Uncommon presentations of breast cancer

Question 1

What is paget’s disease of the breast

Answer 1

Erythema and eczematous change of nipple (not areola) with crusting exudates, can ulcerate and erode

Question 2

What is the pathogenesis of paget’s disease

Answer 2

Malignant cells invade epithelial-epidermal junction and enter epidermis of nipple

Hallmark of malignant, intraepithelial adenocarcinoma cells in epidermis

Associated with DCIS or invasive carcinoma

Question 3

What are the investigations of paget’s disease

Answer 3

Mammography, ultrasound, MRI, confirmatory biopsy if required

Question 4

Is prognosis affected by paget’s disease?

Answer 4

No

Question 5

What is the treatment of paget’s disease

Answer 5

Treat underlying cancer

Question 6

What is gynacomastia?

Answer 6

Benign enlargment of male breast tissue characterised by ductal epithelial hyperplasia, elongation, branching and increased vascularity

Question 7

What are the causes of gynacomastia?

Answer 7

Increased estrogen/testosterone ratio

Drugs - estrogen, spirolactone, anabolic steroids

Organ failure - Liver disease, hyperthyroid, kidney disease , testicular failure

Physiologically present in neonates, puberty and old age

Malnutrtion

Hypogonadism (agenesis, klinefelter)

Neoplastic - carcinoma of breast, testicular tumours

Question 8

What investigations are to be carried out for gynaecomastia?

Answer 8

Biochemical 
Check organs:
Liver, kidney, thyroids
Check hormones:
Testosterone, estradiol, LH, HCG

Imaging:
Mammography/biopsy
Testicular ultrasound
Biopsy if required

What is the management of gynacomastia?
Treat underlying cause
Tamoxifen
Surgical excision