Male Breast Imaging — MCQs
Which of the following is sex cord stromal tumor?
Which of the following is the most sensitive investigation for ductal carcinoma in situ (DCIS) of the breast?
Mammography can be best used in?
Gynaecomastia is caused by which drug?
Which of the following is the karyotype of male who is sexually under developed with rudimentary testes and prostate glands, sparse pubic and facial hair, long arms and legs and large hands & feet?
In which of the following situations is breast conservation surgery not indicated?
Which genetic mutation is most commonly associated with male breast carcinoma?
Best investigation to detect rupture of silicone breast implants is-
Which is the most common type of male breast cancer?
Gold standard investigation for breast carcinoma screening in a patient with silicone breast implants
Male Breast Imaging Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is sex cord stromal tumor?
- A. Seminoma
- B. Choriocarcinoma
- C. Leydig cell tumor (Correct Answer)
- D. Yolk sac tumor
Explanation: ***Leydig cell tumor*** - **Leydig cells** are components of the **sex cords** in the testis and are primarily responsible for **testosterone production** [1]. - Tumors arising from these cells are therefore classified as **sex cord stromal tumors** [1]. *Seminoma* - **Seminomas** are a type of **germ cell tumor**, originating from primordial germ cells or intratubular germ cell neoplasia [2]. - They do not arise from the stromal components of the testis like Leydig cells. *Choriocarcinoma* - **Choriocarcinoma** is a highly aggressive **germ cell tumor** [4] characterized by the presence of both cytotrophoblast and syncytiotrophoblast cells [4]. - It produces **human chorionic gonadotropin (hCG)** [4] and is not derived from sex cord stroma. *Yolk sac tumor* - A **yolk sac tumor**, also known as an **endodermal sinus tumor**, is another type of **germ cell tumor** [3]. - It often produces **alpha-fetoprotein (AFP)** and is not considered a sex cord stromal tumor. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 513-514. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 510-512. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1035-1036. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, p. 982.
Question 2: Which of the following is the most sensitive investigation for ductal carcinoma in situ (DCIS) of the breast?
- A. PET Scan
- B. Ultrasound
- C. Mammography (Correct Answer)
- D. MRI
Explanation: ***Mammography*** - **Mammography** is the **gold standard** and **primary imaging modality** for detecting **ductal carcinoma in situ (DCIS)**, primarily because it excels at visualizing **microcalcifications**, which are the hallmark of DCIS. - Approximately **80-90% of DCIS cases** present as **microcalcifications** on mammograms, making it the most important screening and diagnostic tool. - Mammography has **high sensitivity (85-95%)** for detecting DCIS, especially calcified forms, and is widely available and cost-effective. *MRI* - While **MRI** has high sensitivity for invasive breast cancer and can detect non-calcified DCIS, it is **not the primary screening tool** for DCIS detection. - MRI is typically used for **staging known DCIS**, evaluating **extent of disease**, detecting **additional foci**, and screening **high-risk patients**. - However, MRI has lower specificity and higher false-positive rates compared to mammography, limiting its use as a primary diagnostic tool. *PET Scan* - **PET scans** are generally **not sensitive** for detecting **DCIS** because DCIS lesions typically have a **low metabolic rate** and do not avidly take up the **FDG tracer**. - PET scans are primarily used for detecting **invasive cancers** and assessing **metastatic disease**, not for non-invasive lesions like DCIS. *Ultrasound* - **Ultrasound** has **limited sensitivity** for detecting **DCIS** because DCIS often does not present as a palpable mass or a distinct sonographic abnormality. - While ultrasound can be useful for evaluating palpable masses or guiding biopsies, it frequently **misses microcalcifications** that are characteristic of DCIS. - Ultrasound is mainly used as a **complementary tool** to mammography, not as a primary diagnostic modality for DCIS.
Question 3: Mammography can be best used in?
