Breast Surgery Practice Questions

Q: Which of the following statements is wrong regarding this picture? (Recent NEET Pattern 2016-17)

Fixed to chest wall. ***Fixed to chest wall*** - Phyllodes tumors are typically **mobile** within the breast tissue and are not usually fixed to the chest wall. - Fixation to the chest wall is more characteristic of **advanced invasive breast carcinoma**, not phyllodes tumor. *Cystosarcoma phyllodes* - The image displays a large, rapidly growing breast mass, consistent with the presentation of a **phyllodes tumor** (also known as cystosarcoma phyllodes). - This tumor type is characterized by its **biphasic stromal and epithelial components**. *Can metastasize to lungs* - While phyllodes tumors are often benign, malignant forms can **metastasize hematogenously**, most commonly to the lungs. - This hematogenous spread is characteristic, as **lymph node metastasis is rare**. *It is treated by excision or subcutaneous mastectomy* - Treatment for phyllodes tumors generally involves **wide local excision** with clear margins due to their tendency for local recurrence. - For very large or recurrent tumors, a **mastectomy** (subcutaneous or simple) may be necessary. *Has a leaf-like architecture on histology* - The term "phyllodes" is derived from the Greek word meaning **"leaf-like"**, referring to the characteristic microscopic appearance. - Histologically, these tumors show a **leaf-like pattern** with cleft-like spaces lined by epithelium and hypercellular stroma.

Q: What is the diagnosis of the patient shown in the image? (Recent NEET Pattern 2016-17)

Accessory nipple. ***Accessory nipple*** - The image distinctly shows small, pigmented lesions with a central indentation, consistently located along the **embryonic milk line**. This morphology and location are classic for **supernumerary nipples** or accessory nipples. - While they can vary in appearance, ranging from a simple pigmented macule to a fully developed nipple-areola complex, these lesions clearly fit the description of an accessory nipple. *Polymastia* - **Polymastia** refers to the presence of accessory breast tissue (glandular tissue) along the milk line, which may or may not include a nipple. - The key difference is that polymastia involves actual breast parenchyma, whereas the image shows only nipple structures without underlying breast tissue mass. - Both are congenital anomalies along the milk line, but the clinical presentation differs. *Hypertrophic nevus* - A **hypertrophic nevus** (or mole) is typically a raised, pigmented lesion, but it generally lacks the characteristic central depression or resemblance to nipple tissue seen in the image. - Nevi are common, but their appearance is usually uniform or nodular, not mimicking a breast structure. *Amazia* - **Amazia** refers to the congenital absence of breast tissue, while the nipple is present. - The image shows additional **nipple-like structures**, not the absence of breast tissue or nipples. *Melanoma* - **Melanoma** is a serious form of skin cancer characterized by irregular borders, asymmetry, varied color, and a changing diameter (**ABCDEs of melanoma**). - The lesions in the image appear symmetrical, well-defined, and uniform in color and shape, which are inconsistent with the highly irregular features of melanoma.

Q: Which of the following is not an indication for surgery in the condition shown below?

Patient's decision. ***Patient's decision*** - While patient preferences are crucial in medical decision-making, simply the **patient's decision alone is not a primary medical indication for surgery** in the absence of other objective criteria for a fibroadenoma. - Surgery for **fibroadenoma** is typically guided by clinical and radiological findings, not solely by patient request. *Size more than 5 cm* - A **fibroadenoma** with a size of **more than 5 cm** is generally considered a strong indication for surgical excision. - Large fibroadenomas can cause **cosmetic distortion**, discomfort, and may be harder to distinguish from malignant lesions, especially if they show rapid growth. *Complex type* - **Complex fibroadenomas** have features such as **cysts larger than 3 mm**, sclerosing adenosis, epithelial calcifications, or papillary apocrine metaplasia. - These features are associated with a slightly **increased risk of future breast cancer** and are often considered an indication for excision to rule out malignancy and for risk reduction. *Recurrence* - If a **fibroadenoma recurs** after previous excision, particularly if it grows rapidly or shows atypical features, surgical removal is indicated. - **Recurrence** suggests a persistent or potentially more aggressive benign process that warrants further investigation and management. *Rapid increase in size* - A **rapid increase in size** of a fibroadenoma is a clear indication for surgical excision. - Rapid growth raises concern for **phyllodes tumor** or other potentially aggressive lesions and warrants histopathological examination. - Serial measurements showing significant growth over a short period (typically doubling in size over 3-6 months) indicate the need for surgical intervention.

