The Normal/Abnormal Breast (3)

Question 1

Regarding breast growth, what is E responsible for? P?

Answer 1

E: growth of adipose tissue and lactiferous ducts

P: stimulates lobular growth and alveolar budding

Question 2

High or low tissue density inc risk of b-CA?

Answer 2

High

Question 3

Is pre or post-menopausal obesity a risk factor for b-CA?

Answer 3

Post! Pre actually limits E release

Question 4

What do palpable masses get?

Answer 4

A biopsy

Question 5

What can mammography do regarding masses/lesions? When are they best? What age should they be started?

Answer 5

Detect them 2 years prior to them being palpable

In Females over 40 (breasts are less dense and it’s easier to see things)

40 and have them annually

Question 6

What method of imaging is used for women under 40?

Answer 6

Ultrasonography

Can differentiate cystic from solid lesions

Used as guidance too for biopsies

Question 7

What method of imaging is useful or staging? Scenario of breast implants?

Answer 7

MRI

Question 8

If clear fluid is aspirated from a cystic mass, what’s the next step?

Answer 8

No further eval, f/u in 3 months for breast exam

Question 9

How many samples taken in a core biopsy?

Answer 9

3-6

Question 10

What is the word for breast pain? What are the 3 kinds? What’s the tx?

Answer 10

Mastalgia

Cyclic: starts at luteal phase and ends after menses
Non-cyclic: tumors, mastitis, cysts, drugs (anti-HTN, anti-depressants)
Extramammary: awll trauma, shingles

Danazol (unpleasant SEs)

Properly fitting bra, wt reduction, exercise, dec caffeine, Vit E supp

Question 11

What is bloody nipple discharge?

Answer 11

CA until proven otherwise

- intraductal carcinoma, invasive ductal carcinoma, benign intraductal papilloma

Question 12

What defines a concern for breast malignancy with a mass?

Answer 12

Greater than 2cm in size
Immobiity
Poorly defined margins
Firmness
Skin dimpling/retraction/color change
Bloody discharge
Ipsilateral lymphadenopathy

Question 13

What are the 3 types of benign breast masses?

Answer 13

Non-prolif (includes fibroadenomas)
Prolif w/o atypia
Prolif w/ atypia

Question 14

What is a galactocele?

Answer 14

Non-prolif breast mass

• cystic dilation of a duct filled w/ milky fluid
• occurs near lactation
• secondary inf > acute mastitis
• can be needle-aspirated

Question 15

What’s the morph of a proliferative lesions w/ atypia? What’s tx?

Answer 15

Malignant cells replacing normal cells but the basement membrane is intact and cannot metastasize

Excision + SERM

Question 16

BRCA1 associated w/ 90% of hereditary ovarian CA

Answer 16

BRCA2 is less