Breast lump

Question 1

Mcc of breast lump

Answer 1

Mammary dysplasia

Question 2

Relationship of age and breast lump

Answer 2

<30yrs - Ca not suspected
>50yrs, pain+/- : mcc is breast CA

Breast Ca normally painless,
10% cases pain+

Question 3

Triple test in breast lump

Answer 3

1. H/o and breast exam
2. Imaging - Mamo/USG
3. Biopsy - FNAC and/or core biopsy

Most appropriate/best - Excision biopsy > FNAC

Question 4

Nipple discharge

Answer 4

+/- lump
1. Blood stained:
●<50yrs - Intraductal papilloma
>50yrs - Intraductal Ca
●Fibrocystic breast disease

2. Green grey
   Fibrocystic
   Mammary duct ectasia
3. Yellow
   Fibrocystic
   Intraductal CA
   Abscess
4. White
   Lactational
   Hyperprolactinaemia

Question 5

Paget disease of nipple

Answer 5

Underlying CA+
Red, scabby eczematous looking nipple
… Ulceration

Question 6

Imaging in breast lump according to age

Answer 6

<35yrs: USG b/l .. suspicious .. Mamo
35-50yrs: USG + Mamo
>50yrs: b/l mamo +/- USG

Question 7

Tumour markers

Answer 7

1. Oestrogen receptors - uncommon in normal breast
   Present in 2/3 of breast CA
   Good prognostic indicators
2. Progesterone receptors

Question 8

Mx of cystic breast lump

Answer 8

USG - Investigation of choice
Aspirate
1. Blood stained - cytology …
CA+ .. excision biopsy
CA negative .. review

2. Greenish yellow … cytology
   If residual lump+ after aspiration … excision biopsy
3. Could not aspirate - solid … excision biopsy
4. Recurrence of lump … excision biopsy

Question 9

Mx of solid breast lump

Answer 9

FNAC
If suspicious …
Excision biopsy

Question 10

*Breast CA R/f

Answer 10

1. > 40yrs
2. fam h/o 1st deg relative
3. Alcohol>2SD
4. HRT >5yrs
5. Western pop
6. Late menopause
7. Nulliparous
8. Child after 30yrs
9. Early menarche
10. Ashkenazi jewish ancestry
11. Radiation exposure

Question 11

Breast Ca c/f

Answer 11

1. Painless lump (10% pain)
2. Hard, irregular
3. Paget disease of nipple
4. Peu de orange skin - puckering
5. Nipple discharge

Question 12

Brease CA Mx

Answer 12

Sx + Radiation + Chemo

Insitu Ca - Lumpectomy
Spread - mastectomy

Question 13

Ductal CA insitu

Answer 13

Non-invasive, ductal epithelial cells
Pre cancerous

●Lumpectomy - risk of recurrence, +radio (or)
●Mastectomy - no risk of recurrence
●+/- Radiotherapy
●Tamoxifen if oestrogen receptors +

Good prognosis

Question 14

Ductal papilloma

Answer 14

Large mammary ducts neoplasm
benign
Blood stained discharge
Tripple test to dxt
Excision done

Question 15

Mammary duct ectasia

Answer 15

Large dilated breast ducts
Firm, painful mass near nipple
TOOTH PASTE LIKE DISCHARGE

Recurrence and fistula formation
Happens around menopause
Triple test to dxt

Question 16

Fibrocystic breast disease/ Fibroadenosis

Answer 16

Mammary dysplasia
30-50yrs
Mastalgia before periods
*Nodular, lumpy breasts

Mx:
Diffuse lumpy - Mamo
FNAC

Question 17

*Fibroadenoma

Answer 17

<30yrs, firm, smooth, mobile
BREAST MOUSE
Benign

Triple test

Excision if
1. Suspicious biopy
2. Large adenoma
3. Increasing size
4. >40yrs

Question 18

*Fat necrosis of breast

Answer 18

1. H/o trauma, could be 10yrs ago
2. Lump, nipple retraction, resembling CA
3. Triple test - dxt
4. *Most appropriate inv - excision biopsy
5. Disappears even if untreated