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95 Cards in this Set
- Front
- Back
What are the causes of breast masses?
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inflammatory conditions, response to fluctuating hormones, benign neoplasms, malignant neoplasms
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How do the breasts change from prepuberty to menarche? During menstrual cycle?
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-prepuberty: breast tissue has a few ducts;
-menarche: ducts further develop-->terminal buds proliferate to give rise to lobules (sites of milk formation) -During secretory phase of menstrual cycle: stroma surrounding lobules gets edematous-->breast fullness |
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@ what age, are you more likely to find a malignant mass?
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50
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What is acute mastitis? What causes it? When does it occur? Sx's?
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In first few wks post delivery; Principal organism: Staphylococcus (Streptococcus); Portal of entry: nipple crack;
-Infection confined to 1 segment of breast leading to pain, localized swelling, & inflammation. |
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How does mammary duct ectasia present? At what age?
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palpable mass, often w/ bloody nipple discharge & necrotic debris thru nipple; Get enlarged ducts filled w/ debris & surrounded by fibrous tissue, lots of chronic inflammatory cells; Age: late reproductive life & post menopause;
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What is often in a post-menopasual obese patient & presents as a palpable mass that you think may be breast CA until further study?
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fat necrosis; since breast has lots of fatty tissue, subject to trauma or radiotherapy. Macro: well defined area <2cm, micro: anucleate fat cells surrounded by foamy histiocytes w/ Ca deposition & fibrosis (late)-->b/c fat is a lipid, so saponification of fat is a byproduct of calcium.
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What breast change is in 50% of women & thought to be due to hormonal stimulation? 10% get clinically apparent dz manifest by periodic discomfort & palpable masses like Breast CA. Age?
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fibrocystic change; 30-60 y/o age group;
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In fibrocystic change, describe the microscopic lesions of a 30-45 y/o vs someone 40-menopause. What is thought to cause this?
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30-45: fibroadenosis & epithelial hyperplasia;
40-menopause: fibrocystic change & cystic hyperplasia. b/c of imbalance b/w hyperplasia of ductule & lobular epithelium w/ each menstrual cycle. |
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On palpation, describe the differences w/ fibrocystic change in younger vs older age group.
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younger: diffuse granularity & nodularity; tender esp during secretory phase or premenstrual period of cycle;
older: ill-defined rubbery mass; -areas of discrete swelling representing cyst presence-->making it hard to distinguish from localized CA |
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What is 'blue domed cyst disease'?
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what breast surgeons call fibrocystic change; grossly on younger women: multiple nodules og gray tissue, in older women you have large cysts
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When does fibrocystic change tend to begin to appear?
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premenopausal women when breast CA incidence is starting to inc;
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Do benign proliferative breast lesions inc the chance of subsequently getting breast CA?
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w/ atypical hyperplasia (disorderly cell growth & nuclear pleomorphism) are inc risk for breast CA (5x higher risk!)
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Do women w/ cystic change tend to have atypical hyerplasia?
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no, majority (70%) do not-->so not @ inc risk of getting CA.
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What has a hobnail appearance?
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Microscopy of apocrine metaplasia of fibrocystic change.
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@ what age does gynecomastia tend to occur? What are the causes? Unilateral or bilateral?
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-adolescence or older males;
-from hormonal effect; assoc w/ Klinefelter's syndrome, liver dz, certain drugs like digitalis; -often unilateral; variable amt of ductule proliferation & prominent edematous & cellular stroma |
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Describe juvenile hypertrophy. When does it occur?
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Excessive & persistent enlargement of 1 or both breasts in 11-14 y/o females.
-usually coincides w/ menarche, but may precede it |
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What does juvenile hypertrophy look like micro & macro?
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micro: proliferation of all elements of breast (epithelium, ductules, stroma)
macro: identical to adjacent breast tissue; |
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What is metaplastic change?
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replacement of 1 cell type w/ another type
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What are the characteristics of apocrine metaplasia?
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-cells w/ granular eosinophilic cytoplasm, round nuclei;
-sometimes have decapitation secretions or coarse hyaline globules; -frequently in fibrocystic change; -papillary morphology common in cysts; -NO NECROSIS SEEN (ddx apocrine intraductal CA) |
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What is clear cell metaplasia?
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clear of vacuolated cytoplasm rather than granular & eosinophilic
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What is squamous metaplasia associated w/?
