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Embryologic origin of breast
Ectoderm milk streak
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Hormone involved in duct development
Estrogen
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Hormone involved in lobular development
Progesterone
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Hormone that synergizes estrogen and progesterone
Prolactin
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Nerve innervating serratus anterior
Long thoracic
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Nerve innervating latissiumus dorsi
Thoracodorsal
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Artery supplying serratus anterior
Lateral thoracic
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Artery supplying latissimus dorsi
Thoracodorsal
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Nerve innervating pec major and minor
Medial pectoral
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Nerve innervating pec major only
Lateral pectoral
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Nerve providing sensation to medial arm and axilla
Intercostobrachial
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Valveless vein plexus that allows direct hematogenous mets of breast cancer to spine
Batson�s plexus
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Most common cancer causing primary axillar lymphadenopathy
Lymphoma
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Suspensory ligaments that divide the breast into segments
Cooper�s ligaments
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Most common organism in breast abscesses
S. Aureus
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Causes of breast abscess in nonpregnant women (4)
Actinomyces, TB, syphilis, SLE
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Breast cyst filled with milk; occurs with breastfeeding
Galactocele
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Drugs that can cause gynecomastia (3)
Cimetidine, spironolactone, marijuana
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Most common breast anomaly
Accessory nipples
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Hypoplasia of chest wall, amastia, hypoplastic shoulder, no pectoralis
Poland syndrome
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Treatment of mastodynia
Danazol, OCP�s, NSAIDS
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Benign cluster of calcifications on mammogram that can look like breast ca
Sclerosing adenosis
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Most common cause of bloody discharge from nipple
Papilloma
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Most common breast lesion in adolescents and young women
Fibroadenoma
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Most common cause of green nipple discharge
Fibrocystic disease
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Types of nipple discharge that are concerning
Bloody, unilateral, spontaneous
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Mammogram with Swiss cheese appearance
Diffuse papillomatosis
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Malignant cells of ductal epithelium without invasion of the basement membrane
DCIS
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Margin needed for DCIS
2-3mm
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most aggressive subtype of DCIS
comedo pattern
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marker for potential future malignancy
LCIS
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Treatment of LCIS
Nothing, tamoxifen, or bilateral prophylactic mastectomy
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Lifetime US breast cancer risk
12%
-
minimum size of a detectable mass on mammogram
5mm
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nodes lateral to pectoralis minor muscle
Level I nodes
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Nodes beneath pectoralis minor muscle
Level II nodes
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Nodes medial to pectoralis minor muscle
Level III nodes
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Nodes between pectoralis major and minor
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Mammogram score meaning �probably benign finding�; needs short-term followup
-
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Mammogram score meaning �highly suspicious for cancer�
Birads 5
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Mammogram score meaning �biopsy proven cancer�
Birads 6
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Mammogram score meaning benign finding
Birads 2
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Mammogram score meaning no finding/negative
Birads 1
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Mammogram score meaning �indeterminate; needs additional imaging�
Birads 0
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Most important prognostic staging factor in breast cancer
Nodal status
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5-year survival of breast cancer with 0 positive nodes
75%
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5-year survival of breast cancer with 1-3 positive nodes
60%
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5-year survival of breast cancer with 4-10 positive nodes
40%
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most common distant metastasis of breast cancer
bone
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T staging of breast cancer
T1: <2cm, T2: 2-5cm, T3: >5cm, T4: skin or chest wall involvement
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N staging of breast cancer
N1 ispi axillary, N2 fixed ipsi axillary, N3: ipsi internal mammary nodes
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M staging of breast cancer
Distant mets, including supraclavicular nodes
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Strong risk factors for breast cancer (4)
BRCA gene, >=2 primary relatives w/cancer, previous DCIS, Atypical hyperplasia
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Moderate risk factors for breast cancer (6)
Family hx, early menarche, nulliparity, radiation, previous breast ca, high-fat diet
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Gene associated with ovarian, endometrial, and breast ca
BRCA I
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Gene associated with male breast ca and breast ca
BRCA II
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Percentage of breast cancers negative for both estrogen and progesterone
10%
-
risk factors for male breast cancer (4)
steroid use, XRT, family hx, Klinefelter�s
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% of breast cancers that are ductal
85%
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% of breast cancers that are lobular
10%
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pathological finding conferring worse prognosis of lobular breast cancer
Signet ring cells
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Dermal lymphartic invasion of breast cancer causing dimpling
Peau d�orange
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Surgical option for breast cancer leaving 1-2% of breast tissue
Subcutaneous mastectomy
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Margin needed for invasive cancer lumpectomy
1cm
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tissues resected in radical mastectomy
overlying skin, pec major and minor, level I-III nodes
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contraindications to XRT following breast cancer resection
scleroderma, previous XRT, SLE, active rheumatoid arthritis
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indications for XRT after mastectomy (7)
>4 nodes, skin/chest wall involvement, positive margins, tumor >5cm, extracapsular nodal invasion, inflammatory cancer, fixed axillary nodes
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chance of local recurrence after lumpectomy
10%
-
patients needing chemotherapy
>1cm and all with positive nodes
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patients needing hormonal therapy
those with ER+ or PR+
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risks of tamoxifen (2)
blood clot, endometrial ca (each 1% risk)
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stellate, irregular, speculated mass lesion that is benign
radial scar
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locally invasive spindle cells that mimic breast ca
fibromatosis
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malignant tumors with a benign appearance (3)
mucinous CA, medullary CA, cystosarcoma phylloides
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scaly skin lesion on nipple with DCIS or ductal CA in breast
Paget�s disease
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Tumor resembling giant fibroadenoma; no nodal metastases
Cystosarcoma phylloides
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Lymphangiosarcoma from chronic lymphedema following axillary dissection
Stewart Treves syndrome
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