- A. Early breast carcinoma (Correct Answer)
- B. Mastitis
- C. Fibroadenoma
- D. Phylloides tumor
Explanation: ***Early breast carcinoma*** - **Mammography** is the gold standard for **early detection of breast carcinoma**, particularly for identifying **microcalcifications** and small masses before they are palpable. - It plays a crucial role in **screening asymptomatic women** to reduce breast cancer mortality. *Mastitis* - **Mastitis** is an **inflammatory condition** of the breast, often associated with infection, which is usually diagnosed clinically. - While mammography might show diffuse **increased density**, it is not the primary diagnostic tool and often has limited value due to inflammatory changes masking pathology. *Fibroadenoma* - **Fibroadenomas** are **benign breast tumors** common in younger women, typically appearing as well-circumscribed masses on mammography. - While mammography can detect them, their characterization often requires **ultrasound** and **biopsy** for definitive diagnosis, as differentiation from malignant lesions can be challenging. *Phylloides tumor* - A **Phylloides tumor** is a rare tumor that can be benign, borderline, or malignant, and it typically presents as a rapidly growing, palpable mass. - Mammography may show a well-defined mass, but **ultrasound** and **core needle biopsy** are essential for accurate diagnosis and distinction from fibroadenomas or malignancy.
Question 4: Gynaecomastia is caused by which drug?
- A. Spironolactone (Correct Answer)
- B. Rifampicin
- C. Thiazide
- D. Propranolol
Explanation: ***Spironolactone*** - Spironolactone is a **well-established cause of gynaecomastia**, occurring in 5-10% of patients in a dose-dependent manner. - It acts as an **anti-androgen** by blocking androgen receptors and inhibiting testosterone synthesis, thereby increasing the estrogen to androgen ratio. - It is a **potassium-sparing diuretic** and aldosterone antagonist, commonly used in heart failure, hypertension, and conditions requiring androgen blockade. *Rifampicin* - Rifampicin is an **antibiotic** primarily used to treat tuberculosis and acts as a **strong inducer of cytochrome P450 enzymes**. - While rare hormonal effects have been reported, it is **not a recognized common cause** of gynaecomastia. - Main side effects include hepatotoxicity, orange discoloration of bodily fluids, and drug interactions. *Thiazide* - Thiazide diuretics work by inhibiting the **sodium-chloride cotransporter** in the distal convoluted tubule. - They are **not commonly associated** with gynaecomastia; typical side effects include hypokalemia, hyponatremia, and hyperglycemia. *Propranolol* - Propranolol is a **non-selective beta-blocker** used for hypertension, angina, arrhythmias, and anxiety. - While beta-blockers have rarely been implicated, propranolol is **not a well-established cause** of gynaecomastia compared to spironolactone. - Common side effects include bradycardia, fatigue, and bronchospasm.
Question 5: Which of the following is the karyotype of male who is sexually under developed with rudimentary testes and prostate glands, sparse pubic and facial hair, long arms and legs and large hands & feet?
- A. 45, X
- B. 47, XYY
- C. 46, XY
- D. 47, XXY (Correct Answer)
Explanation: 47, XXY - This karyotype describes **Klinefelter syndrome**, the most common chromosomal disorder affecting males. - The extra X chromosome leads to **primary hypogonadism** with testicular dysgenesis, causing rudimentary testes with small, firm consistency and azoospermia (infertility) [1]. - Clinical features include **sparse body hair** (pubic, facial, and axillary), **eunuchoid body proportions** (long limbs, large hands and feet due to delayed epiphyseal closure), **gynecomastia**, and elevated gonadotropins (FSH/LH) [1]. - Patients have **decreased testosterone** levels and are at increased risk of metabolic syndrome, osteoporosis, and breast cancer [1]. *Incorrect: 45, X* - This karyotype describes **Turner syndrome**, which affects phenotypic females, not males [1]. - Characterized by **short stature** (opposite of the long limbs described), webbed neck, shield chest, and **gonadal dysgenesis** with streak ovaries. - Does not present with male characteristics or testicular development. *Incorrect: 47, XYY* - This karyotype describes **XYY syndrome** (Jacob's syndrome). - Individuals are typically **tall with normal male sexual development** and normal fertility. - May have mild learning difficulties or behavioral issues, but do NOT present with hypogonadism, sparse body hair, or rudimentary testes. *Incorrect: 46, XY* - This is the **normal male karyotype** with standard male sexual development. - Would present with normal secondary sexual characteristics, normal testicular size, and normal testosterone levels—completely contrary to the clinical picture described. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 173-175.
Question 6: In which of the following situations is breast conservation surgery not indicated?
