Breast Surgery

Question 1

young woman with firm, rubbery mass that moves easily with palpation - - dx?

Answer 1

fibroadenoma

Question 2

dx test for fibroadenoma

Answer 2

FNA for cytology

USG - good diagnostic choice for this condition

Question 3

when are mammograms not done?

Answer 3

before age 20 and during lactation

Question 4

tx of fibroadenoma

Answer 4

excision is optional

Question 5

14 yo girl has a firm, rubbery, movable mass in her left breast that she noticed 1 year ago and has since grown to be about 6 cm - dx

Answer 5

giant juvenile fibroadenoma

Question 6

management of giant juvenile fibroadenoma

Answer 6

surgical resection to avoid cosmetic deformity (they are locally invasive)

Question 7

a woman in her late 20s presents with a slow growing mass that has been there for 7 years; the mass is firm, rubbery, moveable and is not attached to chest wall or overlying skin; there are no palpable axillary nodes - dx?

Answer 7

cystosarcoma phyllodes

Question 8

management of cystosarcoma phyllodes

Answer 8

Dx. core/incisional biopsy

Tx. margin free resection (can become malignant)

Question 9

middle aged woman presents with tenderness in both breasts related to menstrual cycle with multiple lumps on both breasts that tend to come and go; she now has a firm, round 2 cm mass that has not gone away for 6 weeks - dx?

Answer 9

likely fibrocystic disease

Question 10

diagnostic approach to fibrocystic disease

Answer 10

1. mammogram

2. aspiration of mass

Question 11

management of cyst with aspiration

Answer 11

if clear fluid and mass goes away - no further w/u
if fluid bloody - send to cytology
if recurs or does not go away - do biopsy

Question 12

34 yo woman presents with bloody discharge from her nipple; there are no palpable masses - dx?

Answer 12

intraductal papilloma

- dx with mammogram

Question 13

tx of intraductal papilloma

Answer 13

surgical resection to relieve symptoms

- can be guided by galactogram or retroareolar exploration

Question 14

lactating mother with cracks in her nipple develops a red, hot fluctuating, tender mass in the breast along with fever and leukocytosis - dx

Answer 14

abscess

- if pt were not lactating, an abscess is cancer until proven otherwise

Question 15

tx of breast abscess

Answer 15

incision and drainage

- biopsy of abscess wall should be included

Question 16

best way to diagnose breast cancer in older women?

Answer 16

mammographically guided multiple core biopsies

Question 17

diagnosis of breast cancer in pregnant women

Answer 17

usg-guided biopsy

Question 18

what are the limits of treating pregnant pts with breast cancer?

Answer 18

1. no chemo in first trimester
2. no radiation therapy at all
3. termination not needed

Question 19

strong indicators for breast cancer

Answer 19

• orange peel skin
• ill defined, fixed mass
• retraction of overlying skin
• retraction of nipple
• eczematoid lesions of areola
• palpable axillary LN

Question 20

52 yo woman has a mass in her axilla that is hard, moveable - next step?

Answer 20

do mammogram looking for breast ca.

LN biopsy

Question 21

on routine screening mammogram, radiologist reports an irregular area of increased density with fine microcalcifications that was not present 2 years ago -> what shoud you do?

Answer 21

work up for breast ca - > obtain multiple biopsies

Question 22

hormonal therapy of choice in premenopausal women with breast ca

Answer 22

tamoxifen

Question 23

hormonal therapy of choice in post-menopausal women with breast ca.

Answer 23

anastrazole

Question 24

tx of brain mets from breast cancer

Answer 24

high dose steroids and radiation

surgical resection may be possible