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infarcted papilloma which may follow FNA biopsy, Phyllodes tumor, syringomatous adenoma, ducts w/ perareolar abscess, lining of biopsy cavity (squamous metaplasia can be confused w/ CA!)
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Describe the characteristics of mucinous metaplasia.
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-rare, typically affects nl isolated lobule, may occur in papilloma, no known pre-neoplastic potential;
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Who gets lactational change and how does it present?
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-Repro age females w/ recurrent hx of pregnancy; rarely, postmenopausal females (digitalis, neuroleptics); males on stilbestrol;
-May present as mass during pregnancy or post-partum. |
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Describe the micro & macro changes of lactational change?
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macro: sharply circumscribed, may involve a pre-existing tubular adenoma (=lactating adenoma) <5cm.
micro: expanded lobules, secretory or regressive patterns seen. Foamy (milk thats being produced) background differentiates it from CA. |
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describe the characteristics of scerlosis adenosis. Bilateral or unilateral?
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-common lesion, often bilateral!
-may form mass (<2cm), but usually microscopic finding; |
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What do you seen w/ micro of sclerosing adenosis?
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micro: lobular architecture preserved-->this is key to diagnosis; fibrosis may distort lumina & make myoepithelial cells prominent. (preservation of epithelium & myoepithelium=bening. If you lose myoepithelial cells, then its an invasive CA).
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What is in the differential diagnosis of someone w/ sclerosing adenosis?
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-atypical apocrine adenosis: atypical lobular cells w/ apocrine cells;
-invasive CA: no myoepithelial cells (loses this layer!) |
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Who is affected by complex sclerosing lesion/radial scar and how does it appear? Bilateral or unilateral?
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-middle age to older women.
-frequently multiple & bilateral -radiology: stellate mass is suspicious -macro: may form palpable mass; -micro: central scar w/ stellate arrangement of ducts; pattern may be obscrued by only pt of lesion being sampled w/ core biopsy; 30% have atypia & CA. |
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How does someone w/ duct ectasia/periductal mastitis present?
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majority are subclinical; pts present w/ nipple pain & tenderness or chronic nipple discharge.
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Describe the lesion of duct ectasia/periductal mastitis.
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-Lesion shows lymphoplasma infiltrate & pigmented histiocytes w/ foam cells in epithelium & lumen which obliterate lumen rather than cause ectasia. Acute form w/ PMNs is rarely seen.
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What is collagenous spherulosis & what should be considered in its differential diagnosis?
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-incidental microscopic finding consisting of spheres of eosinophilic material surrounded by myoepithelial cells Epithelial cells around lesion may be benign, atypical or malignant.
-DDx: DCIS, Adenoid cystic CA, lobular neoplasia |
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What population is more likely to get acute mastitis? They have an increased chance of getting what?
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often cracks in nipple in nursing women-->allows bacterial entry (staph or anaerobes);
-inc risk for inversion of nipple or congenital anomaly; -Micro: squamous metaplasia of lg ducts or thick walled abscess cavity from chronic infection. |
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What is the cause of granulomatous mastitis? what should be in the differential?
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-idiopathic in US;
-DDx: TB, fungi, protozoa, duct rupture, rxn to CA, sarcoid, Wegener's. |
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Leakage/rupture of silicome implants can cause what? Whats in micro?
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Mastitis-->from additives and/or silicone. Micro: histiocytes w/ FBG w/ fibrosis & empty spaces w/ refractile material. Changes in regional lymph nodes
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Besides gynecomastia, what other breast pathology can occur in males? It feels like painless dense rubbery fibrous tissue. Its also in women 24-72 age range.
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Lymphocytic mastitisu (DM or fibrous mastopathy is the idiopathic form)
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A pt w/ systemic dz like RA or amyloidosis can get what in the breast? What does it look like w/ macro/micro?
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amyloid tumor in breast; Macro: nodule w/ granular or waxy cut surface. Micro: amorphous eosinophilic material w/ FBG rxn. (Congo red-->apple green birefringence)
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what is the most common benign breast neoplasm in women 25-35 y/o? who is more likely to get them?
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fibroadenoma; african americans
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do fibroadenomas predispose to breast CA?
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No
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What does fibroadenoma feel like on palpation and on cut section?
