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87 Cards in this Set
- Front
- Back
what are the two cell types that line the ducts and lobules of the breast
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myoepithelial
luminal epithelial |
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what is important to know about carcinoma in situ of the breast in reference to the duct system
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1 duct systems is intertwined with all the others and occupies more than 1 quadrant of the breast. so even though the cancer may only be in one duct it can still be in several quadrants of the breast.
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what are the lesions of the terminal duct loular unit?
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cyst
sclerosiing adenosis small duct papilloma hyperplasia atypical hyperplasia carinoma |
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what are the lesions of the lobular stroma?
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fibroadenoma
phyllodes tumor |
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what are the lesions of the nipple and areola
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duct ectasia
recurrent suareolar abscess solitary ductal papilloma paget disease |
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what are the lesions of the interlobular stroma
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fat necrosis
lipoma fibrosu tumor firomatosis sarcoma |
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which type of cancer is more common in the breast ductal or lobular
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ductal is more common
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what is a change in the breast that can be confused for malignancy and why?
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lactation can cause cells to take on an appearance of foamy cytoplasm and enlarged nuclei
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what are some differences between young breast and older breast
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younger breast are denser on mammogram and have more lobules
older breast lubules often atrophic and most tissue is adipose. harder to spot masses in younger patients dense breast tissue. on mammongraphy |
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what are some congenital anomalies of the breast
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absence
supernumerary nipples or breasts accessory axillary breast tissue congenital inversion of niples macromastia(juvenile hypertrophy) |
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what is the importance of knowing if a patient has the congential anomaly of axillary breast tissue?
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cancer can spread into that axillary tissue and if a surgeon does a mastectomy they may miss the tissue in the axillary region.
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what does breast pain usually indicate?
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benign masses
95% of painful masses are benign |
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what are the stats about palpable masses in the breast
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under 40 mostly benign
over 50 mostly malignant |
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what does nipple discharge indicate
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most often nipple discharge is benign but if the discharge is bloody that can be worrisome
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what is the typical mammographic findings that indicate benign or malignant
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benign- well circumscribed round and no extensions
malgnant -extensions from lesion. crab like, radial extensions |
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what are the inflammatory disorders of the breast
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acute mastitis/abscess
periductal mastitis mammary duct etasia fat necrosis granulomatous mastitis |
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when do most cases of acute mastitis occur?
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during breast feeding
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what is the most common organism that causes acute mastitis and what type of organism is it?
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staphylococcus gram positive cocci
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what is the second most common cause of acute mastitis and what are the implications of it. what type of organism is it
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streptococccus gram positive cocci
can invovle the entire breast. |
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what is the presentation of periductal mastistis also called zuska disease?
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presents with painful erythematous subareolar mass
not associatted with lactation |
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what is a common risk factor in most patients with zuska disease?
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smokers
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what is the pathology behind zuska disease?
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squamous metaplasioa of the nipple duct linign leads to keratin pluggin, duct dilation, rupture and associated chronic inflammation to the keratin.
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who is the common patient with mammary duct etasia
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50-60yo woman who has given birth several times
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what is the presentation of mammary duct ectasia
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poorly defined palpable periareolar mass, often with thick white nipple discharge, skin retraction
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what is the pathology of mammary duct ectasia
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dilation of ducts with inspissated secretions, marked periductal chronic and granulomatous inflammatory reaction.
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what is the presentation of fat necrosis
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history of traumomr to breast or prior surgery
presents with painless palpable mass, skin thickening or retraction denisity or calcifications on mammogram |
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what is seen histiologically in fat necrosis
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fibrosis
histiocytes fibroblasts inflammatory cells |
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what is the single most common disorder of the female breast?
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fibrocytic changes grade 1 non-proliferative
40% of all lumps probably related to changes from menstrual cycle |
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what is the classic gross pathology of fibrocystic changes
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blue dome cyst
with local fibrosis surrounding it |
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what is the microscopic pathology found in fibrocytic changes
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cysts formatiom, fibrosis and adenosis
APOCRINE hyperplasia-cells with low nucleas to cytoplasm ratio, bright pink. prominent nucleus and nucleuolus |
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what are the characteristics proliferative breast disease
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characterized by proliferation of ductal epithelium and or stroma
small increased risk for cancer |
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what is important for differentiating ductal hyperplasia in proliferative breast disease from cancer
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if a duct is surrounded by myoepithelial cells it is assumed to be a non invasive process.
