repro. Mehl. breast neoplasia 12-22 (1) Flashcards
Most common malignant (ie has metastatic potential) breast cancer?
DCIS
microcalcifications in mammography = ?
DCIS till proven otherwise
DCIS. next best step?
needle-guided open biopsy
FNA is wrong
DCIS. related disease?
Paget disease of breast (looks like a nipple with eczema in patient over 50) is often the cutaneous extension of an underlying DCIS.
Invasive ductal. Invasive form of ductal carcinoma. what is seen on biopsy?
Cells on biopsy have stellate morphology.
LCIS. Same as DCIS, malignant potential but not yet invaded.
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LCIS. on histo looks like how?
Appears as linear rows of cells (“Indian file”) on histo.
LCIS. This (on histo) is supposedly due to decr. E-cadherin expression, where the cells don’t clump together the same way they do as with ductal carcinomas.
I haven’t seen USMLE give a fuck about this detail, but I’m mentioning it because if you ever talk to an attending about breast cancers, they become like hysterical over this detail.
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Invasive lobular. how percent bilateral?
Invasive form of lobular carcinoma.
20-30% bilateral.
Intraductal papilloma. definition?
Unilateral bloody/rusty nipple discharge = intraductal papilloma till proven otherwise.
Inflammatory carcinoma. CP?
Can appear as a red/inflamed breast, as though there’s an infection.
Rubor (redness), dolor (pain), tumor (swelling), calor (heat).
Inflammatory carcinoma.
Peau d’orange is an orange peel-appearing texture of the breast due to
tethering of the skin by Coopers ligaments in the setting of blockage of
lymphatic drainage by tumor cells.
Comedocarcinoma.
Cancer with cheese-like consistency. Nonexistent on USMLE. Don’t think I’ve ever seen it assessed.
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Medullary carcinoma.
- Another nonsense / garbage diagnosis on USMLE.
- Mentioning comedo- and medullary carcinomas because if I don’t, then at
some point I’ll get some whiny/mousy DMs from students about why I didn’t
mention them.
.
most common breast tumor overall?
Fibroadenoma. benign
Fibroadenoma. CP?
Presents as rubbery, mobile, non-tender breast lump in woman 20s-30s.
Fibroadenoma. CP on UG?
Will appear as solid breast mass without calcification on ultrasound.
Fibroadenoma. BEST NEXT STEP?
FNA is next best step to confirm Dx. If confirmed fibroadenoma, they do not
need to be excised.
Cystosarcoma phyllodes. CP? on microscopy?
Fast-growing breast lesion that appears “leaf-like” on light microscopy.
Can be benign or malignant based on histo.
BRCA points. inheritance in what fasion?
BRCA 1/2 are tumor suppressor genes but are inherited in an autosomal
dominant fashion with incomplete penetrance (i.e., sometimes can skip a
generation). A pedigree requiring you know this pattern is asked on NBME.
BRCA points. what nbme wants you also know? apie molecular mechanism
NBME also wants you to know that, with BRCA mutations, the molecular
process that’s fucked up is “recombinational double-stranded DNA repair.”
