ABSITE ch 24 breast

1. Embryologic origin of breast

Ectoderm milk streak

2. Hormone involved in duct development

Estrogen

3. Hormone involved in lobular development

Progesterone

4. Hormone that synergizes estrogen and progesterone

Prolactin

5. Nerve innervating serratus anterior

Long thoracic

6. Nerve innervating latissiumus dorsi

Thoracodorsal

7. Artery supplying serratus anterior

Lateral thoracic

8. Artery supplying latissimus dorsi

Thoracodorsal

9. Nerve innervating pec major and minor

Medial pectoral

10. Nerve innervating pec major only

Lateral pectoral

11. Nerve providing sensation to medial arm and axilla

 Intercostobrachial

12. Valveless vein plexus that allows direct hematogenous mets of breast cancer to
spine

Batson�s plexus

13. Most common cancer causing primary axillar lymphadenopathy

Lymphoma

14. Suspensory ligaments that divide the breast into segments

Cooper�s ligaments

15. Most common organism in breast abscesses

S. Aureus

16. Causes of breast abscess in nonpregnant women (4)

Actinomyces, TB, syphilis, SLE

17. Breast cyst filled with milk; occurs with breastfeeding

Galactocele

18. Drugs that can cause gynecomastia (3)

Cimetidine, spironolactone, marijuana

19. Most common breast anomaly

Accessory nipples

20. Hypoplasia of chest wall, amastia, hypoplastic shoulder, no pectoralis

Poland syndrome

21. Treatment of mastodynia

Danazol, OCP�s, NSAIDS

22. Benign cluster of calcifications on mammogram that can look like breast ca
 Sclerosing adenosis

23. Most common cause of bloody discharge from nipple

Papilloma

24. Most common breast lesion in adolescents and young women

Fibroadenoma

25. Most common cause of green nipple discharge

Fibrocystic disease

26. Types of nipple discharge that are concerning

Bloody, unilateral, spontaneous

27. Mammogram with Swiss cheese appearance

Diffuse papillomatosis

28. Malignant cells of ductal epithelium without invasion of the basement membrane

DCIS

29. Margin needed for DCIS

2-3mm

30. most aggressive subtype of DCIS

comedo pattern

31. marker for potential future malignancy

LCIS

32. Treatment of LCIS

Nothing, tamoxifen, or bilateral prophylactic mastectomy

33. Lifetime US breast cancer risk

 12%

34. minimum size of a detectable mass on mammogram

5mm

35. nodes lateral to pectoralis minor muscle

Level I nodes

36. Nodes beneath pectoralis minor muscle

Level II nodes

37. Nodes medial to pectoralis minor muscle

Level III nodes

38. Nodes between pectoralis major and minor

39. Mammogram score meaning �probably benign finding�; needs short-term
followup
40. Birads 3
41. Mammogram score meaning �highly suspicious for cancer�

Birads 5

42. Mammogram score meaning �biopsy proven cancer�

Birads 6

43. Mammogram score meaning benign finding

Birads 2

44. Mammogram score meaning no finding/negative

Birads 1

45. Mammogram score meaning �indeterminate; needs additional imaging�

Birads 0

46. Most important prognostic staging factor in breast cancer

 Nodal status

47. 5-year survival of breast cancer with 0 positive nodes

75%

48. 5-year survival of breast cancer with 1-3 positive nodes

60%

49. 5-year survival of breast cancer with 4-10 positive nodes

40%

50. most common distant metastasis of breast cancer

bone

51. T staging of breast cancer

T1: <2cm, T2: 2-5cm, T3: >5cm, T4: skin or chest wall involvement

52. N staging of breast cancer

N1 ispi axillary, N2 fixed ipsi axillary, N3: ipsi internal mammary nodes

53. M staging of breast cancer

Distant mets, including supraclavicular nodes

54. Strong risk factors for breast cancer (4)

BRCA gene, >=2 primary relatives w/cancer, previous DCIS, Atypical

hyperplasia

55. Moderate risk factors for breast cancer (6)

Family hx, early menarche, nulliparity, radiation, previous breast ca, high-fat
diet

56. Gene associated with ovarian, endometrial, and breast ca

BRCA I
57. Gene associated with male breast ca and breast ca

BRCA II

58. Percentage of breast cancers negative for both estrogen and progesterone

10%

59. risk factors for male breast cancer (4)

steroid use, XRT, family hx, Klinefelter�s

60. % of breast cancers that are ductal

85%

61. % of breast cancers that are lobular

10%

62. pathological finding conferring worse prognosis of lobular breast cancer

Signet ring cells

63. Dermal lymphartic invasion of breast cancer causing dimpling

Peau d�orange

64. Surgical option for breast cancer leaving 1-2% of breast tissue

Subcutaneous mastectomy

65. Margin needed for invasive cancer lumpectomy

1cm

66. tissues resected in radical mastectomy

overlying skin, pec major and minor, level I-III nodes

67. contraindications to XRT following breast cancer resection

scleroderma, previous XRT, SLE, active rheumatoid arthritis

68. indications for XRT after mastectomy (7)

>4 nodes, skin/chest wall involvement, positive margins, tumor >5cm,

extracapsular nodal invasion, inflammatory cancer, fixed axillary nodes

69. chance of local recurrence after lumpectomy

10%

70. patients needing chemotherapy

>1cm and all with positive nodes

71. patients needing hormonal therapy

those with ER+ or PR+

72. risks of tamoxifen (2)

blood clot, endometrial ca (each 1% risk)

73. stellate, irregular, speculated mass lesion that is benign

radial scar

74. locally invasive spindle cells that mimic breast ca

fibromatosis

75. malignant tumors with a benign appearance (3)

mucinous CA, medullary CA, cystosarcoma phylloides

76. scaly skin lesion on nipple with DCIS or ductal CA in breast

Paget�s disease

77. Tumor resembling giant fibroadenoma; no nodal metastases

Cystosarcoma phylloides

78. Lymphangiosarcoma from chronic lymphedema following axillary dissection

Stewart Treves syndrome