414 Obstetrics and Gynecology Board Review •••
❍ What nerve injuries can occur after a mastectomy?
The long thoracic nerve innervates the serratus anterior muscle, and injury results in winged scapula. The
thoracodorsal nerve can be injured causing paresis of the latissimus dorsi muscle. Injury to the intercostal brachial
nerve causes numbness, tingling, or pain on the upper, medial aspect of the ipsilateral arm.
❍ What is the best single indicator of breast cancer prognosis?
The extent of nodal involvement.
❍ What is the characteristic histologic invasion pattern of infiltrating lobular carcinoma?
These tumors classically invade in a single file fashion and exhibit a “targetoid” or concentric ring formation
around normal ducts.
❍ What is the prognosis of medullary carcinoma?
It has an excellent prognosis with 10-year survivals of up to 90%.
❍ What is the prognosis for tubular carcinoma?
It is the best of all invasive carcinomas with a 5-year survival rate approaching 100%.
❍ What is the prognosis for mucinous (colloid) carcinoma of the breast?
It has a 10-year survival of up to 90% for the typical mucinous carcinoma.
❍ How common are axillary lymph node metastases in tubular carcinoma?
<10% of cases.
❍ What is the maximal tumor measurement for a stage I breast carcinoma?
2 cm or less.
❍ What is the maximal tumor measurement for a stage II breast carcinoma?
5 cm or less.
❍ How does the presence or absence of hormone receptors in a tumor affect prognosis?
Tumors with high numbers of hormone receptors have a slightly better prognosis than those without.
❍ How does mammary Paget disease differ from extramammary Paget disease?
While it is uncommon to have underlying adenocarcinoma in extramammary Paget disease, Paget disease of
the nipple is characterized by the presence of intraepidermal malignant cells from an underlying invasive ductal
carcinoma or DCIS.
❍ What is the clinical presentation of mammary Paget disease?
Erythema, thickening, crusting, and/or itching of the nipple-areolar complex.