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PLAB 1 August 2024 > Breast surgery > Flashcards

Breast surgery Flashcards

1
Q

Describe the histology of benign breast cancer conditions.

A
  • Well circumscribed
  • Unencapsulated
  • Clean margins
  • Columnar cell hyperplasia
  • Fibrocystic changes
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2
Q

Name the benign breast conditions.

A
  • Fibrocystic changes
  • Fibroadenoma
  • Breast cyst
  • Lactational mastitis
  • Periductal mastitis
  • Duct ectasia
  • Fat necrosis
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3
Q

Benign breast conditions

What are the symptoms and presentation of fibroadenoma?

A
  • Common in adolescent women;
  • Firm;
  • Non tender;
  • Highly mobile;
  • Upper outer quadrant.
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4
Q

Benign breast conditions

How is the diagnosis of fibroadenoma made?

A

Most appropriate investigation:
- Ultrasound

If required:
- FNAC
- Biopsy

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5
Q

What is the histology presentation of fibroadenoma?

HIGH YIELD

A
  • ⬇︎ stromal cellularity;
  • Overgrowth of fibrous and glandular tissue;
  • Duct-like epithelium with fibrous bridging (????);
  • Well circumscribed;
  • Unencapsulated;
  • Clear margins;
  • Separated from the surrounding fatty tissues.
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6
Q

Benign breast conditions

What are the symptoms and presentation of fibrocystic changes?

A
  • Affects premenopausal women;
  • Pain and lumpiness of breast.
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7
Q

Benign breast conditions

What are the symptoms and presentation of breast cyst?

A
  • Fluid filled round mass;
  • Asymptomatic or painful.
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8
Q

What are the symptoms and presentation of lactational mastitis?

A

Symptoms:
- Unilateral and firm;
- Erythema in a wedged shaped area;
- Tender breast;
- Usually on the first 3 months of breast-feeding;

Cause:
- S. Aureus

Rx:
- Analgesics;
- Warm compress;
- Keep on breast-feeding;
- Flucloxacillin;
- Penicillin allergy: erytromycin / clarithromycin

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9
Q

Benign breast conditions

What are the symptoms and presentation of periductal mastitis?

A

Symptoms:
- Green nipple discharge;
- Peri-areolar mass;
- Nipple rectration;
- Periareolar redness
- Hot and tender breast

Cause:
- S. Aureus

Risk factor:
- Smoking

Rx:
- Analgesics;
- Warm compress;
- Co-amoxiclav;
- Penicillin allergy: erytromycin / clarithromycin

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10
Q

Benign breast conditions

What are the symptoms and presentation of duct ectasia?

A

Symptoms:
- Green or brown nipple discharge;
- Nipple rectration;
- Subareolar mass (near the nipple);
- Perimenopausal and postmenopausal women;

Cause:
- Dilation of breast ducts;

Risk factor:
- Smoking

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11
Q

Benign breast conditions

What are the symptoms and presentation of fat necrosis?

A

Symptoms:
- Firm localized lump
- Erythema

Cause:
- Trauma

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12
Q

What are the symptoms and presentation of duct / mamillary fistula?

A

Cause: sequelae of periductal mastitis.

Symptoms:
- Pain around areola;
- Sweeling;
- Redness;
- Fever;

Risk factor:
- Smoking
- Periductal mastitis

Rx:
- Fistulectomy
- Antibiotics

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13
Q

Describe the types of mastalgia.

A

Cyclical:
- Bilateral breast pain;
- Starts 1-3 days before the menstrual cycle;
- Common in young women;

Non-cyclical:
- Not related to menstrual cycle;
- Usually unilateral;
- > 40 years of age;

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14
Q

What is the Rx of mastalgia?

A
  • Analgesia
  • Supportive better fitting bra during the day;
  • Soft supportive bra at night.
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15
Q

In relation to mastalgia, when should a patient be given an urgent referral?

A

If presenting with:
➜ Mastalgia + Discrete lump + Family h/o of breast cancer.

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16
Q

What are the symptoms of intercostobrachial neuralgia?

A

➔ Pain in the area of the intercostobrachial nerve.

Affects the:
- Chest;
- Upper arm;
- Axilla.

17
Q

What is the cause of intercostobrachial neuralgia?

A
  • Breast surgery;
  • Axillary lymph node dissection.
18
Q

What is the cause of intraductal papilloma?

A

➔ Benign tumour due to a papilloma (wart) within the breast ducts.

Common in women between 35-55 YO.

19
Q

What are the symptoms of intraductal papilloma?

A
  • Serous or bloody nipple discharge;
  • (Sometimes) lump near the areola;
20
Q

DDx between:
- Duct ectasia;
- Breast cancer;
- Intraductal papilloma.

A

Duct ectasia
- Green/brown discharge;
- Inverted nipples;
- Mass near areola;

Breast cancer
- Hard, irregular mass;
- Not restricted to the areola area;

Intraductal papilloma
- Serous/bloody discharge;
- Lump near areola.

21
Q

What are the symptoms of Paget’s disease (breast)?

A
  • Bloody nipple discharge;
  • Dry areolar skin ➝ itching;
  • Ulcerated nipples;

◆ Chronic: Inverted nipple.

22
Q

What is the investigation of Paget’s disease (breast)?

A
  • Skin punch biopsy.
23
Q

What are the investigations of choice for breast disorders?

In terms of age.

A

➜ Ultrasound:
- Women < 40 years.

➜ Mammography:
- Women ≥ 40 years.

24
Q

Describe how is the mammogram screening done.

A

Age 50-70 years:
- Every 3 years.

Age 40-70 years
Every 1 year if:
- Family history;
- BRCA gene positive

25
Q

Describe what is Phyllodes tumour.

A
  • Benign fibro-epithelial tumour;
  • Common in 40-50 year (pre-menopausal women);
  • Fast growing;
  • Painless;
  • Large size.
26
Q

What are the indications for prophylatic mastectomy?

A
  • Strong family history;
  • Positive BRCA;
  • Breast cancer in one breast;
  • Biopsy suggestive of lobular carcinoma;
  • Biopsy suggestive of atypical hyperplasia.
27
Q

What are the complications seen post mastectomy?

A
  • Upper limb lymphoedema (due to removal of axiliary lymph nodes);
  • Frozen shoulder (due to reduced shoulder movement);
  • Scar tissue cording in the armpit.
28
Q

What is the management of complications seen post mastectomy?

A
  • Exercise
  • Compression bandaging for lymphoedema
  • Scar mobilisation
29
Q

What is the management when breast cancer is suspected?

A
  • 2 week wait referral to breast clinic;

Breast clinic:
- < 40 Ultrasound
- > 40 Mammogram
- Biopsy (core needle or FNAC)

30
Q

Histopathology

What are the labs requested in breast cancer?

A

Histopathology
- Oestrogen receptor (ER)
- Progesterone receptor (PR)
- Human epidermal growth receptor 2 (HER2)

ER positive breast cancer:
- Premenopausal ➝ Tamoxifen
- Postmenopausal ➝ Anastrozole (aromatose inhibitors)
- Men ➝ Tamoxifen

HER 2 positive breast cancer:
- Trastuzumab

31
Q

When doing treatment for breast cancer with tamoxifen, which medication should be added?

A

Biphosphonates.

32
Q

In a pregnant woman, what treatment is recommended for breast cancer?

A
  • Surgery;
  • Chemotherapy (not on the 1st trimester).

Radiotheraphy is not recommended.

PLAB 1 August 2024 (32 decks)

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