Breast

Question 1

management of mastitis

Answer 1

symptom relief with NSAIDs and warm compress
if not improving consider flucloxacillin or clindamycin for 7-10 days

Question 2

blood stained discharge from nipple with no palpable lump

Answer 2

intraductal papilloma

Question 3

menopausal woman, discharge thick and green
smoker

Answer 3

mammary duct ectasia

Question 4

when to refer for surgery with a fibroadenoma

Answer 4

> 3cm

Question 5

hormonal therapy for breast carcinoma

Answer 5

tamoxifen in pre-menopausal patients
aromatase inhibitors are advised for post-menopausal patients
- anastrozole
- letrozole

Question 6

management of mastalgia

Answer 6

after completely ruling out malignancy
evening primrose oil and tamoxifen

Question 7

mechanism of action of aromatase inhibitors

Answer 7

reduce peripheral synthesis of oestrogen

Question 8

mechanism of action of tamoxifen

Answer 8

partial antagonism of the oestrogen receptors

Question 9

common sites of breast cancer metastasis

Answer 9

bones, liver, lung and brain

Question 10

inflammatory benign breast disease

Answer 10

fat necrosis
duct ectasia
acute mastitis/abscess

Question 11

presentation of gynaecomastia

Answer 11

typically enlarging breast(s) or sub-areolar mass
- in men
ductal growth without lobular development

Question 12

presentation of fibrocystic change

Answer 12

smooth discrete lumps
sudden pain
cyclical pain
lumpiness
incidental finding
screening

Question 13

what is a hamartoma

Answer 13

circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution

Question 14

pathology of fat necrosis

Answer 14

damage and disruption of adipocytes
infiltration by acute inflammatory cells
foamy macrophages/histicoytes
calcification

Question 15

pathological features of duct ectasia

Answer 15

periductal inflammation
periductal fibrosis
scarring and distortion

Question 16

management of duct ectasia

Answer 16

treat acute infections
exclude malignancy
stop smoking
excise ducts

Question 17

clinical features of phyllodes tumour

Answer 17

age 40-50
slow growing unilateral breast mass
- cystosarcoma phyllodes
- stromal overgrowth

Question 18

malignant phyllodes tumour

Answer 18

sarcomatous

Question 19

pathological features of phyllodes tumour

Answer 19

tumour border
stromal cellularity
stromal atypia
mitotic activity
stromal overgrowth

Question 20

presentation of intraductal papilloma

Answer 20

age 35-60
nipple discharge +/- blood
asymptomatic at screening
nodules
calcification

Question 21

what are in situ carcinomas

Answer 21

confined within basement membrane of acini and ducts
cytologically malignant but non-invasive
- lobular
- ductal

Question 22

two types of lobular in situ neoplasias

Answer 22

atypical lobular hyperplasia (ALH)
lobular carcinoma in situ > 50% of breast involved

Question 23

which hormone stimulates the lactiferous duct system to grow at puberty

Answer 23

oestrogen

Question 24

which hormone stimulates the mammary glands to produce milk

Answer 24

prolactin

Question 25

which hormone stimulates myoepithelial cells lining the milk ducts to contract

Answer 25

oxytocin

Question 26

what is the most common histological type of breast cancer

Answer 26

invasive ductal cancer

Question 27

what would microcalcifications seen on mammogram mean

Answer 27

ductal carcinoma in situ

Question 28

woman presents with a painless, firm, discrete, mobile mass, which has a solid appearance on ultrasound scan

Answer 28

sclerosing adenosis