Breast Lesions

Question 1

fibroadenoma story

Answer 1

woman with smooth, painless, nontender, well circumscribed, nodule who is under 30 comes because she is scared shes got cancer. You do a core/ excisional biopsy/ FNA + U/S and find out that its PROLIFERATIVE but benign, so you excise if symptomatic or just f/u q6mos x 2 yrs. Tell her to be afraid though- because shes at increased risk of cancer

Question 2

Fibrocystic disease

Answer 2

Woman scared due to bilateral upper and outer quadrant breast pain with some focal cystic areas. You U/S +- FNA, or do mammogram, and see that its just fibrous + cystic changes that dont increase her risk of breast cancer. For Tx, aspirate if its a cyst ( to get rid of the lump), and give reassurance, analgesia.

Question 3

breast abscess

Answer 3

woman comes in with breast that is hot, hurts, nipple inverted with D/C. U/S to make sure its just pus ( if suspiscious of cancer need biopsyy/MRI), and then give broad spectrum Abx, Incision adn Drain pus. If she doesnt want to treat, you tell her that leaving pus means breast tissue damaged/ might create fistula

Question 4

DCIS - ductal carcinoma in situ

Answer 4

story: woman gets a screening mammogram and there are “microcralcifications”. This could be DCIS or LCIS. So now you do a CORE NEEDLE biopsy, and CT for mets. Treat with lumpectomy with wide excision margins + radiation. She may need masectomy if the microcalcifications are everywhere

Question 5

LCIS story. Doc, whats my cancer risk?

Answer 5

For some reason the woman was having biopsy and they found these malignant cells completely contained in the breast lobe. You further investigation with mammo, U/S, CORE needle biopsy and if theres something there, treat with excisional biopsy + tamoxifen if needed. not a precursor lesion to cancer, but considered a risk fact for breast cancer development

Question 6

Infiltrating ductal carcinoma - most common breast cancer

Answer 6

woman has a palpable breast pass, and mammogram shows spiculated mass + calcifications. To make sure its not a benign mass, you do mammo, U/S, core needle biopsy. To make sure the cancer hadnt gone elsewhere you do bone scan, Abdo U/S, CT
- the ductal cells migrate into the supporting stroma, so treatment is lumpectomy +- chemo with recurrence in 5 years.

Question 7

Invasive lobular carcinoma

Answer 7

this one is similar to infiltrating ductal carcinoma, but has less calcifications so its harder to pick up on mammogram. pt may or may not have palpable mass. Investigate with mammo, US, cores of breast and axillary lymph nodes. You stage it, and then treat it by cutting it out + chemo.

Question 8

pagets disease

Answer 8

the story is that a woman comes in and her nipple looks weird, and you see scaling/ eczema of the nipple. You wonder if it is eczema, or contact dermatitis, or even SCC, BCC/ malignant melanoma. So you do a wedge/punch biopsy + mammogram to see if there are cysts anywhere else. Biopsy +, you do TNM staging and excise the nipple, areola + underlying cancer. you have a decreased 5 yr survival if the mass is palpable. :(