Breast

Question 1

Noticed breast lump 3 months ago, mobile, hardened one week after periods. Dx?
a) Fibroadenoma
b) Breast cancer
c) Intradural papilloma

Answer 1

Fibroadenoma

Question 2

50 year old Chinese lady with bilateral nipple retraction and painless discharge. Excision biopsy of nipple shows central duct dilatation and inflammation and periductal inflammation. Has been treated with surgery and requires no more treatment. What is the most likely diagnosis?
a) Mammary duct ectasia
b) Paget’s disease of the breast
c) Intraductal papilloma
d) Eczema

Answer 2

Mammary duct ectasia

Bilateral, inflammation + thickening of milk ducts with discharge

Question 3

Unilateral breast duct secretion with blood present. Diagnosis?
a) Mammary duct ectasia
b) Paget’s disease of the breast
c) Intraductal papilloma
d) Eczema

Answer 3

Intraductal papilloma = benign tumour of breast duct epithelial cells 􏰀 bloody discharge

Question 4

50 year old female Indian real estate agent, who presents with discomfort of the left nipple. It has been going on for some months now. She has tried topical emollients, but they had no effect. She has been otherwise well. On exam there is an eczemoid appearance of the left nipple and areolla. There is a discrete tethered nodule underneath the skin. There is no lymphadenopathy. What’s the most likely diagnosis?
a) Eczematous nipple
b) Breast cancer
c) Mammary Duct Ectasia
d) Intraductal papilloma
e) Fibrocystic disease
f) Breast abscess
g) Fibroadenoma

Answer 4

Pagets disease - DCIS

50-60% cases have underlying invasive carcinoma as well as DCIS

Question 5

Female with breast lump. Palpable axillary lymph nodes. Dx? a) Breast cancer
b) Fibroadenoma

Answer 5

Breast cancer

Question 6

Lady who has had a breast cancer removed, 13mm invasive ductal carcinoma, 4cm margin, 2/17 axillary lymph nodes positive. Which is the factor is most likely to impact her future prognosis?
a) Positive axillary lymph node involvement
b) Histological Grade of the tumor
c) Surgical margins
d) Size of the tumor
e) Subtype of the tumour

Answer 6

Positive axillary lymph node involvement

Question 7

68 year old female who has noticed lump in breast after her dog jumped up at her chest. Mobile and firm lump upper outer quadrant, 2 weeks later. Previous normal mammogram 2y ago
a) Fibroadenoma
b) Fat necrosis
c) Breast cancer
d) Hematoma

Answer 7

b) Fat necrosis

Fat necrosis if occur weeks after attack Breast cancer if noticed when dog attacked
- Upper outer quadrant (50%) > central (20%) > upper inner (15%) > 10% lower outer > 5% lower inner

Question 8

A 30-year-old woman sustained a traumatic blow to her right breast. The bruising resolved within three weeks but she felt a lump that persisted below the bruise. What is the most likely diagnosis?
a) Fibrocystic change
b) Fat necrosis
c) Fibroadenoma
d) Ductal carcinoma in-situ
e) Mammary duct ectasia

Answer 8

b) Fat necrosis

Question 9

Bilateral nipple milky discharge and irregular periods.

Dx? a) Prolactinoma
b) Intraductal papilloma

Answer 9

Prolactinoma