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what are the findings in proliferative conditions that are associated with a slight increased risk of cancer(1.5-2 times)
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sclerosing adenosis, moderate to florid ductal hyperplasia, papillomatosis(marked)
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what are the findings in proliferative conditions that are associated with signficantly increased risk (4-5 timse)
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atypical hyperplasia(ductal or lobular)
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what characterizes atypical ductal hyperplasia
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monoclonal hyperplasia population of ductal cells that take up part of but not the entire duct
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what characterizes atypical lobular hyperplasia
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monotonization of entire lobule
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what is the most common benign neoplasm
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fibroadenoma
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what are the benign neoplasms of the breast
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fibroadenoma
intraductal (large duct) papilloma nipple adenoma |
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what makes up fibroadenoma?
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ducts and stroma
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what is the typical presentation of fibroadenoma?
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20-40
aries from introalobular stroma frequently mulitple and bilateral may calcify sperical nodules, sharply circumscribed and mobile |
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what distinguishes a phyllodes tumor from a fibroandenoma?
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loss of biphasic pattern(ie ratio of duct to stroma), infiltrative borders, stromal cellulartity, nuclear pleomorhpism and mitoses
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what is the prognosis for phyllodes tumor
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most are benign but reccurent
high grade ones are malignant with frequent local recurrance and distant hematogenous metastastes |
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what is the typical description of a phyllodes tumor?
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leaf like
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what are the benign stromal lesions
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pseudoangiomatous stromal hyperplasia(PASH)
myofibroblastoma fibroma fibromatosis |
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what is the most common non-skin maliganancy in women
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carcinoma of the breast
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what are the risk factors that increase risk for breast cancer
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age
age of menache(earlier start increased risk) age of first live birth(increased later) BRCA, p53 mutations prior breast biopsies with atypical hyperplasia nonhispanic caucasian women have highest rate exposure to estrogen or radiation obesity |
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which type of BRCA related cancer is estrogen receptor positive?
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BRCA 1
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what are the common genetics causes of breast cancer
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BRCA1-2
p53 CHECK2 PTEN LKBI/STK11 ATM |
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what is P53 associated with
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most common mutated gene in sporadic breast cancer
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what is PTEN associated with
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Cowden syndrome
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what is LKBI/STK11 associated with?
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PJ syndrome
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what is ATM associated with
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Ataxia telangiectasia
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what is the stepwise progession of low grade invasive carinoma of breast
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normal/nonproliferative
proliferative atypical hyperplasi low/moderate grade DCIS low/moderate grad invasive carcinoma |
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what are the classifications of breast cancer
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noninvassive(in situ)
-ductal carcinoma in situ(DCIS) -lobular carcinoma in situ(LCIS) invasive(infiltrating |
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what are the subtypes of invasive carcinoma
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invasive ductal carcinoma
invasive lobular carcinoma medullary carcinoma colloid/munious carcinoma tubular carcinoma adenoid cystic carcinoma apocrine carcinoma invasive papillary carcinoma. |
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what stain can be used to differentiate ductal and lobular carcinoma?
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e-cadherin
absent in lobular |
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what type of cancer has the most normal RNA
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lobular
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what cancer has the more abnormal RNA
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triple negative basal like carcinoma
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what is seen on mammography in ductal carcinoma in situ
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calcification
linear and pleomorphic clustered |
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what is ductal carcinoma in situ(DCIS) defined as?
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consist of a malignant clonal population of cells limited to ducts and lobules by the basement membrane, myoepithelial cells are preserved.
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what is the gross finding in DCIS
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caseating necrosis
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what are the 4 subtypes of DCIS
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solid
micropapillary papillary cribriform |
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what are the two main things that determine prognosis in DCIS
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nuclear grade and presence of comedonecrosis(central necrosis)
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how are nuclei graded in DCIS
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how pleomorphic the nuclei are.
