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Questions and Answers
Which of the following is a risk factor for Tietze's Syndrome?
Which of the following is a risk factor for Tietze's Syndrome?
Tietze's Syndrome can lead to cancer.
Tietze's Syndrome can lead to cancer.
False
What is the most common pathological cause of green or bluish nipple discharge?
What is the most common pathological cause of green or bluish nipple discharge?
Duct papilloma
The common treatment for Tietze's Syndrome includes the use of ______.
The common treatment for Tietze's Syndrome includes the use of ______.
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Match the type of nipple discharge with its associated condition:
Match the type of nipple discharge with its associated condition:
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Which organism is most commonly associated with lactational breast abscesses?
Which organism is most commonly associated with lactational breast abscesses?
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What BIRADS score is associated with a complex cyst?
What BIRADS score is associated with a complex cyst?
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Fluctuation is an early sign of a breast abscess.
Fluctuation is an early sign of a breast abscess.
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A simple cyst has a solid component and requires a core biopsy.
A simple cyst has a solid component and requires a core biopsy.
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What are two common symptoms of a lactational breast abscess?
What are two common symptoms of a lactational breast abscess?
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The main treatment for recurrent non-lactational breast abscesses due to tuberculosis includes __________.
The main treatment for recurrent non-lactational breast abscesses due to tuberculosis includes __________.
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What is the recommended lifestyle change for managing breast pain according to the information?
What is the recommended lifestyle change for managing breast pain according to the information?
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Mondor's disease is caused by thrombophlebitis of the ______ veins.
Mondor's disease is caused by thrombophlebitis of the ______ veins.
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Match the following types of breast abscesses with their corresponding HPE findings:
Match the following types of breast abscesses with their corresponding HPE findings:
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Match the medication with its recommended dosage.
Match the medication with its recommended dosage.
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What is the management for breast cancer diagnosed in the 1st trimester?
What is the management for breast cancer diagnosed in the 1st trimester?
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Ductal Carcinoma In Situ (DCIS) is classified as an invasive form of breast cancer.
Ductal Carcinoma In Situ (DCIS) is classified as an invasive form of breast cancer.
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What is the most common type of Ductal Carcinoma In Situ (DCIS)?
What is the most common type of Ductal Carcinoma In Situ (DCIS)?
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The presence of clustered microcalcifications on a mammogram is associated with ________ carcinoma.
The presence of clustered microcalcifications on a mammogram is associated with ________ carcinoma.
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Match the following risk factors with their corresponding conditions:
Match the following risk factors with their corresponding conditions:
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Which of the following treatments is indicated for a patient with metastatic breast cancer who is BRCA positive?
Which of the following treatments is indicated for a patient with metastatic breast cancer who is BRCA positive?
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Hormonal therapy for breast cancer includes Palbociclib, Ribociclib, and Abemaciclib.
Hormonal therapy for breast cancer includes Palbociclib, Ribociclib, and Abemaciclib.
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What is the typical management approach for patients with locally advanced breast cancer (LABC)?
What is the typical management approach for patients with locally advanced breast cancer (LABC)?
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Pregnancy associated breast cancer typically presents with ______ tumors that are often aggressive.
Pregnancy associated breast cancer typically presents with ______ tumors that are often aggressive.
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Match the following drugs to their primary use in breast cancer treatment:
Match the following drugs to their primary use in breast cancer treatment:
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Which of the following is considered the first line treatment for a malignant phyllodes tumor?
Which of the following is considered the first line treatment for a malignant phyllodes tumor?
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Fibroadenosis commonly presents with cyclical mastalgia that worsens during the menstrual cycle.
Fibroadenosis commonly presents with cyclical mastalgia that worsens during the menstrual cycle.
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What is the age range associated with phyllodes tumors, particularly those most often seen?
What is the age range associated with phyllodes tumors, particularly those most often seen?
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A risk factor for developing fibroadenosis is age greater than ______ years.
A risk factor for developing fibroadenosis is age greater than ______ years.
