ABSITE – Breast CORRECT
QUESTIONS & ANSWERS(RATED A+)
What is the histology of infiltrating lobular carcinoma? - ANSWERClassic histologic
appearance of invasive lobular carcinoma of breast origin with small ovoid cells with
little cytoplasm in an infiltrating single-file pattern
How to treat breast abscesses that are large OR have overlying skin necrosis OR
have loculations? - ANSWERIncision and drainage
serial needle aspiration is preferred for simple abscesses
*continue breastfeeding if feasible
What is the management for fibroadenomas? - ANSWERFibroadenomas are benign
lesions that can be followed with clinical exam or ultrasound
If there is any concern for cancer on biopsy, the mass is enlarging (>2 or 3cm), or it
causes pain, it should be excised
Fibroadenomas that are degenerating are coarse and popcorn calcification on
mammography
Fibroadenomas can fluctuate with menses and grow with the hormonal stimulation of
oral contraceptives and pregnancy
Fibroadenoma identities can be confirmed by ultrasound-guided core biopsy, after
which most can be left in place and observed over time with serial exams or
ultrasound if a mass is not palpable
How do you treat true gynecomastia in a young male? - ANSWERDirect surgical
excision of the glandular tissue and liposuction of the surrounding adipose tissue
may be adequate to treat true gynecomastia
*If the breast tissue has grown in size, more extensive excision of the breast tissue
involving the skin excision may be necessary to achieve a satisfactory cosmetic
outcome
Less likely to regress with observation alone or with aromatase inhibitors due to
fibrosis that has likely set in
What are the risk factors for male breast cancer? - ANSWERestrogen exposure
significant family history
BRCA mutation (BRCA 1 = 1% lifetime risk; BRCA 2 = 10% lifetime risk)
Prior chest radiation
Androgen insufficiency, testicular atrophy
Obesity, cirrhosis
Klinefelter syndrome
, Treatment for male breast cancer - ANSWERlumpectomy, SLNB, radiation is
mainstay
simple mastectomy
Endocrine therapy b/c most male breast cancers are estrogen receptor positive (give
tamoxifen x5 years)
*men are likely to present later and receive less adequate treatment
*men are less likely to get lobular histology due to lack of terminal lobules in the
breast
Describe the BIRADS classification: - ANSWERBIRADS 0 : need additional imaging
BIRADS 1 : negative, continue routine screening, 0% likelihood cancer
BIRADS 2 : benign, continue routine screening, 0% likelihood cancer
BIRADS 3 : likely benign, screening short interval (6 mo), 2% or less likelihood
cancer
BIRADS 4 : suspicious, tissue diagnosis (core needle or excisional bx if core needle
inconclusive), >2% to <95% likelihood cancer depending on radiographic suspicion
BIRADS 5 : highly suggestive of malignancy, tissue diagnosis (bx), 95% or greater
likelihood cancer
BIRADS 6 : bx proven malignancy, surgical excision when clinically appropriate,
cancer proven
What is the reconstruction option for a patient with history of mastectomy and
irradiation and do not want to perform a procedure on the contralateral breast? -
ANSWERDeep inferior epigastric flap (DIEP) reconstruction b/c no muscle is taken
and it is the preferable option in cases that the arterial perforators are viable (it will
provide both soft tissue and volume and offer abdominal wall preservation...but slight
increase in rate of partial flap loss and necrosis)
**breast reconstruction is a combination of both soft tissue and volume
After mastectomy when the breast is irradiated, the tissue can change resulting to a
decrease volume and increased risk of contracture
For breast reconstruction there are multiple options such as:
tissue expanders with later exchange for an implant
immediate implant placement (increased risk of capsule contracture due to damaged
skin)
latissimus dorsi flap with an implant or thoracodorsal arteyr perforator flap (TDAP)
(both do not give volume for symmetry)
and autologous tissue (pedicled or free)
What imaging should all women over the age of 40 with a palpable breast mass
undergo? - ANSWERDiagnostic mammogram AND ultrasound
in order to classify the nature of the lesion by BIRADS to guide management
How is the treatment different for non-classic lobular carcinoma in situ vs. classic
lobular carcinoma in situ (LCIS)? - ANSWERNon-classic lobular carcinoma in situ
(LCIS) (or pleomorphic or florid LCIS) is recommended to undergo a needle-
localized excision of the area involved