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usually solitary, freely movable & not fixed to chest wall; don't infiltrate surrounding tissue; cut section: soft gray; micro: biphasic appearance of proliferation of ductules & mensenchyme
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The myxoid change of a fibroadenoma is associate w/ Carney's complex. What is Carney's complex?
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myxoma of heart, skin, hyperpigmentation of skin & endocrine changes.
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What benign neoplasm is in women >50 y/o & is the most common cause of bloody breast discharge from torsion/hemorrhage? Its found as single lesion w/ large duct, usually close to nipple
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Intraductal papilloma (no myoepithelail cells, have atypical intraductal proliferation; arborizing growth pattern projecting into lg duct; can get CA in papilloma)
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Are intraductal and intralobular CA invasive?
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No, they're non-invasive in situ and early dz, but they can be assoc w/ fibrosis, may present as mass, & detect w/ mammography.
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What is it called when there is ductal (DIN) and lobular neoplasia (LIN)?
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Intraductal neoplasia (these are preneoplastic processes for malignnacy)
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What are the characteristics of DIN?
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distinct cell borders, secondary lumens-rosettes, larger nuclei than LIN, variants: stratified, spindle cell, apocrine;
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What are the characteristics of LIN?
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indistinct cell borders, solid or loosely cohesive, intracytoplasmic lumens, small uniform nuclei, variants: pleomorphic;
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Which stage of DIN has cribriform proliferation of uniform cells?
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DIN 1: low risk
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Which stage of DIN has comedo necrosis (completely occludes duct?
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DIN 3
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What is microinvasive CA? If you detect this, how is it managed?
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cluster of tumors cells break thru basement membrane, area <2mm; managed as DCIS;
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What % of DCIS has been found to have metastasized?
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3%
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What does microinvasive CA look like on micro?
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tongue-like invasion from duct; stroma frequently fibroblastic & myxoid.
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What condition will cause an inc risk for invasive lobular & ductal bilaterally, is not detectable macroscopically, and on micro is in a clover like pattern?
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LIN
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How are LIN 1, 2, & 3 lesions differentiated?
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based on inc distention of acini to confluence of acini.
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At 50 years old, what is your risk of developing breast CA?
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50%
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What is the risk of developing breast CA in American women?
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1 in 8
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Breast cancer is the _____ cancer in women, and ______in cancer deaths in women.
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top, 2nd in most
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How have the incidence and mortality of breast CA changes in the past half century?
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1% annual inc in incidence (lung cancer has had a much larger change inc in incidence), constant mortality (thus more cures & found @ much earlier stages-->more in situ & stage 1 b/c of inc emphasis of breast CA diagnosis & more mammograms)
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What is the 5 yr survival in someone w/ stage 1 vs stage 4 breast ca?
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stage 1: 84%, Stage 4: 48%
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What % of breast CA's now are node negative at diagnosis?
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85%
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What % of breast CA are small, noninvasive lesions picked up my mammograms?
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65%
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Is the incidence of breast CA higher in white or black women? Prognosis?
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incidence higher in whites, prognosis worse in blacks
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Which countries have inc risk of breast ca: those in N America & N. Europe or those in Africa or Asia?
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N. America/N. Europe
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How do you define regional spread of breast cancer/
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to lymph nodes, chest wall, or skin
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What are the risk factors for breast ca?
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age, country, fam hx, previous hx of CA or breast dz, estrogen: early menarche & late menopause & obesity, estrogenic drugs but OCPs seem ok, inc income or SES, previous fibrocytsic dz if atypical hyperplasia is detected in lesion
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should a woman w/ breast cancer diagnosis take OCPS?
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no b/c breast CA growth is promoted by estrogen
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Is a patient w/ benign breast dz at inc risk of getting breast CA?
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depends on type of dz; low risk w/ proliferative dz w/ no atypia; Significantly inc risk w/ proliferative dz w/ atypia.
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Pts w/ which gene mutation have 85% chance of developing CA by 70?
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BRCA1 mutation
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Pts w/ which gene have a worse breast CA prognosis?
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Her2/neu
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Which Breast CA gene is assoc w/ inc risk of ovarian CA?
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BRCA1
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Which 2 gene mutations are responsible for 80% of familial early onset causes of IDC, NOS?
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BRCA1 (chromosome 17q21) & BRCA2 (chrom 13q12-13)
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What is the most common type of infiltrating ductal CA?