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Match the following characteristics with their associated conditions:
Match the following characteristics with their associated conditions:
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What is the most common benign condition in individuals aged 15-25?
What is the most common benign condition in individuals aged 15-25?
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Fibroadenomas are typically painful and hard to move.
Fibroadenomas are typically painful and hard to move.
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Which of the following is considered a poor prognostic factor for breast cancer?
Which of the following is considered a poor prognostic factor for breast cancer?
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Every patient should have a mammogram once a year after five years of treatment.
Every patient should have a mammogram once a year after five years of treatment.
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What is the recommended imaging method for assessing fibroadenomas?
What is the recommended imaging method for assessing fibroadenomas?
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What is the role of axillary lymph node status in breast cancer prognosis?
What is the role of axillary lymph node status in breast cancer prognosis?
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A _____ fibroadenoma is categorized as BIRADS III/IVa and requires a biopsy.
A _____ fibroadenoma is categorized as BIRADS III/IVa and requires a biopsy.
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Which option is true regarding the management of breast cancer?
Which option is true regarding the management of breast cancer?
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Patients with high ______ index are often associated with more aggressive forms of breast cancer.
Patients with high ______ index are often associated with more aggressive forms of breast cancer.
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Match the following indications for surgery with their corresponding descriptions:
Match the following indications for surgery with their corresponding descriptions:
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Lobular carcinoma in situ (LCIS) is classified as a risk factor for breast cancer.
Lobular carcinoma in situ (LCIS) is classified as a risk factor for breast cancer.
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Match the follow-up schedule with the corresponding time frame:
Match the follow-up schedule with the corresponding time frame:
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What is the primary diagnostic method for breast cancer mentioned?
What is the primary diagnostic method for breast cancer mentioned?
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Which molecular testing results suggest a high risk for breast cancer?
Which molecular testing results suggest a high risk for breast cancer?
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Male patients have a similar follow-up protocol as female patients after breast cancer treatment.
Male patients have a similar follow-up protocol as female patients after breast cancer treatment.
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The typical histopathological examination of invasive lobular cancer reveals a ______ pattern.
The typical histopathological examination of invasive lobular cancer reveals a ______ pattern.
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Match the following parameters of the Van Nuys Prognostic Index with their scoring outcome:
Match the following parameters of the Van Nuys Prognostic Index with their scoring outcome:
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List two patient factors that contribute to poor prognosis in breast cancer.
List two patient factors that contribute to poor prognosis in breast cancer.
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What is the most common clinical feature of a duct papilloma?
What is the most common clinical feature of a duct papilloma?
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Duct ectasia is more commonly associated with younger women under 30.
Duct ectasia is more commonly associated with younger women under 30.
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What is the surgical treatment option for a duct papilloma?
What is the surgical treatment option for a duct papilloma?
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The risk of cancer is ______ times greater in patients with papillomatosis compared to solitary papilloma.
The risk of cancer is ______ times greater in patients with papillomatosis compared to solitary papilloma.
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Match the type of duct papilloma with its description:
Match the type of duct papilloma with its description:
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Which symptom is associated with Paget's Disease?
Which symptom is associated with Paget's Disease?
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Duct ectasia is characterized by dilated ducts and stasis of secretions.
Duct ectasia is characterized by dilated ducts and stasis of secretions.
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What type of discharge is typically seen in duct ectasia?
What type of discharge is typically seen in duct ectasia?
