpectomy with ALND (or SLNB); postop XRT

A

Lobular cancer

60
Q

May need chemotherapy and XRT 1st, then mastectomy
• Considered T4 disease
• Very aggressive, median survival of 36 months
• Has dermal lymphatic invasion, which causes peau d’orange lymph edema appearance; erythematous and warm

A

Inflammatory cancer

61
Q

What are Contraindications to SLNB?

A

pregnancy, multicentric disease, neoadjuvant, clinically positive nodes, prior axillary surgery, inflammatory or locally advanced disease

62
Q
  • Removes all breast tissue including the nipple areolar complex
  • Includes axillary node dissection ( Ievel I nodes)
A

Modified radical mastectomy

63
Q

Includes MRM and overlying skin, pectoralis major and minor muscles, and Ievel l, II, and Ill lymph nodes; • Rarely performed anymore

A

Radical mastectomy

64
Q

Complications of mastectomy

A

infection, flap necrosis, seromas

65
Q

Complications of axillary lymph node dissection

A

Infection, lymphedema, lymphangiosarcoma;
Axillary vein thrombosis;
Lymphatic fibrosis;
Intercostal brachiocutaneous nerve

66
Q

hyperesthesia of inner arm and lateral chest wall; most commonly injured nerve after mastectomy; no significant sequelae

A

Intercostal brachiocutaneous nerve

67
Q

Indications for XRT after mastectomy

A
  • > 4 nodes
  • Skin or chest wall involvement
  • Positive margins
  • Tumor > 5 cm (T3 )
  • Extracapsular nodal invasion
  • Inflammatory CA
  • Fixed axillary nodes ( N2 ) or internal mammary nodes ( N3 )
68
Q

Who gets Chemotherapy?

A

•Positive nodes - everyone gets chemo except postmenopausal women with
positive estrogen receptors get tamoxifen
•>1 cm and negative nodes - everyone gets chemo except patients with positive estrogen receptors get tamoxifen
•

69
Q

List 2 main risks of Tamoxifen

A

1% risk of blood clots; 0.1 % risk of endometrial CA

70
Q

Malignant tumors with a benign appearance (smooth, rounded masses)

A

Malignant tumors with a benign appearance (smooth, rounded masses) mucinous CA,
medullary CA,
cystosarcoma phyllodes

71
Q

Resembles giant fibroadenoma; has stromal and epithelial elements (mesenchymal tissue);
• Can often be large tumors
• Tx: WLE with negative margins; no ALND

A

Cystosarcoma phyllodes;

• 10% malignant, based on mitoses per high-power field (> 5-10)

72
Q

Lymphangiosarcoma from chronic lymphedema following axillary dissection (MRM)
• Patients present with dark purple nodule or lesion on arm 5- 10 years after surgery

A

Stewart-Treves syndrome

73
Q

DEF: hypoplasia or complete absence of the breast, costal cartilage and rib defects, hypoplasia of the subcutaneous tissues of the chest wall, and brachysyndactyly

A

Poland’s syndrome

74
Q

DEF: ovarian agenesis and dysgenesis

A

Turner’s syndrome

75
Q

DEF: displacement of the nipples and bilateral renal hypoplasia) may have polymastia as a component

A

Fleischer’s syndrome

76
Q

Fibrous bands of connective tissue travel through the breast insert perpendicularly into the dermis, and provide structural support

A

Cooper’s suspensory ligaments

77
Q

The breast receives its principal blood supply from?

A

(a) perforating branches of the internal mammary artery; (b) lateral branches of the posterior intercostal arteries; (c) branches from the axillary artery ( including the highest thoracic, lateral thoracic, and pectoral branches of the thoracoacromial artery)

78
Q

May provide a route for breast cancer metastases to the vertebrae, skull, pelvic bones, and central nervous system?

A

Batson’s vertebral venous plexus, which invests the vertebrae and extends from the base of the skull to the sacrum

79
Q

Resection of the intercostobrachial nerve causes?

A

Loss of sensation over the medial aspect of the upper arm

80
Q

Name the Hormone: primary hormonal stimulus for lactogenesis

A

Prolactin

81
Q

Name the Hormone: regulate the release of estrogen and progesterone from the ovaries

A

luteinizing hormone (LH) and follicle-stimulating hormone (FSH)

82
Q

Name the Hormone: the release of LH and FSH from the basophilic cells of the anterior pituitary is regulated by the secretion of ?

A

gonadotropin-releasing hormone (GnRH) from the hypothalamus.

83
Q

Name the hormone: initiates contraction of the myoepithelial cells, which results in compression of alveoli and expulsion of milk into the lactiferous sinuses

A

Oxytocin

84
Q

Describe the GAIL model

A

relative risk model

  1. age at menarche
  2. # of biopsies
  3. Age at 1st live birth
  4. # of first degree relatives with BC

Surgery (33 decks)

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