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what is the stain to tell if DCIS is invasive
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p63 and smooth muscle myosine
screening for myoepithelial cells completely surrounding the ducts |
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what is pagets disease?
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DCIS tumor cells that extend from nipple ducts into the contiguous skin
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what is the hallmark of pagets disease
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involvment of the epidermis by malignant cells
ulceration, fissures and ooxin of the skin of the nipple |
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what is a difference in the presentation of lobular carcinoma in situ(LCIS) as compared to DCIS
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LCIS does not present with calcification and is usually detected as an incidental finding in biopies done for other reasons
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what does it mean to a patient to have LCIS?
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there is no real treatment, you cant cut it out like you can with DCIS.
there is an increaseing risk of 1% per year with LCIS for subsequent risk of carcinoma. patient can opt for bilarteral mastectomy but most just opt to increase screening. |
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what are the grading criteria for infiltrating ductal carcinoma?
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ductal formation-more ducts lower score
nuclear pleomorphism-more pleomorphism higher score mitosis-more mitosis higher score all graded out of 3 |
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what are the characteristics of infiltrating lobular carcinoma?
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difficult to detect on PE or radiology
more often bilateral multicentric within same breast frequent metastasize cells lack E-cadherin |
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where do infiltrating lobular carcinoma usually metastasize to
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CSF, serosal surfaces, ovary and uterus.
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what is the typical score of a infiltrating lobular carcinoma
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5/9
3-no duct formation 1-little nuclear pleomorphism 1-low mitosis number |
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what is the typical arrangements of infiltrating lobular carcinoma
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targetoid arranging around the duct or in sheets
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what are the cell types found in medullary carcinoma
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lymphocytes
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what is the tumor grade for all medullary carcinoma?
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9/9 poorly differentiated
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what is the prognosis of medullary carcinoma?
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slighlty better than NST despite presence of poor prognostic factors
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discribe colloid carcinoma
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presence of multiple colloidal areas full of mucus
slow growing occuring mostly in older women little metastic potential good overal prognosis typically grade 5 |
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what is the character of tubular carcinoma
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very well differentiated 3/9 score
good prognosis frequenlty associated with ALH, LCIS, or low grad DCIS seldom can this be diagnosed occuring alone |
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what are the major prognostic indicators in breast cancer
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invasive vs in siitu
distant metastases lymph nod involvement size locally advanced(hard to find borders if it has spread to skind or pectoralis muscle) inflammatory carcinoma(ulceration and poe de orange) not good |
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what are the predicative markers and what do they indicate
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ER-estrogen receptor if positive can treat with estrogen
PR-progesterone receptor if positive can treat with progesterone Her2/Neu- only positive in poorly differentiated cancers, nuclear membrane staining, can be treated with herceptin if Her2/Neu positive usually ER/PR neg triple negative breast cancer is the worst associated with highest level or RNA and no real treatments |
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what type of cancer is associated with post radiation?
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vascular tumor(angiosarcoma)
not good prognosis |
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what is gynecomastia?
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enlargments of male breast
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what are the causes of gynecomastia
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puberty or the very aged
klinefelter syndrome functioning testicular tumors cirrhosis of the liver drugs-alcohol, marijuana, heroin and some psychoactives morticians: an estrogen containing embalming cream has been reported to cause gynecomastin in morticians |
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what are the characteristics of male breast cancer
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very rare
0.11% chance for average male occurs usually in the older strongly associated with BRCA2 acillary lymph nodes involvement common on presentation distant metastases to lungs, brain, bone, and liver are common |
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what is EIC
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extensive intraductal component
seen in ductal carcinoma in situ, indicating that there is a lot of diffuse ductal involvment and bc this cannot be felt by the surgeon its often difficult to ensure the entire margin of the tumor has been removed often with high EIC mastectomy is the best option |
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what are tram tracks on mammogram?
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clacification of vessels benign finding no indication of cancer
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