Surgery Flashcards
Most common cause of spontaneous unilateral nipple discharge
Solitary intraductal breast papilloma
Management of breast papilloma
Excision and circumareolar incision
Indications for surgical removal in simple breast cyst
- The cyst recurs multiple times
- If a needle biopsy reveals findings of atypia, incompletely removes the mass
- If the cyst is large and painful for the patient.
Management of breast cyst
Usually conservative by aspiration
Gynecomastia in teenagers
- Occurs between the age of 13 and early adulthood.
- It presents as a tender, firm, smooth mass in the subareolar region.
- Observation is done because it usually regresses within 1 to 2 years.
Gynecomastia in teenagers: surgical incision may be needed if it is
- Unilateral
- Unable to regress in 18 to 24 months,
- Causing cosmetic issues.
Ultrasound findings of malignant lesions
- micro calcifications
- distortion of surrounding breast architecture
- internal echoes
- irregular borders
Ultrasound findings of benign lesions
- Round
- Hypoechoic
- Slightly lobular
- Well-defined mass
Li-Fraumeni syndrome
- Autosomal dominant mutation of the TP53 gene
- High risk for multiple malignancies at a young age (breast cancer, osteosarcoma, leukemia, lymphoma, brain tumors, adrenocortical carcinoma).
Genetic mutations associated with an increased risk for breast cancer:
- BRCA1, BRCA2,
- TP53 (Li-Fraumeni syndrome)
- PTEN (Cowden syndrome)
- Peutz-Jeghers syndrome
- Klinefelter syndrome
Most common breast cancer diagnosed in men
- Invasive ductal carcinomas
- Hormone receptor positive
American Cancer Society has recommended annual MRI screening beginning at age 30 years for women at high lifetime risk for breast cancer development (approximately 20% to 25% or greater), these include:
- Known BRCA1 or BRCA2 gene mutation
- First-degree relative with BRCA1 or BRCA2 gene mutation, but have not had genetic testing themselves
- Radiation therapy to the chest between the ages of 10 and 30
- Lifetime risk of breast cancer >20%
- Li-Fraumeni syndrome or Cowden syndrome or a first-degree relative with one of these syndromes
Women at moderately increased lifetime risk (15% to 20%) should consult with their physicians about the benefits and limitations of adding MRI screening, these include:
- Lifetime risk of breast cancer of 15%-20% according to risk assessment tools based mainly on family history
- Personal history of breast cancer, DCIS, LCIS, atypical ductal hyperplasia, or atypical lobular hyperplasia
- Extremely dense breasts or unevenly dense breasts when viewed by mammograms
Antireflux surgery is more successful in patients who have:
- typical symptoms of GERD
- good response to antireflux therapy
The most common histopathological type of esophageal cancer that arises in the upper portion of the esophagus
Squamous cell carcinoma
