Diseases of the Breast

Question 0

Management of a fibroadenoma

Answer 0

• Make a diagnosis with either a sonogram, find needle aspirate or core needle biopsy.
• Once diagnosis is confirmed, excision is optional

Question 1

An 18-year-old woman has a firm, rubbery mass in the left breast that moves easily with palpation. What is it?

Answer 1

Fibroadenoma

Question 2

A 14-year-old girl has a firm, movable, rubbery mass in her left breast that was first noticed one year ago and has since grown to be about 6 cm in diameter. What is it?

Answer 2

Giant juvenile fibroadenoma

Question 3

Management of a giant juvenile fibroadenoma

Answer 3

Resection is required to avoid cosmetic deformity

Question 4

A 27 year old immigrant from Mexico has a 12 x 10 x 7 cm mass in her left breast. Present for seven years, slowly growing to present size. The mass – firm, rubbery, completely movable – not attached to Chestwall or to overlying skin. No palpable axillary nodes. What is it?

Answer 4

Cystosarcoma phyllodes, benign condition that can turn into an outright malignant sarcoma

Question 5

Management of cystosarcoma phyllodes

Answer 5

After tissue diagnosis, proceed with margin – free resection

Question 6

Management of a palpable cyst in fibrocystic disease

Answer 6

• cystic mastitis, mammary dysplasia
• start with mammogram to see if there are other nonpalpable lesions.
• aspiration of cyst, not FNA
• if bloody -> cytology

Question 7

A 34-year-old woman has been having bloody discharge from the right nipple, on and off for several months. There are no palpable masses. What is it?

Answer 7

Intraductal papilloma

Question 8

Management of an intraductal papilloma

Answer 8

• mammogram, the only way to detect cancer that is not palpable.
• if negative, RESECTION to provide symptomatic relief and further exclude malignancy given bloody discharge

Question 9

How can a resection be guided for an intraductal papilloma?

Answer 9

galactogram, sonogram, retroareolar exploration.

Question 10

A 26-year-old lactating mother has cracks in the nipple and develops a fluctuating, bread, hot, tender mass in the breast, along with fever and leukocytosis. What is it?

Answer 10

Abscess. Only lactating breasts are entitled to develop abscesses. Anyone else, breast abscesses are cancer until proven otherwise

Question 11

Management of a breast abscess.

Answer 11

Incision and drainage

If answer says biopsy of the abscess wall choose this

Question 12

A 49-year-old woman has a firm, 2 cm mass in the right breast, which is been present for three months. What is the next step in management?

Answer 12

Mammogram to explore for other nonpalpable lesions and then multiple core biopsies of the known 2 centimeter mass are needed

Question 13

A 42-year-old woman hits her breast with a broom handle all doing housework. She notices a lump in that area time, and one week later the lump is still there. She has a 3 cm hard Mastie been side effect of breast, and some superficial ecchymosis over the area. What is the next step and management

Answer 13

Mammographic guided core needle biopsy. Cancer until proven otherwise, trauma often brings the area to the attention of the patient but is not the cause of the lump

Question 14

A 60 year-old woman has a routine, screening mammogram. Radiologist reports an irregular area of increased density, with fine micro calcifications, that was not present two years ago on a previous mammogram. What is the next step in management?

Answer 14

Mammographically guided core needle biopsy. This is a description of a malignant radiologic image. We need a tissue diagnosis -> obtain multiple core biopsy

Question 15

A 44-year-old woman has a 2 cm palpable mass in the upper outer quadrant of her right breast. A core biopsy shows infiltrating ductal carcinoma. The masses freely movable, and her breast is of normal, rather generous size. She has no palpable lymph nodes, and mammogram showed no other lesions. What is the best treatment?

Answer 15

With a small tumor far away from the nipple, the standard option is segmental resection or lumpectomy with axillary node sampling (SNB) to determine the need for adjuvant systemic therapy. Radiation to follow

Question 16

62-year-old woman has a 4 cm heart mass under the nipple and Ariola over smallish left breast. Call biopsy diagnosed infiltrating ductal carcinoma. No palpable at our notes and mammogram shows no other lesions. What is the best treatment option?

Answer 16

Total mastectomy or simple mastectomy with axillary sampling of sentinel nodes required. Radiation not needed when the whole breast is removed unless masses very large, for example greater than or equal to 5 cm or if lymph nodes contain metastasis

Question 17

Which type of breast cancer has a higher incidence of bilaterality?

Answer 17

LOBULAR has a higher incidence of being bilateral but not enough to justify bilateral mastectomy

Question 18

52-year-old woman has a suspicious area on mammogram. Multiple radiologically guided core biopsies showed ductal carcinoma in situ. What is the next step and management?

Answer 18

• no axillary sampling is needed if the lesion is confined to one quadrant.
• lumpectomy and radiation should be performed
• if multicentric lesions, total mastectomy or simple mastectomy is needed with sentinel node biopsy

Question 19

Diagnosis of advanced cancer of the breast. Next step in management?

Answer 19

Tissue diagnosis is needed either a core or incisional biopsy.
Chemotherapy is first-line treatment with perhaps radiation. Palliative only. If tumor shrinks, it may become operable for palliation.

Question 20

37-year-old woman has lumpectomy and axillary something will nonsampling for 3 cm infiltrating carcinoma. That’s all the sports clear surgical margins and metastatic cancer in both the Sentinel excellent Larry notes that were removed. Tumor is positive for estrogen and progesterone receptors. What is the treatment?

Answer 20

CHEMOTHERAPY is mandatory here after SURGICAL treatment followed by radiation and finally HORMONAL therapy which given her age should be tamoxifen.
If the sentinel lymph node dissection is positive for metastasis, levels I and II lymph node dissection must also be done

Question 21

How should all invasive cancers be treated?

Answer 21

Locally by surgery/radiation therapy and systemically by chemo/hormonal therapy.
(The only subgroup of woman who will not have chemotherapy are those who are node negative, have a tumor less than 1 cm in size, have hormone receptors on cancer, and are typically postmenopausal.)