EMQs in Clinical Medicine.pdf - Peshawar Medical College

174 The abdomen and surgery
60 Breast conditions
Answers: F M H A K
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A 75-year-old woman presents to her GP with a breast lump in the
upper outer quadrant. On examination the lump is hard and irregular.
There is axillary lymphadenopathy.
A hard irregular lump is a cause for concern and warrants further
investigation.
A 53-year-old woman presents with nipple retraction and a greenyyellow
discharge. Her ductogram shows dilated breast ducts.
Duct ectasia is a condition that usually occurs peri-/postmenopausally. It
has been suggested that there is hypertrophy of the ductal epithelium,
which subsequently breaks down and causes obstruction (and hence
stagnation of secretions). There is periductal inflammation that can lead
to fibrosis and nipple retraction. It is important to rule out carcinoma
especially as a mass or blood-stained discharge can also be seen in duct
ectasia. A ductogram characteristically shows the presence of enlarged,
dilated breast ducts.
A 21-year-old woman presents with a smooth, non-tender, highly
mobile mass on the upper outer quadrant of the right breast. Fine
needle aspiration does not reveal malignant features.
Fibroadenomas are characteristically highly mobile and have the
consistency of firm rubber. This has given rise to the description of a
fibroadenoma as a ‘breast mouse’. A fibroadenoma has the appearance
of a well-defined rounded lesion on mammogram. Fibroadenomas should
be excised not only to confirm the diagnosis (particularly as an early
carcinoma in older women may mimic a fibroadenoma) but also because
they enlarge over time.
A 70-year-old woman presents with a worsening eczema-like rash
overlying the areola and nipple. The rash does not itch. On
examination a palpable mass can be felt under the rash.
This condition is caused by an intraductal carcinoma, which spreads up
to the skin of the nipple causing eczematous changes. There is gradual
erosion and ulceration of the nipple. Fortunately, as the carcinoma is
superficial and presentation is early (because of the eczematous changes),
the prognosis is good.
A 26-year-old woman presents a fortnight post partum with a
painful, enlarged left breast. On examination she is pyrexial and her
breast is tender and inflamed. There are no palpable masses.
Inflammation of the breast post partum can be caused by obstruction
of the ducts, resulting in extravasation of milk into perilobular tissue.