Q: In the MRI breast shown below, 4 cm mass is present with no nodal metastasis. Which is the stage of breast cancer?

Stage II. ***Stage II*** - A tumor of **4 cm** with no nodal metastasis is classified as pT2, N0, M0. This falls under **Stage IIA** breast cancer according to the TNM staging system. - Stage II breast cancer typically includes tumors that are larger than 2 cm but not larger than 5 cm (T2N0), or smaller tumors with lymph node involvement. - The **4 cm size with N0 status** specifically defines Stage IIA. *Stage 0* - Stage 0 represents **ductal carcinoma in situ (DCIS)** or **lobular carcinoma in situ (LCIS)**, which are non-invasive breast cancers. - This case describes a **4 cm mass**, indicating an invasive tumor, not in-situ disease, ruling out Stage 0. *Stage I* - Stage I breast cancer includes tumors that are **2 cm or smaller** (T1) and have no lymph node involvement (N0). - Since the mass is **4 cm**, it exceeds the size criteria for Stage I. *Stage III* - Stage III breast cancer involves **larger tumors** (greater than 5 cm) or any tumor size with extensive lymph node involvement, or tumors invading the chest wall/skin. - While this mass is 4 cm, there is **no nodal metastasis**, which rules out Stage III. *Stage IV* - Stage IV breast cancer indicates the presence of **distant metastases** (M1), meaning the cancer has spread to other parts of the body. - The information provided clearly states **no nodal metastasis**, and no information about distant spread, therefore Stage IV is incorrect.

Question 1

A 45-year-old woman presents with a 2 cm palpable mass in the upper outer quadrant of her right breast. Mammography shows a spiculated lesion with microcalcifications. Core needle biopsy reveals invasive ductal carcinoma, ER-positive, PR-positive, HER2-negative. Sentinel lymph node biopsy shows no metastases. Apply the appropriate surgical management.

Accepted Answer

Lumpectomy with radiation therapy

Answer

Lumpectomy alone without radiation

Answer

Bilateral mastectomy with reconstruction

Answer

Simple mastectomy without reconstruction

Answer

Modified radical mastectomy with immediate reconstruction

Question 2

Which of the following statements is wrong regarding this picture? (Recent NEET Pattern 2016-17)

Accepted Answer

Fixed to chest wall

Answer

Cystosarcoma phyllodes

Answer

Can metastatise to lungs

Answer

It is treated by excision or subcutaneous mastectomy

Answer

Has a leaf-like architecture on histology

Question 3

A 24-year-old female patient presents with bilateral breast mass. On physical examination this breast mass is hyper mobile and soft. The mammogram is shown below. What is the most possible diagnosis?

Accepted Answer

Fibroadenoma

Answer

Breast cyst

Answer

Ductal carcinoma in situ

Answer

Lobular carcinoma

Answer

Phyllodes tumor

Question 4

What is the diagnosis of the patient shown in the image? (Recent NEET Pattern 2016-17)

Accepted Answer

Accessory nipple

Answer

Hypertrophic nevus

Answer

Amazia

Answer

Melanoma

Answer

Polymastia

Question 5

The surgeon attending has completed a modified radical mastectomy for a carcinoma breast patient. You have to suture the wound using subcuticular sutures. Which of the following sutures would you choose?

Accepted Answer

Monocryl

Answer

Vicryl Plus

Answer

Prolene

Answer

PDS

Answer

Mersilk

Question 6

Which of the following is not an indication for surgery in the condition shown below?

Accepted Answer

Patient's decision

Answer

Size more than 5 cm

Answer

Complex type

Answer

Recurrence

Answer

Rapid increase in size

Question 7

In the MRI breast shown below, 4 cm mass is present with no nodal metastasis. Which is the stage of breast cancer?

Accepted Answer

Stage II

Answer

Stage I

Answer

Stage III

Answer

Stage IV

Answer

Stage 0

Breast Surgery — MCQs

Breast Surgery — MCQs

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