Breast Surgery

Question 1

• peri areolar mass/mass behind nipple and tenderness
• green discharge from nipple
• treated with antibiotics
• hx of smoking
• nipple retraction may be present

Diagnosis?

Answer 1

PERIDUCTAL MASTITIS

Question 2

Histology findings:
- well circumcised, smooth, regular, firm
- highly mobile
- size hasn’t changed in years
- unencapsulated
- clear margins
- separate from surrounding fatty tissue
- overgrowth of fibrous and glandular tissue
- low stromal cellularity
- duct like epithelium with fibrous bridging.

Diagnosis?

Answer 2

FIBROADENOMA

Question 3

Patient is being treated with Tamoxifen. What medication should be added?

Answer 3

BISPHOSPHONATES
- reduce risk of bone metastasis in breast cancer.

Question 4

• hx of chemo and radiotherapy
• hx of angiosarcoma
• purple nodule on chest
• enlarging
• irregular borders
• purple/blue pigmentation

Diagnosis?

Answer 4

ANGIOSARCOMA

Question 5

• unilateral
• pruritis/dryness/scaly/itchy/erythematous nipple
• no discharge
• nipple may bleed
• inverted nipple over time

Diagnosis?

Answer 5

PAGETS DISEASE
in situ carcinoma involving nipple epidermis

MX
skin punch biopsy

Question 6

• hx of mastectomy and axillary LN removal
• presents with upper limb swelling
• also, hx of insect bite but long time ago and no rash or itchiness (if 1-2 hrs hx of bite > angioedema would be the diagnosis)
• no fever

Diagnosis?

Answer 6

LYMPHOEDEMA
axillary LN

other symptoms post lymph node clearance:
- frozen shoulder
- fluid collection at site
- numbness around scar and upper limb

Question 7

• smoker
• brown/green foul-smelling discharge
• pain
• subareolar mass/mass behind nipple
• nipple retraction

Diagnosis?

Answer 7

DUCT ECTASIA

MX
Galactogram

Question 8

• US shows hypoechoic mass, irregular borders/spiculated/micro lobulated margins and posterior acoustic shadowing
• lump is firm and fixed

Next step?

Answer 8

CORE BIOPSY

Imaging already shows malignancy findings so no need for mammogram.

Fine needle would be used if cystic lesion/Fibroadenoma.

Question 9

• painless bleeding from nipple
• no mass
• no skin changes

Diagnosis?

Answer 9

INTRADUCTAL PAPILLOMA

MX
Galactogram

Question 10

• usually, bilateral
• pain related to menstrual cycles
• dull and achy pain
• no mass
• no nipple discharges
• no skin changes

Diagnosis?

Answer 10

CYCLICLA MASTALGIA

MX
- paracetamol
- NSAID topical
- better fitting bra

Question 11

• unilateral pain
• intermittent
• burning/stabbing pain
• no relation to menstrual cycle
• no mass
• no nipple discharges

Diagnosis?

Answer 11

NON-CYCLICLA MASTALGIA

Question 12

• hx of trauma to breast
• subareolar mass
• may have bruising/dimpling
• mass is painless and firm

Diagnosis?

Answer 12

FAT NECROSIS

Question 13

• man with hx of breast cancer
• had surgery

What adjunctive therapy would you add?

Answer 13

TAMOXIFEN
- most men are ER 2 +

Question 14

histopathological findings:
- encapsulated adipocytes with fibrotic stroma

Diagnosis?

Answer 14

HAMARTOMA

Question 15

Most common breast cancer?

Answer 15

INTRADUCTAL INVASIVE CARCINOMA
- extending to epithelium causes skin to be red and dimpled

Question 16

• hx of breast cancer treatment
• presents with thirst and confusion
• drowsy
• shoulder pain

Which electrolyte abnormality?

Answer 16

HYPERCALCEMIA
due to bone metastasis in breast cancer

presentation:
- MOANS: decreased bowel activity > constipation
- STONES: polydipsia/polyuria due to nephrogenic diabetes insipidus. Also results in kidney stones.
- GROANS: lethargy/confusion/depression
BONES; bone pain seen in hyperparathyroidism.
- ECG shows short QT

MX
IV saline

Question 17

• milky or yellow (if hx of I and D of abscess) discharge from nipple/peri areolar discharge
• pain around nipple
• swelling and redness
• fever may be present
• no mass
• no LN
• no skin changes
• no nipple retraction

Answer 17

MAMILLARY DUCT FISTULA

associated with smoking and periductal mastitis.

MX
- fistulectomy with antibiotics