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Endo/Repro > Normal and Abnormal Breasts > Flashcards

Normal and Abnormal Breasts Flashcards

1
Q

What is a part of the normal anatomy of the breast?

A
  • Modified sebaceous gland
  • Composed of glands, milk ducts, connective tissue and fat
  • 12-20 lobes with disproportionate amount of glandular tissue in the upper outer quadrants
  • Lobules consist of clusters of secretory cells lined with myoepithelial cells
  • Rich in blood supply and lymphatic systemic
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2
Q

What is estrogen responsible for in the breast?

A
  • Growth of adipose tissue and lactiferous ducts
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3
Q

What is progesterone responsible for in the breast?

A
  • Stimulation of lobular growth and alveolar budding
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4
Q

What are some congenital anomalies of the breast?

A
  • Absence of the breast
  • Accessory breast tissue along the milk line
  • Extra nipples (polythelia)
  • Accessory breast (polymastia)
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5
Q

What are the two most common complaints with the breast?

A
  • Breast pain

- Mass

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6
Q

What is needed from the patient history when they come in for breast complaints?

A
  • Location
  • Duration
  • Nipple discharge
  • Changes in size
  • Associated with menstrual cycle
  • Risk factors
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7
Q

What are some risk factors for breast cancer?

A
  • Age
  • Personal history of breast, endometrial, or ovarian cancer
  • History of atypical hyperplasia
  • High breast tissue density
  • First degree relatives with breast or ovarian cancer
  • Early menarche
  • Late cessation of menses
  • No term pregnancies
  • Never breastfed
  • Recent and long term use of OCPs
  • Postmenopausal obesity
  • Height (tall)
  • High socioeconomic status
  • Ashkenazi jews
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8
Q

What is done during the PE for a breast exam?

A
  • Evaluate both breasts
  • Complete exam including axilla and chest wall
  • Palpable mass always gets a biopsy
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9
Q

What are some diagnostic tests done for a breast complaint?

A
  • Mammogram
  • U/S
  • MRI
  • Fine needle aspiration
  • Core biopsy
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10
Q

What are some details about a mammogram?

A
  • Able to detect lesions about 2 years before they become palpable
  • Densities and calcifications are suspicious findings and clinically inapparent masses of less than 1 cm can be detected
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11
Q

Who is a mammogram best used for?

A
  • Women 40 years and older
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12
Q

What does a screening mammogram look like?

A
  • No complaint/concerns

- 4 images: 2 craniocaudal and 2 mediolateral, can be done by standard radiograph versus digital enhancement

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13
Q

What does a diagnostic mammogram look like?

A
  • Done in women with a complaint or palpable mass or to adjunct an abnormal screening mammogram
  • Contralateral breast should be imaged at same time
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14
Q

What are some details about ultrasound?

A
  • Useful for evaluating inconclusive mammogram findings
  • Allows to differentiate between cystic versus solid lesions as well as show solid tissue within or adjacent to a cyst that may be malignant
  • May be used when performing core needle biopsies
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15
Q

Who is an ultrasound best used for?

A
  • Women under the age of 40 and others with dense breast tissue
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16
Q

What are some details for an MRI?

A
  • Useful adjunct to diagnostic mammography in suspicious masses
  • Used post cancer diagnosis for further evaluation of staging
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17
Q

Who is an MRI best used for?

A
  • Women at high risk for breast cancer like BRCA carriers
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18
Q

What is a fine needle aspiration biopsy?

A
  • Useful for determining solid versus cystic mass
  • Done in office
  • Aspiration using 22-24 gauge needle
  • Return for clinical breast exam in 4-6 months if cyst completely disappears with aspiration
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19
Q

What is done with the results from a fine needle aspiration biopsy?

A
  • Clear fluid: no further evaluation

- Bloody fluid: sent for cytology and patients need a diagnostic mammogram/US

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20
Q

What happens if the cyst reappears or does not resolve with aspiration?

A
  • Diagnostic mammogram/US and perform biopsy
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21
Q

What is a core needle biopsy?

A
  • Uses a large needle (14-16 gauge)
  • Used to get tissue from larger solid masses for diagnosis
  • 3-6 samples about 2 cm long are obtained
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22
Q

What are some types of mastalgia?

A
  • Cyclic
  • Noncyclic
  • Extramammary
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23
Q

What is cyclic mastalgia?

A
  • Breast pain that starts at the luteal phase of the menstrual cycle and ends after onset of menses
24
Q

What is noncyclic mastalgia?

A
  • Not associated with menstrual cycle
  • Due to tumors, mastitis, cysts
  • Could be associated with meds like antidepressants, antihypertensives, hormonal meds
25
Q

What is extramammary mastalgia?

A
  • Pain due to chest wall trauma, shingles, fibromyalgia
26
Q

What are some treatment options for mastalgia?

A
  • Danazol: side effects basically make the pt more masculine
  • SERMS (tamoxifen): increased risk of hyperplasia and DVT
  • OCPs may help
  • Symptoms relief: properly fitting bra, weight reduction, exercise, decrease caffeine intake
27
Q

What are some details with nipple discharge?

