The Surgical Review- Breast Flashcards
what are the boundaries of the breast?
sternum medially, latissimus dorsi laterally, clavicle superiorly, inframammary crease inferiorly
blood supply of the breast?
- internal mammary
2. lateral thoracic arteries
5 important nerves to identify during mastectomy
- Lateral pectoral: pectoralis major
- Medial pectoral: pectoralis minor
- Long thoracic nn: serratus anterior and subscapularis
- Thoracodorsal: latissimus dorsi
- Intercostobrachial: sensory fibers to the skin of axilla, medial upper arm and lateral breast
What are the BIRADs scores?
- incomplete, additional imaging needed
- negative, routine mammo
- benign finding, routing mammo
- probably benign, short term fu
- suspicious, consider biopsy
- highly suggestive of malignancy
what is mondor’s disease?
thrombophlebitis of superficial veins of the anterior chest wall and breast
tx: anti-inflammatories and warm compresses
most common cause of bloody nipple discharge?
intraductal papilloma
what are the five subtypes of DCIS?
- Comedo: high grade and necrosis
- Cribriform
- Micropapilary
- Papillary
- Solid
what are 4 other less well known subtypes of invasive breast carcinoma?
- Tubular
- Medullary
- Mucinous
- Metaplastic
what are the major determinants of prognosis in breast cancer?
tumor size and lymph node status
what are the most common sites of distant metastasis in breast ca? 5
- bone
- lung
- liver
- brain
- spine
HER2-neu is associated with what 3 factors of prognosis?
- Increased rate of metastases
- Poorer overall survival
- Refractoriness to chemotherapy
what is the function of HER2neu
tyrosine kinase growth factor receptor
what is the pathogenesis of peak d’orange in inflammatory breast ca?
dermal lymphatic congestion with tumor cells
what is the strongest risk factor for male breast cancer?
klinefelter syndrome
how do phyllodes tumors metastases and where to?
hematogenously
to lung, bone, and abdominal viscera
what 3 veins are most commonly affected in mondors disease?
- Lateral thoracic vein
- thoracoepigastric vein
- superficial epigastric vein
what are the three management options when LCIS is discovered?
- close surveillance
- Tamoxifen (shown to reduce breast ca risk)
- Bilateral total masties w recon
what is the difference in breast ca of BRCA 1 vs BRCA2 mutations?
BRCA1 more likely to be poorly differentiated and hormone receptor negative whereas BRCA2 is well differentiated and hormone receptor positive
hereditary breast ca accounts for what percentage of all breast cancers?
5-10%
what accounts for nearly 40% of male breast cancers?
BRCA2
Increased risk family history of breast cancer includes what? (6)
- At least 3 first or second degree relatives with breast ca at any age
- 2 first degree relatives with breast ca including one who was diagnosed
which type of DCIS is assoc w the worse prognosis?
comedo
which type of cancer stains positive for S-100 antigen?
Melanoma
which type of invasive breast ca has the most favorable prognosis?
tubular
neighborhood calcification is a feature characteristic of what?
LCIS
what defines a women at “high risk” for breast cancer?
a women as least 35years of age with a 5yr predicted risk of breast cancer of 1.67% or greater (using the gail model)
the primary severe adverse reaction to trastuzumab is?
cardiac toxicity: CHF and decreased LVEF
what is the most common type of breast lymphoma?
B cell: diffuse large B cell lymphoma
treatment of breast lymphoma?
if low grade/localized: excision
if high grade: CHOP + XRT
what is CHOP therapy?
Cyclophosphamide, hydroxydoxorubicin, vincristine, prednisone
what artery does the long thoracic nerve run with?
subscapular artery
woman w a teardrop deformity of her breast and rapidly growing mass?
phyllodes tumor: careful, they can be confused clinically/radiographically/histologically with fibroadenoma
treatment of choice for phyllodes tumor? benign vs malignant?
wide local excision with at least 1cm margin for both benign and malignant, rarely go to lymph nodes
how do malignant phyllodes tumors spread?
hematogenously
strongest risk factor for development of angiosarcoma?
lymphedema, but can also arise in radiation naiive pts de novo
how do you differentiate angiosarcoma from hemangioma?
presence of necrosis
treatment of angiosarcoma?
wide excision to negative margin, no need to do SLNBx
what is batson plexus?
venules that encircle the vertebrae and course along the spine, path for metastasis of breast and prostate cancer to the spine/spinal cord
what is the single most important predictor of 10-20 year survival rates in breast ca?
number of axillary lymph nodes involved with metastatic dx
what is stewart treves syndrome?
deadly malignancy that forms in chronically edematous limbs ie lymphedema after modified radical mastectomy, mets to lungs early on, tx = wide excision and debridement often amputation
what is one connective tissue disorder that is NOT a contraindication to breast conserving treatment?
Rheumatoid arthritis (SLE and scleroderma are bc they may be exacerbated by radiation therapy)
MOA tamoxifen
an estrogen agonist but a competitive estrogen antagonist in the breast
