The correct answer is CRisk factors- Age
- Exposure to exogenous estrogen
- Family history
- Pregnancy
- Genetics
AGE
- 85% of breast cancers occur in women over 50yrs
- 10% in women in their 40’s
Family history
- first degree relatives is most important
- number of affected family members-increased risk with closer the relation and earlier the age of diagnosis
Endogenous estrogen
- Prolonged exposure to endogenous estrogen.
- Look at early onset of menarche-age <12yrs
Pregnancy
- Pregnancy- first life birth before 30yrs
- Risk increases for live births after 35yrs
- Risk again increases for nulliparous women
- Also there is an increased risk with lower cumulative months of lactation
- All of these prolong lifetime exposure to estrogen peaks of menstrual cycle
Prolonged exposure to exogenous estrogen
- After menopause –initiation of estrogen replacement therapy ( ERT)
- Delays onset of osteoporosis
- Protective against heart disease and stroke
- Studies have shown an increased risk of breast cancer after 5yrs
- Consensus that benefits outweigh risks
Also implicated is oral Contraceptives-suspected increased risk but evidence is contradictory,newer formulas combo of low dose estrogen and progesterone are thought to be better
The correct answer is C
Pancreatic endocrine tumor, functional
Somatostatin-secreting (somatostatinoma) (diabetes mellitus, cholelithiasis, steatorrhea, hypochlorhydria)
Adrenocorticotropic hormone-producing (Cushing’s syndrome: central obesity, muscle weakness, glucose intolerance, hypertension)
- Insulinoma
- Most common islet cell tumor
- May secrete enough insulin to cause hypoglycemia
- Sxs: confusion, stupor, loss of consciousness
- Morphology
- most are solitary adenomas, 10% are multiple, 10% are metastatic
- See diffuse islet hyperplasia, with normal β cells (rectangular granules)
- Gastrinoma (Zollinger-Ellison syndrome)
- Triad of disease: peptic ulcers, gastric hypersecretion, endocrine gastrin-secreting tumor
- 60% are malignant
- Histology is similar to normal G cells
- Pts present with severe diarrhea, fluid/electrolyte imbalance and malabsorption
- Glucagonoma
- sxs similar to diabetes mellitus; have migratory skin erythema and anemia
- Somatostatinoma
- sxs: diabetes mellitus, cholelithiasis, steatorrhea, hypochlorhydria
- VIPoma
- sxs: watery diarrhea, hypokalemia, achlorhydria; associated with neural crest tumors
The Correct Answer is AThe gastrinoma syndrome, or Zollinger-Ellison syndrome, has traditionally been associated with a severe, fulminant ulcer diathesis, often with multiple ulcers, and ulcers in unusual locations such as the post-bulbar region of the duodenum and proximal jejunum.
The vast majority of Zollinger-Ellison syndrome (ZES) patients will develop ulcers, usually in the duodenal bulb, but sometimes also in the postbulbar duodenum or jejunum. An elevated serum gastrin concentration in a patient who is not achlorhydric is pathognomonic of the disease. Secretin testing adds little but may be positive on occasion in the rare patient with only minimally elevated serum gastrin. Extremely elevated serum gastrin levels (>1000 pg/ml) are not diagnostic of ZES as similar elevations do occur in patients who are achlorhydric. Therefore it is generally necessary to document the presence of gastric acid production when evaluating very elevated serum gastrin concentrations with gastric pH measurements or formal gastric analysis.