A
  • Usually benign
  • Could be sign of endocrine disorder or cancer
  • Unilateral or bilateral, color, consistency, spontaneous, or expressed all give clues
28
Q

What does bloody nipple discharge indicate?

A
  • Cancer until proven otherwise
  • Concern for intraductal carcinoma or invasive ductal carcinoma
  • Could be benign intraductal papilloma
29
Q

How is bloody nipple discharge evaluated?

A
  • With breast ductography and requires ductal excision
30
Q

What are some concerns for breast malignancy?

A
  • Greater than 2cm
  • Immobility
  • Poorly defined margins
  • Firmness
  • Skin dimpling/retraction/color changes
  • Bloody nipple discharge
  • Ipsilateral lymphadenopathy
31
Q

What are the three categories of breast masses?

A
  • Non proliferative- RR of developing cancer is 1.0
  • Proliferative without atypia- RR 1.5-2
  • Proliferative with atypia- RR 8-10
32
Q

What are fibrocystic changes seen in nonproliferative breast masses?

A
  • Spectrum of changes observed in the normal breast present in about 50% of women
33
Q

What is adenosis?

A
  • Lobular growth with increased number of glands
34
Q

What is lactational adenomas?

A
  • Due to hormonal response
35
Q

What are fibroadenomas?

A
  • Most common benign tumor in female breast
  • Solid, rubbery, mobile, and typically solitary
  • Usually 2-4 cm but could reach 15 cm which causes in increased risk of cancer
36
Q

Who usually presents with fibroadenomas?

A
  • In late teens or early 20s
37
Q

What is a galactocele?

A
  • Cystic dilation of duct filled with milky fluid
  • Occurs near time of lactation
  • Secondary infection may produce acute mastitis
38
Q

How is a galactocele treated?

A
  • Typically can be needle aspirated
39
Q

What are some details about proliferative without atypia breast masses?

A
  • Usually not palpable- found on imaging
  • Epithelial hyperplasia
  • Sclerosing adenosis
  • Complex sclerosing lesions
  • Papillomas
40
Q

What is epithelial hyperplasia?

A
  • Overgrowth of cells that line the ducts
41
Q

What is sclerosing adenosis?

A
  • Increased fibrosis within breast lobules
42
Q

What are complex sclerosing lesions?

A
  • Tubules trapped in a dense stroma surrounded by radiating arms of epithelium
43
Q

What are papillomas?

A
  • Intraductal growths
  • Typically seen in women 30-50
  • Cause serous or serosanguinous discharge
44
Q

What happens in proliferative breast masses with atypia?

A
  • Malignant cells replace the normal epithelium lining the ducts or lobules (carcinoma in situ)
  • Lobular carcinoma in situ (LCIS)
  • Ductal carcinoma in situ (DCIS)
45
Q

What is LCIS?

A
  • Not a precursor to breast cancer but risk factor for developing breast cancer
46
Q

What is DCIS?

A
  • Ducts are filled with atypical epithelial cells and women are increased risk for developing invasive disease or reoccurrence of DCIS
47
Q

How are LCIS and DCIS treated?

A
  • With excision and then followed with treatment with selective estrogen receptor modulators
48
Q

How is age a risk factor for developing breast cancer?

A
  • Majority occur after 50

- Caucasian women at greater risk except black women less than 45 are at greater risk

49
Q

How does family history and genetics affect developing breast cancer?

A
  • Women with first degree relatives with breast cancer have a 1.5 higher risk
  • BRCA genes
  • BRCA1: women have up to a 72% lifetime risk for developing breast cancer and the mutation rarely causes cancer in men
  • BRCA2: women have a 69% chance of developing cancer and men have a 6.8%
50
Q

How can radiation exposure affect developing breast cancer?

A
  • > 20 cGy

- Time to develop lesion from exposure is 5 to 10 years

51
Q

What is the Gail model for breast cancer risk?

A
  • Usefulness decreased in second degree relatives with breast cancer
  • Falsely elevated in patients with multiple breast biopsies
  • Women considered high risk are counseled on prophylactic therapy
52
Q

What is the most common breast cancer?

A
  • Ductal: most common in women in their 50s and spreads to regional nodes
53
Q

What does the treatment options for breast cancers depend on?

A
  • Depends on stage and use receptor status in addition to staging to determine prognosis (estrogen, progesterone)
54
Q

What are some treatment options for breast cancer?

A
  • HER2/NEU (oncogene)- worse prognosis and is found in 20-30% of invasive cancers
  • Surgical therapy: lumpectomy with radiation or mastectomy (outcomes are equal)
55
Q

What medical therapy is used for breast cancer?

A
  • Adjuvant therapy is used in all stages which reduces risk of recurrence by 1/3 and reduces death by 30%
  • Chemotherapy kills cancer cells
  • Hormonal therapy: antagonizes to estrogen, reduces risk of cancer in bilateral breast
  • Aromatase inhibitors: prevent production of estrogen in postmenopausal women
  • Trastuzumab: acts on protein made by HER2/NEU

Endo/Repro (31 decks)

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