Natsumi Breast Conditions

Question 1

Investigation methods for gynecomastia

Answer 1

Labs:

• serum TSH, PRL, LH, FSH, free testosterone, estradiol, LFTs
• Elevated B-HCG → locate primary tumor

Imaging:

• Chest x-ray
• CT chest, abdomen, and pelvis
• US testicles to r/o testicular mass

Question 2

Spironolactone, digoxin, and chemotherapy can cause which breast condition?

Answer 2

Gynecomastia

Question 3

• Mastitis is common in which population and by what organism?
• Clinical features?
• How would you investigate? Tx?

Answer 3

• lactating women, 2-3 weeks postpartum
• S. aureus
• Clinica (unilateral localized pain, malodorous breast milk worse with nursing)
• Alternate warm and cold compress, antibiotics, continue to breastfeed

Question 4

This condition involves the nipple and the areola unilaterally as dermatitis. The skin becomes ulcerated and erythematous. Oozing with serosanguineous discharge and can have an itching or burning sensation. What do you suspect? How do you test? Treatment?

Answer 4

Dx: Paget’s disease - poor prognosis

Test:
1. Scrape cytology → large cell with high nuclear to cytoplasmic ratio with occasional acinar formation, and intracytoplasmic vacuoles

2. Punch/wedge/excisional biopsy

Tx: Oncology referral

Question 5

Diagnostic for which condition:

Scrape cytology → large cell with high nuclear to cytoplasmic ratio with occasional acinar formation, and intracytoplasmic vacuoles

Answer 5

Paget’s disease

Question 6

A 26 yo F PTC with a non-tender, firm, smooth, rubbery, mobile, well-circumscribed nodule on the upper outer quadrant. What do you suspect?

Answer 6

Fibroadenoma - increased estrogen sensitivity

It’s benign so you don’t do anything.

• Ultrasound
• Bx is you suspect malignancy

Question 7

A 26 yo F PTC with premenstrual breast tenderness and lumpiness on both of her breasts. PE revealed multiple nodules and palpable lumps. Her last period was 3 weeks ago. What do you suspect and what’s your next step?

Answer 7

Fibrocystic breast disease

• Ultrasound to distinguish between fluid-filled vs solid mass

Question 8

A 52 yo F PTC with painless, non-mobile, non-tender lump with nipple discharge on her left breast.

G1P1 at age 34. Has a history of OCP for 12 years.

What do you suspect? Next step?

Answer 8

Breast cancer

1. Ultrasound - differentiate between cystic and solid masses
2. Mammography → microcalcifications, poorly identified mass, spiculated border, architectural distortion,
3. MRI - high sensitivity, low specificity
4. Needle aspiration for fluid cytology (cystic lesion)
5. Fine needle aspiration (solid mass)
6. Core needle biopsy
7. Excisional biopsy - DO NOT PERFORM for diagnosis if possible
8. DEXA, abdominal ultrasound, chest X-ray, head CT

Question 9

BRCA 1 & BRCA 2

Answer 9

breast cancer

Question 10

MRI for breast cancer has (low/high) sensitivity, (low/high) (specificity)

Answer 10

MRI for breast cancer has

• HIGH sensitivity
• low specificity

Question 11

Screening mammogram should be done for ages __ every ___ years

Answer 11

50-74, q2-3 years

Only screen 75+ if the benefit outweighs the risk

Question 12

If you detect metastasis of breast cancer, what other tests should you complete?

Answer 12

DEXA, abdominal ultrasound (liver metastasis), chest X-ray, head CT (if neurological sxs present)

Question 13

Ductal carcinoma in SITU are non-palpable (T/F)

Answer 13

True - detected by SCREENING mammogram

Question 14

breast cancer that is contained within the breast ducts

Answer 14

Ductal carcinoma in SITU

Question 15

Breast cancer that may extend into the skin (lymph obstruction), causes an orange-peel appearance with erythema, non-putting skin edema, and tender breasts and lumps.

Answer 15

Invasive inflammatory carcinoma

Peau d’ orange

Question 16

Most common breast cancer

Answer 16

Invasive ductal carcinoma of the breast

Question 17

Breast cancer may extend to the skin, causing dimpling and retraction.

Answer 17

Invasive ductal carcinoma of the breast

• retraction caused by cooper ligaments invasion
• originates from the ductal epithelium and infiltrates into the thoracic fascia to become fixed to the chest wall

Question 18

Breast cancer that is rubbery and ill-defined, with no palpable findings nor mammographic findings. Usually found incidentally on breast biopsy for another indication.

Tx?

Answer 18

Lobular carcinoma in SITU - neoplastic cells contained within breast lobule

Tx: Tamoxifen for chemoprevention (oncology) & exicision biopsy to r/o malignancy