Breast Surgery Practice Questions

Q: A slit-shaped nipple is seen in which of the following conditions?

Duct ectasia. **Explanation:** **Duct Ectasia** is the correct answer because of the specific pathological process involving the subareolar ducts. In this condition, the major lactiferous ducts become dilated and filled with inspissated (thickened) secretions. This leads to chronic periductal inflammation, which eventually results in **fibrosis**. As this fibrosis progresses, it causes shortening of the ducts, which pulls the nipple inward. Unlike the circular "pitting" retraction seen in malignancy, the retraction in duct ectasia typically occurs in a linear fashion, resulting in a characteristic **slit-like nipple**. **Why the other options are incorrect:** * **Duct Papilloma:** This is the most common cause of bloody nipple discharge. It typically presents as a small, non-palpable lesion within a major duct and does not usually cause nipple retraction or shape changes. * **Paget’s Disease:** This presents as an eczematous, itchy, or crusting lesion of the nipple-areola complex. While it can destroy the nipple over time, it is characterized by surface erosion rather than a slit-like deformity. * **Carcinoma of the Breast:** Malignancy causes nipple retraction due to the infiltration of the **Lactiferous ducts** or **Cooper’s ligaments**. This typically results in a fixed, deep, and often asymmetrical "pitting" or "indrawing" of the nipple, rather than a transverse slit. **Clinical Pearls for NEET-PG:** * **Duct Ectasia** is also known as **Plasma Cell Mastitis** (due to the characteristic inflammatory infiltrate). * **Nipple Discharge:** In duct ectasia, the discharge is typically thick, creamy, or "toothpaste-like" (multi-colored/greenish). * **Management:** The definitive surgical treatment for duct ectasia is **Hadfield’s operation** (Total subareolar duct excision). * **Differential:** Always differentiate from **Zuska’s Disease**, which is recurrent subareolar abscesses associated with smoking and squamous metaplasia of the ducts.

Q: Which of the following benign conditions can mimic cancer in the breast?

Fat necrosis. **Explanation:** **Fat Necrosis** is the most notorious mimic of breast carcinoma. The underlying medical concept involves the saponification of adipose tissue, usually following trauma (though trauma is only reported in 50% of cases). As the area heals by fibrosis, it forms a **hard, irregular, fixed lump** that may be associated with **skin tethering or nipple retraction**. On mammography, it can show microcalcifications or a "spiculated mass," further mimicking malignancy. Histologically, it is characterized by "foamy macrophages" and "oil cysts." **Analysis of Incorrect Options:** * **Accessory axillary breast tissue (A):** This presents as a soft, bilateral swelling in the axilla that fluctuates with hormonal changes (e.g., during menstruation or pregnancy). It lacks the hard, infiltrative features of cancer. * **Fibrocystic disease (C):** This is a spectrum of changes (cysts, fibrosis) characterized by **cyclical mastalgia** and "lumpiness." While common, it is typically diffuse and tender, unlike the painless, fixed mass of cancer. * **Granulomatous mastitis (D):** While it can present as a firm mass, it is usually associated with inflammatory signs, multiple discharging sinuses, and abscess formation, making it more likely to be confused with tuberculosis or an abscess than a primary malignancy. **High-Yield Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Core Needle Biopsy is essential to differentiate fat necrosis from cancer. * **Mammographic Hallmark:** Look for **"Egg-shell calcification"** (rim calcification) in later stages of fat necrosis. * **Other Mimics:** Radial Scar (complex sclerosing lesion) and Mondor’s Disease (thrombophlebitis of superficial veins) are also important clinical mimics of breast cancer.

Question 1

A patient underwent breast conservation surgery for a 3 cm lesion along with sentinel lymph node biopsy, which showed one-third of sentinel lymph nodes are positive for macrometastasis. What is the next step in management?

Accepted Answer

Completion axillary lymph node dissection, chemotherapy, and radiotherapy

Answer

Modified radical mastectomy with level I lymphadenectomy

Answer

Modified radical mastectomy with level III lymphadenectomy

Answer

Only chemotherapy and radiotherapy

Question 2

Which of the following statements regarding breast cancer metastasis is true?

Accepted Answer

Metastases occur after breast cancers acquire their own new blood supply.

Answer

Batson's plexus facilitates metastasis to the lungs.

Answer

Natural killer cells have a role in breast cancer immunosurveillance.

Answer

Twenty percent of women who develop breast carcinoma metastases will do so within 60 months of treatment.

Question 3

A slit-shaped nipple is seen in which of the following conditions?

Accepted Answer

Duct ectasia

Answer

Duct papilloma

Answer

Paget's disease

Answer

Carcinoma of the breast

Question 4

Which of the following benign conditions can mimic cancer in the breast?

Accepted Answer

Fat necrosis

Answer

Accessory axillary breast tissue

Answer

Fibrocystic disease

Answer

Granulomatous mastitis

Question 5

What surgical management is appropriate for Stage I and II breast cancer?

Accepted Answer

Lumpectomy and axillary clearance

Answer

Total mastectomy

Answer

Modified radical mastectomy

Answer

Lumpectomy, axillary clearance, and radiotherapy

Breast Surgery — MCQs

Breast Surgery — MCQs

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