Breast Surgery

Question 1

What signs and symptoms should be enquired about upon presentation of a breast abnormality?

Answer 1

Pain, nipple discharge, mass, skin changes, contour of the breast, appearance of areolar, mammogram appearance.

Question 2

What could focal breast pain be indicative of?

Answer 2

Ruptured cyst or inflammation.

Question 3

What type of nipple discharge is most concerning?

Answer 3

Unilateral and spontaneous.

Question 4

What is milky nipple discharge indicative of?

Answer 4

An endocrine cause.

Question 5

What could serous and bloody nipple discharge be indicative of?

Answer 5

Benign papilloma.

Question 6

When is a mass most worrying?

Answer 6

If it is hard, craggy and fixed.

Question 7

What is calcification on a mammogram indicative of?

Answer 7

DCIS or benign changes.

Question 8

What could a density on a mammogram indicate?

Answer 8

Carcinoma, cyst, fibroadenoma.

Question 9

What is a fibroadenoma?

Answer 9

Benign overgrowth of collagenous mesenchyme of one breast lobule.

Question 10

What age do people suffer from fibroadenomas?

Answer 10

Presents up to menopause but usually <30.

Question 11

How do fibroadenomas present?

Answer 11

Firm, smooth, mobile ‘breast mouse’ that is painless.

Question 12

What is infective mastitis?

Answer 12

Staph aureus from nipple cracks lead to abscess formation.

Question 13

How does infective mastitis present?

Answer 13

Painful, hot area of breast. Usually associated with lactation.

Question 14

How is infective mastitis treated?

Answer 14

Express milk and give abx.

Question 15

What are breast cysts?

Answer 15

Fluid filled round lumps not attached to any tissue.

Question 16

Are breast cysts painful?

Answer 16

Yes.

Question 17

How do breast cysts appear on a mammogram?

Answer 17

Halo appearance.

Question 18

In what age group do breast cysts usually present?

Answer 18

> 30 years, especially perimenopausal.

Question 19

How is a diagnosis of a breast cyst confirmed?

Answer 19

Aspiration.

Question 20

In what age group do phyllodes usually present?

Answer 20

> 40 years.

Question 21

What is the histological appearance of phyllodes?

Answer 21

Stroma appears cellular and atypical.

Question 22

Are phyllodes benign or malignant and how are they treated?

Answer 22

Most are benign but can be malignant so need to excise with wide local margins.

Question 23

What are the symptoms of duct ectasia?

Answer 23

Ducts block and stagnant secretions appear as green/brown nipple discharge and sometimes retraction or a lump.

Question 24

In what age group does duct ectasia usually present?

Answer 24

Usually occurs around menopause.

Question 25

What is an in-situ carcinoma?

Answer 25

Neoplastic populations of cells that is limited to ducts and lobules by the basement membrane so the myoepithelium is preserved. Can’t metastasise.

Question 26

What is an invasive carcinoma?

Answer 26

Neoplastic populations of cells that can invade the basement membrane through to the stoma, and can go on to metastasise.

Question 27

What are the two types of in-situ carcinoma?

Answer 27

Ductal and lobular.

Question 28

What does imaging of a DCIS show?

Answer 28

Mammogram: calcification or mass. Histology: central necrosis.

Question 29

What are the two types of invasive carcinoma?

Answer 29

Ductal and lobular.

Question 30

What proportion of breast cancers do ductal invasive carcinomas form?

Answer 30

75%.

Question 31

What does imaging of a ductal invasive carcinoma show?

Answer 31

Can appear to be well differentiated with tubular lines or can be poorly differentiated with sheets of pleomorphic cells.

Question 32

What pathophysiological changes occur in lobular invasive carcinomas?

Answer 32

Cells infiltrate in single file and lack cohesion.