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Study Notes
Tietze’s Syndrome
- Increased risk in smokers, unlikely to be cancer
- Pain is non-cyclical
- Trigger point at costochondral junction
- Treatment includes anti-inflammatory agents and intralesional steroids
Nipple Discharge
- Serous discharge is common during puberty, pregnancy, and lactation
- Milky discharge can occur during lactation, but can also be pathologic
- Green or bluish discharge can be a sign of duct papilloma
- Bloody nipple discharge is common during lactation, but may be a sign of cancer
Lactational Breast Abscess
- Staphylococcus aureus is the most common organism responsible
- Entry point is often cracked nipple
- Symptoms include pain, swelling, and fever
- Fluctuation is a late sign
Recurrent Non Lactational Breast Abscesses
- Tuberculosis is characterized by caseating granulomas, positive AFB stain, and positive gene expert for TB
- Idiopathic granulomatous mastitis is characterized by non-caseating granulomas and negative AFB stain
- Inflammatory cancer is characterized by carcinoma, negative AFB stain, and negative gene expert for TB
Breast Cysts
- Simple cysts are smooth walled with no solid components
- Complex cysts have solid components in the cyst wall
- Complicated cysts may require antibiotics
Non-Cyclic Mastalgia
- Mondor’s disease is a thrombophlebitis of chest veins
- Lateral thoracic vein is the most common vessel affected
- Image shows location of Mondor’s Cord
Breast Cancer Management
- If surgery is needed during pregnancy, breast conserving surgery is recommended in the 2nd or 3rd trimester, followed by radiation therapy after delivery
- Mastectomy is recommended in the 1st trimester
- Chemotherapy is contraindicated in the 1st trimester, but safe in 2nd and 3rd trimesters
- Hormone therapy and radiation therapy are contraindicated in all trimesters
Bilateral Breast Carcinoma
- Usually associated with BRCA gene mutations
- Both breasts are staged separately if diagnosed at the same time
Male Breast Carcinoma
- Risk factors include BRCA1/2 mutations, obesity, Klinefelter Syndrome, alcohol intake, and liver cirrhosis
- Clinical findings include a hard mass or lump
- Diagnosis is made by biopsy
- Prognosis is the same as female breast cancer
Ductal Carcinoma in Situ (DCIS)
- Non-invasive
- Papillary is the most common type
- Comedo with necrosis is the most aggressive type
- ER, PR positive, microcalcification positive
Active Space - LABC
- Criteria include T3NMO, any T4, any N2, any N3
- Management includes neoadjuvant chemotherapy followed by surgery and radiation therapy
- Hormone therapy is used if ER and PR are positive
- Trastuzumab is used for 1 year if Her2-neu positive
Metastatic Breast Cancer
- Management is palliative
- Olaparib can be used if BRCA positive
ER, PR, Her2-Neu
- Hormonal therapy includes palbociclib, ribociclib, and abemaciclib
- If resistance develops chemotherapy (pembrolizumab or atezolizumab for PD-L1 negative)
- Trastuzumab is used in combination with chemotherapy for TNCB
- If resistance develops, consider lapatinib, treatment for brain metastasis, and IV anti-Her2-neu
Pregnancy Associated Breast Cancer (PABC)
- Occurs during pregnancy or within 1 year of delivery
- Features include ER, PR negative and aggressive tumors
- Diagnosed by core biopsy
- Imaging includes ultrasound (initial)
Breast Cancer Diagnosis and Treatment
- Image-guided core biopsy is the preferred diagnostic method
- Management includes simple mastectomy, breast conserving surgery, and radiation therapy
- Chemotherapy is not indicated
- Hormone therapy is used in ER, PR positive tumors
Van Nuys Prognostic Index
- Helps to determine need for radiation therapy
- Score is based on tumor size, margin status, grade and necrosis, and patient age
- Does not include ER, PR status
Lobular Carcinoma in Situ (LCIS)
- Classified as a risk factor for breast cancer
- Often bilateral and multicentric
- Usually ER and PR positive
- Most commonly an incidental finding in diagnostic imaging
- Patients are kept under surveillance
- Can progress to invasive ductal or invasive lobular
- Invasive lobular is often bilateral, multicentric, and associated with E-cadherin mutation
Prognostic Factors
- Most important prognostic factor is axillary lymph node status