QUESTIONS & ANSWERS(RATED A+)
What is the histology of infiltrating lobular carcinoma? - ANSWERClassic histologic
appearance of invasive lobular carcinoma of breast origin with small ovoid cells with
little cytoplasm in an infiltrating single-file pattern
How to treat breast abscesses that are large OR have overlying skin necrosis OR
have loculations? - ANSWERIncision and drainage
serial needle aspiration is preferred for simple abscesses
*continue breastfeeding if feasible
What is the management for fibroadenomas? - ANSWERFibroadenomas are benign
lesions that can be followed with clinical exam or ultrasound
If there is any concern for cancer on biopsy, the mass is enlarging (>2 or 3cm), or it
causes pain, it should be excised
Fibroadenomas that are degenerating are coarse and popcorn calcification on
mammography
Fibroadenomas can fluctuate with menses and grow with the hormonal stimulation of
oral contraceptives and pregnancy
Fibroadenoma identities can be confirmed by ultrasound-guided core biopsy, after
which most can be left in place and observed over time with serial exams or
ultrasound if a mass is not palpable
How do you treat true gynecomastia in a young male? - ANSWERDirect surgical
excision of the glandular tissue and liposuction of the surrounding adipose tissue
may be adequate to treat true gynecomastia
*If the breast tissue has grown in size, more extensive excision of the breast tissue
involving the skin excision may be necessary to achieve a satisfactory cosmetic
outcome
Less likely to regress with observation alone or with aromatase inhibitors due to
fibrosis that has likely set in
What are the risk factors for male breast cancer? - ANSWERestrogen exposure
significant family history
BRCA mutation (BRCA 1 = 1% lifetime risk; BRCA 2 = 10% lifetime risk)
Prior chest radiation
Androgen insufficiency, testicular atrophy
Obesity, cirrhosis
Klinefelter syndrome
, Treatment for male breast cancer - ANSWERlumpectomy, SLNB, radiation is
mainstay
simple mastectomy
Endocrine therapy b/c most male breast cancers are estrogen receptor positive (give
tamoxifen x5 years)
*men are likely to present later and receive less adequate treatment
*men are less likely to get lobular histology due to lack of terminal lobules in the
breast
Describe the BIRADS classification: - ANSWERBIRADS 0 : need additional imaging
BIRADS 1 : negative, continue routine screening, 0% likelihood cancer
BIRADS 2 : benign, continue routine screening, 0% likelihood cancer
BIRADS 3 : likely benign, screening short interval (6 mo), 2% or less likelihood
cancer
BIRADS 4 : suspicious, tissue diagnosis (core needle or excisional bx if core needle
inconclusive), >2% to <95% likelihood cancer depending on radiographic suspicion
BIRADS 5 : highly suggestive of malignancy, tissue diagnosis (bx), 95% or greater
likelihood cancer
BIRADS 6 : bx proven malignancy, surgical excision when clinically appropriate,
cancer proven
What is the reconstruction option for a patient with history of mastectomy and
irradiation and do not want to perform a procedure on the contralateral breast? -
ANSWERDeep inferior epigastric flap (DIEP) reconstruction b/c no muscle is taken
and it is the preferable option in cases that the arterial perforators are viable (it will
provide both soft tissue and volume and offer abdominal wall preservation...but slight
increase in rate of partial flap loss and necrosis)
**breast reconstruction is a combination of both soft tissue and volume
After mastectomy when the breast is irradiated, the tissue can change resulting to a
decrease volume and increased risk of contracture
For breast reconstruction there are multiple options such as:
tissue expanders with later exchange for an implant
immediate implant placement (increased risk of capsule contracture due to damaged
skin)
latissimus dorsi flap with an implant or thoracodorsal arteyr perforator flap (TDAP)
(both do not give volume for symmetry)
and autologous tissue (pedicled or free)
What imaging should all women over the age of 40 with a palpable breast mass
undergo? - ANSWERDiagnostic mammogram AND ultrasound
in order to classify the nature of the lesion by BIRADS to guide management
How is the treatment different for non-classic lobular carcinoma in situ vs. classic
lobular carcinoma in situ (LCIS)? - ANSWERNon-classic lobular carcinoma in situ
(LCIS) (or pleomorphic or florid LCIS) is recommended to undergo a needle-
localized excision of the area involved
