Surgery Flashcards
A female with one or more risk factors for breast cancer presents with a mass in the ———quadrant of the breast. Think: She’s at risk for cancer, and 50% of breast cancers occur in the that quadrant. Therefore, the mass is likely to be malignant
upper outer
Perform breast self-examination at same time each month (———is ideal timing).
1 week after menstrual period
Palpable breast masses should have a ——— biopsy (as opposed to an ———)
core needle
FNA
A 42-year-old woman presents with an undiagnosed breast mass. Next step?
Evaluate without delay. Observation is not an option if age >30.
A female presents complaining of nipple pain during breast-feeding with focal erythema and warmth of breast on physical exam. Dx? Workup/next step?
Dx: Mastitis ± breast abscess.
Next step: Workup may include ultrasound of the breast, and possible incision and drainage if fluctuance (abscess) is present.
A female presents complaining of nipple pain with focal erythema and warmth of breast on physical exam. Dx if lactating/breastfeeding vs not lactating/breastfeeding?
If lactating/breastfeeding, think Mastitis ± breast abscess
If a nonlactating women presents with similar picture, consider inflammatory carcinoma.
A 25-year-old female presents with a painful breast mass several weeks after sustaining breast trauma by a seat belt in a car accident. Dx?
Think: The most common cause of a persistent breast mass after trauma is fat necrosis.
Fat necrosis of breast: exam findings and treatment?
Findings: Irregular mass without discrete borders that may or may not be tender; later, collagenous scars predominate.
Tx: Excisional biopsy with pathologic evaluation for carcinoma.
Fibroadenoma: definition and risk factors?
Definition: Fibrous stroma surrounds ductlike epithelium and forms a benign tumor that is grossly smooth, white, and well circumscribed.
Risk factors: More common in black women than in white women. Most common breast lesion in adolescents and young females.
Fibroadenoma: Incidence, Signs, Dx with?
Incidence: Typically occurs in late teens to early 30s; estrogen sensitive (increased tenderness during pregnancy).
Signs and symptoms: Smooth, discrete, circular, mobile mass.
Diagnosis: FNA
A 20-year-old female presents with a well-circumscribed mass in her left breast. It is mobile, nontender, and has defined borders on physical exam. Think?
Fibroadenoma until proven otherwise.
A female presents complaining of acute pain in her axilla and lateral chest wall, and a tender cord is identified on physical exam. Think?
Mondor’s disease versus chest wall infection. Confirm with ultrasound.
Mondor’s disease most commonly develops along
the course of a single vein
A 35-year-old female presents with a straw-colored nipple discharge and bilateral breast tenderness that fluctuates with her menstrual cycle. Think?
Fibrocystic changes. Consider a trial of OCPs or NSAIDs.
Fibrocystic changes in breast: Presentation, exam, evaluation:
Presentation: Breast swelling (often bilateral), tenderness, and/or pain.
Physical exam: Discrete areas of nodularity within fibrous breast tissue.
Evaluation: Serial physical examination with documentation of the fluctuating nature of the symptoms is usually sufficient unless a persistent discrete mass is identified; definitive diagnosis requires aspiration or biopsy with pathologic evaluation. Symptoms thought to be of hormonal etiology and tend to fluctuate with the menstrual cycle.
A 45-year-old female presents with breast pain that does
not vary with her menstrual cycle
with lumps behind the nipple–areolar complex and a history of a nonbloody nipple discharge. Think?
Mammary duct ectasia (plasma cell mastitis)
There is no need for axillary node dissection in phyllodes tumor (cystosarcoma phyllodes), as
lymph node metastases do not occur. If malignant, will spread hematogenously.
Phyllodes tumor (cystosarcoma phyllodes): Characteristics vs Fibroadenoma, Exam, Dx, Tx?
Characteristics: Indistinguishable from fibroadenoma by US or mammogram. The distinction between the two entities can be made on the basis of their histologic features (phyllodes tumors have more mitotic activity).
Exam: Large, freely movable mass with overlying skin changes
Diagnosis: Definitive diagnosis requires biopsy with pathologic evaluation.
Treatment:
- Smaller tumors: Wide local excision; Larger tumors: Simple mastectomy.
- No need for sentinel lymph node biopsy.
A 35-year-old female presents with a 1-month history of a spontaneous unilateral bloody nipple discharge. Radial compression of the involved breast results in expression of blood at the 12 o’clock position. Think?
Intraductal papilloma (A benign local proliferation of ductal epithelial cells. Unilateral serosanguineous or bloody nipple discharge. Subareolar mass and/or spontaneous nipple discharge.)
Most common cause of unilateral bloody nipple discharge:
Intraductal papilloma. (A benign local proliferation of ductal epithelial cells. Unilateral serosanguineous or bloody nipple discharge. Subareolar mass and/or spontaneous nipple discharge.)
Green nipple discharge: if cyclical and nonspontaneous, likely due to
fibrocystic breast
Bloody nipple discharge: if unilateral, most likely due to
intraductal papilloma
Bilateral nipple discharge: if milky, consider
intracranial etiology, obtain prolactin level
A 14-year-old male complains of gynecomastia. Tx?
Wait and watch. Perform surgery only if progressive