- Estrogen receptor and progesterone receptor status are important for metastatic breast cancer
Poor Prognostic Factors
- Increased tumor size, increased disease stage, axillary node involvement, increased tumor grade, histopathological variance, Her2/neu positive and triple negative, lymphovascular invasion, extensive DCIS, high Ki-67 index, younger age, premenopausal status, BRCA-associated tumor, family history of breast cancer, personal history of breast cancer, obesity, sedentary lifestyle, and incomplete treatment
Follow-up
- Clinical visits every 3 months for the first 2 years
- Every 6 months between years 2 and 5
- Every year after 5 years
- Physical examination every visit
- Mammogram or ultrasound annually
- Pelvic ultrasound for patients on tamoxifen
- Serum Ca 15-3
Early Breast Cancer (T1, T2, N0, N1/mo)
- Breast conserving surgery is the preferred treatment
- If sentinel lymph node biopsy is negative, chemotherapy is not indicated if breast conserving surgery is selected
- If breast conserving surgery is not possible, mastectomy is recommended
- If lymph node biopsy is positive, chemotherapy is recommended
- Hormone therapy is indicated in ER, PR positive tumors
Molecular Testing
- Recommended in T1, T2 / N0, N1/mo
- Patients at low risk can avoid chemotherapy
- Patients at high risk should receive chemotherapy
- Chemotherapy is recommended for TNBC and Her2 positive tumors
Phyllodes Tumor
- Aka cystosarcoma phyllodes
- Stromal tumor
- Occurs in 4th and 5th decades
- Diagnoses is by core biopsy
- Benign, borderline, and malignant types are categorized based on mitotic figures
- Treatment includes surgery (wide local excision or lumpectomy)
- Simple mastectomy for larger tumors
- Radiation therapy is indicated in malignant phyllodes
- Recurrence can happen
- No role for chemotherapy
Fibroadenosis/Fibrocystic Disease
- Common in women over 25 years until menopause
- Cyclical mastalgia is the most common presenting symptom
- Pain peaks before the menstrual cycle
- Tender nodularities or lumps in breast are assessed by the Cardiff Lucknow Nodularity Score
Fibroadenoma
- Most common cause of breast lumps
- Common in women aged 15 to 25
- Firm, painless, lobulated, and mobile
- Initial imaging of choice is breast ultrasound
- BIRADS II is the most common staging
- Biopsy indicated for complex or atypical fibroadenomas
Indications for Surgery
- Increased size or rapid increase in size
- Family history of breast cancer
- Painful fibroadenoma
- Giant fibroadenoma
- Patient desires surgery
Fibroadenoma Surgery
- Older methods involved open surgery
- Latest methods include vacuum-assisted, scarless breast surgery
Duct Papilloma
- Most common cause of bloody nipple discharge from a single duct
- Associated with papillary DCIS in 10% of cases
- Clinical features include unilateral periareolar nodule and bloody nipple discharge after pressing
Duct Ectasia
- Occurs in postmenopausal women and smokers
- Clinical features include dilated ducts, stasis of secretions, periductal mastitis, greenish or bluish discharge, and periareolar abscess or sinus
Types of Duct Papilloma
- Solitary papilloma is a single papilloma
- Papillomatosis has multiple papillomas
- Juvenile papillomatosis (Swiss cheese disease) is characterized by multiple papillomas in young women
Diagnosis and Treatment of Duct Papilloma
- Ultrasound may show papillomatous growth in the dilated ducts
- If inconclusive, an MRI is indicated
- Microdochectomy is the treatment of choice
- Other procedures like major duct excision and cone excision are possible after antibiotics if needed
Paget’s Disease vs. Eczema
- Paget’s disease affects the nipple-areolar complex in the breast and is unilateral
- Eczema affects the skin bilaterally and does not cause destruction
- Paget’s disease has an underlying lump
- Paget’s cells are usually ER, PR negative and CEA positive
- Paget’s disease is treated by removal of the underlying lump
- Eczema is treated with topical steroids
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Description
Test your knowledge on various breast disorders including Tietze’s syndrome, nipple discharge, and breast abscesses. This quiz covers relevant symptoms, causes, and treatments to help solidify your understanding of these conditions.
