Breast 2

Question 1

When does fibroadenosis affect females?

Answer 1

after puberty and before menopause (in anovulatory periods)

Question 2

Where is progesterone released from?

Answer 2

The ovaries from corpus luteam when it ruptures

Question 3

What’s the pathology of fibrocystic disease? (fibroadenosis)

Answer 3

• fibrosis
• adenosis
• cyst formation
• papillomatosis
• epitheliosis
• atypical epithelial hyperplasia

Question 4

is fibroadenosis precancerous?

Answer 4

NO
except if there is
- marked papillomatosis
- atypical epithelial hyperplasia

Question 5

What is gynecomastia?

Answer 5

enlargement of male breast due to increase in glandular element

Question 6

increase in fat element in male breast is called?

Answer 6

Lipomastia

Question 7

What are the physiological causes of gynecomastia?

Answer 7

• neonatal: high maternal estrogen
• pubertal: hormonal imbalance
• old age: low testicular function

Question 8

what is the most common cause of gynecomastia?

Answer 8

idiopathic

Question 9

What drugs could cause gynecomastia?

Answer 9

digitalis
aldactone
cimitidine

Question 10

How to treat gynecomastia if it’s physiological or idiopathic?

Answer 10

wait for 6 months it may disappear

if the patient demands it, preform surgical interventiom

Question 11

if a patient presents with a recent onset of gynecomastia, what is the first line of treatment?

Answer 11

search for the secondary cause and treat the underlying cause

Question 12

a patient presents with unilateral bleeding from 1 duct, what is your diagnosis?

Answer 12

duct papilloma

Question 13

What causes the retroareolar breast lump causing obstruction in a ductal papilloma?

Answer 13

the retention cyst

Question 14

What is the treatment of a duct papilloma?

Answer 14

Microdochectomy

Question 15

What is the most common cause of breast lump is young females?

Answer 15

fibroadenoma

Question 16

the most common cause of breast PAIN in young females is?

Answer 16

fibroadenosis

Question 17

how do we treat hard fibroadenoma?

Answer 17

enucleation because it has 2 complete capsules

Question 18

how do we treat soft fibroadenoma?

Answer 18

excision with a safety margin because it has an incomplete capsule

Question 19

What is the phyllodes tumor?

Answer 19

giant type of soft intra-canalicular fibroadenoma

cystosarcoma pylloides

Question 20

What is the most common cause of lipid discharge from nipple?

Answer 20

duct ectasia

Question 21

What are the 3 most common pathologies occurring in pregnant females?

Answer 21

• lactating adenoma
• galactocele
• breast infarction

Question 22

How should secondary causes be ruled out in gynecomastia?

Answer 22

• hormonal assay
• pelvi-abdominal CT
• scrotal ultrasound

Question 23

What is a genetic cause of gynecomastia?

Answer 23

Klinefeter syndrome

Question 24

What are pathological hormonal causes of gynecomastia?

Answer 24

HIGH ESTROGEN

• LCF
• feminizing tumors

LOW TESTOSTERONE

• orchectomy
• testicular atrophy

Question 25

A female presents to the clinic with mastalgia that is increase premenstrual & my breast movement. She has dull aching pain. On palpation nodularity is felt. What is your diagnosis for these signs & symptoms, and what should be seen on further investigation to confirm your diagnosis?

Answer 25

Fibroadenosis smooth filling defect should be seen on ductography

Question 26

How should fibroadenosis be treated?

Answer 26

- reassurance - analgesia - anti-prolactin: Parlodel - androgenic steroid: Danazol

Question 27

What are the surgical indications for fibroadenosis?

Answer 27

- doubtful diagnosis | - large recurrent cyst

Question 28

What are the lines of treatment for gynecomastia?

Answer 28

If SECONDARY - treat the cause (stop offending drug or remove tumor) If IDIOPATHIC - subcutaneous mastectomy - liposuction - endoscopic surgery

Question 29

What is the gross picture of fibroadenosis?

Answer 29

in major milk duct - pedunculated mass - may ulcerate and bleed - may cause ductal obstruction

Question 30

What are the differences between peri-canaliculaar & intra-canalicular fibroadenoma?

Answer 30

PERI-CANALICULAR INTRA-CANALICULAR - hard - soft - in 20-30 y/o - in 30-50 y/o - small - large - smooth - lobulated - firm to hard - soft - whorly - cystic degeneration - 2 capsules - incomplete - more fibrous - more glandular - never turns malignant - may turn into a sarcoma

Question 31

What are the signs & symptoms seen to diagnose fibroadenoma?

Answer 31

- painless breast mass - freely mobile (BREAST MOUSE) - no axillary LN enlargement

Question 32

What is the clinical description of Phyllodes tumor?

Answer 32

- huge soft mass in the breast - can cause pressure necrosis of the skin leading to ulceration (PROBE TEST for diagnosis) - soft fibroadenoma - may show malignant transformation & metastasis

Question 33

How should Phyllodes tumor be treated?

Answer 33

Wide local excision up to simple mastectomy