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IDC, NOS
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What is the tx for infiltrating ductal CA?
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lumpectomy or simple mastectomy
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What is IDC w/ dermal lymphatic plugging by tumor emboli w/ LN mets?
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'inflammatory' CA
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When does infiltrating ductal CA have a nipple discharge?
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if its assoc w/ larger ducts
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What 3 things does the Scarff-Bloom-Richardson system measure?
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tubule formation, mitotic activity, nuclear pleomorphism
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What are the three grades of infiltrating ductal carcinoma accoding to the S-B-R system?
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3-5: well differentiated, grade 1; 6-7: moderately differtiated, grade 2; 8-9: poorly differentiated, grade 3.
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What age group gets infiltrative ductal CA vs intralobular CA?
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infiltrative: pre and post menopausal women;
intralobular: premenopausal women |
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How does intralobular ca present?
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NOT as mass--usually incidental finding; Usually bilateral and multifocal!
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What % of intralobular CA develops into invasive cancer?
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25%. Controversy about amt of surgery, sometimes bilateral mastectomy for invasive
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Is invasive breast CA usually w/ pre or post menopausal women?
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Usually post
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Invasive breast cancer is usually of what type?
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infiltrative
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is premenopausal ca and those found in 20s and 30s usually aggressive?
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YES! usually aggressive, bilateral, assoc w/ fam hx of breast cancer
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Which types of breast CA have a better prognosis?
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mucinous, tubular, medullary are better compared to infiltrating lobular and ductal which have a similar tx & prognosis.
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What is Paget's dz?
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type of breast CA where overlying epidermis is infiltrated by individual Cancer cells arising in underlying adjacent breast CA; Sx: eczema centered primarily around nipple & areolar region;.
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What are the characteristics of male breast cancer/
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1% of all breast cancer; older men; Sx: asymtpomatic, nipple discharge or Paget's dz.
-inc risk w/ Klinefelter's -same prognosis as female breast CA -higher incidence of mets (55%) -ER+. +/- PR +, +/-RSA |
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What is a phyloddes utmor (aka giant fibroadenomas or cystosarcoma phyloddes)?
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-tend to occur in 40 y/0, presents as painless discrete mass, often longstanding w/ sudden enlargement;
-consists of epithelium and assoc neoplastic stroma (biphasic tumor like fibroadenoma) & heterologous elements more often seen (chondroid, osseous, lipioud) than in fibroadenoma. -tend to recur but don't metastasize, good prognosis; -Image: leaf like processes protrude into cystic spaces lined by epithelial & myoepithelial cells; |
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What is peau d'orange?
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as skin lymphaics are invaded, skin taken on characteristics dimpling similar to orange skin in appearance.
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What happens as the breast malignancy grows?
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can palpate mass, infiltrates into surrounding breast tissue, attaches to underlying muscle, peau d'orange, nipple retraction w/ growth into surrounding muscle; malignancy can ulcerate thru skin, bleed, discharge necrotic material
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Which lymph nodes does breast CA drain into?
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axillary
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What are the most common places of breast CA mets?
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brain, bone marrow (but can go anywhere; painful to bone as its osteoblastic)
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Post mastectomy, where does breast CA commonly occur?
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scar site, can recur as much as 20 yrs post initial tx
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What are the 4 stages of breast CA?
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Stage I: node negative;
Stage II: breast mass w/ LN mets or involvement of overlying skin Stage III: more extensive, involves extensive adherence to skin, muscle, fixed lymph nodes Stage IV: widely metastatic dz |
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Which breast CA pt has the best prognosis?
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if their axillary LN's are negative (or one w/ less than 4 positive ones); if pt has hormone receptors (ER or PR)b/c can remove estrogen influence or anti-estrogens like tamoxifen
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Which monoclonal Ab drug has been shown to slow growth of HER-2 positive tumors. It blocks HER-2 receptors and controls growth.
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Herceptin
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Does chemo inc breast CA pt survivial?
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yes, but if LN negative, reluctance to tx them w/ aggressive chemo-->should look at different prognostic factors
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Pts w/ which gene amplification (aka erbB2/neu) have inc numbers of growth factor receptors, have more aggressive malignancies, and this is overexpressed in 25-35% of primary breast CA's and is assoc w/ inc risk of recurrent dz or shorter overall survivial?
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HER-2 gene
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