- A. SLE
- B. Large pendular breast
- C. Diffuse microcalcification
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - All listed scenarios—**large pendular breast**, **SLE**, and **diffuse microcalcification**—represent situations where breast conservation surgery is generally contraindicated or challenging. - Their presence often necessitates alternative treatment approaches, such as mastectomy, to achieve optimal oncologic and cosmetic outcomes. *Large pendular breast* - While not an absolute contraindication, a **very large or pendulous breast** can make it difficult to achieve a satisfactory cosmetic outcome after breast conservation surgery. - The disproportionate breast size post-lumpectomy may lead to significant **asymmetry**, requiring further reconstructive procedures. *SLE* - Patients with **Systemic Lupus Erythematosus (SLE)** are at an increased risk of complications from radiation therapy, a mandatory component of breast conservation surgery. - They tend to experience more severe and prolonged **acute and chronic skin reactions** to radiation, which can significantly impair healing and quality of life. *Diffuse microcalcification* - **Diffuse microcalcification** within the breast can indicate widespread in situ carcinoma (e.g., DCIS) or an invasive carcinoma with extensive intraductal component. - In such cases, achieving **clear surgical margins** with breast conservation surgery can be challenging and often leads to multiple re-excisions or an increased risk of local recurrence.
Question 7: Which genetic mutation is most commonly associated with male breast carcinoma?
- A. BRCA2 mutation (Correct Answer)
- B. TP53 mutation
- C. PALB2 mutation
- D. BRCA1 mutation
Explanation: ***BRCA2 mutation*** - **BRCA2 mutations** are the most common genetic mutations found in men with **breast cancer**, significantly increasing their lifetime risk. - They are also associated with an increased risk of **prostate cancer**, **pancreatic cancer**, and **melanoma** in men. *TP53 mutation* - **TP53 mutations** are associated with **Li-Fraumeni syndrome**, a hereditary cancer syndrome that increases the risk of various cancers, including sarcomas, brain tumors, and early-onset breast cancer in women. - While it can increase breast cancer risk, it is less commonly associated with **male breast carcinoma** compared to BRCA2. *PALB2 mutation* - **PALB2 (Partner And Localizer of BRCA2) mutations** are associated with an increased risk of breast cancer in both men and women, acting in concert with BRCA2. - While impactful, they are less prevalent than **BRCA2 mutations** in male breast cancer overall. *BRCA1 mutation* - **BRCA1 mutations** primarily increase the risk of breast and ovarian cancer in women. While they can increase the risk of **male breast cancer** to some extent, their contribution is much lower than that of **BRCA2 mutations** [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Breast, pp. 1058-1059.
Question 8: Best investigation to detect rupture of silicone breast implants is-
- A. Mammography
- B. X-ray
- C. MRI (Correct Answer)
- D. USG
Explanation: ***MRI*** - **Magnetic Resonance Imaging (MRI)** is considered the **gold standard** for detecting silicone breast implant ruptures due to its superior soft tissue contrast and ability to differentiate silicone from other tissues. - It can accurately identify both **intracapsular** (linguine sign) and **extracapsular** ruptures, as well as associated silicone granulomas. *Mammography* - While useful for breast cancer screening, **mammography** has limited sensitivity for detecting silicone implant ruptures, especially subtle ones. - It can show indirect signs like implant contour abnormalities or increased implant density but is often inconclusive for rupture diagnosis. *X-ray* - **X-rays** provide very little information regarding the integrity of silicone breast implants because silicone is radiolucent and does not show up clearly on standard radiographs. - Its utility is primarily for detecting calcifications or foreign bodies, not implant rupture. *USG* - **Ultrasound (USG)** can be a useful initial screening tool for detecting implant ruptures, showing signs like the **"stepladder sign"** for intracapsular rupture or anechoic collections (silicone outside the capsule). - However, its accuracy is highly operator-dependent, and it may miss subtle ruptures or be limited by poor visualization due to scar tissue, making MRI a more definitive choice.
Question 9: Which is the most common type of male breast cancer?
- A. Inflammatory Breast Cancer
- B. Invasive Ductal Carcinoma (Correct Answer)
- C. Invasive Lobular Carcinoma
- D. Mucinous Carcinoma
Explanation: ***Invasive Ductal Carcinoma*** - This is by far the most common type of breast cancer in men, accounting for approximately **80-90%** of all male breast cancer cases. - It originates in the **milk ducts** and then invades the surrounding breast tissue. *Invasive Lobular Carcinoma* - This type of cancer originates in the **milk-producing glands (lobules)**. - It is **extremely rare** in men due to the underdeveloped and non-functional lobules in the male breast. *Mucinous Carcinoma* - This is a **rare subtype** of invasive ductal carcinoma characterized by cancer cells that produce **mucin**. - It accounts for only a small percentage of male breast cancers, typically **2-3%** of cases. *Inflammatory Breast Cancer* - This is a **rare and aggressive** form of breast cancer characterized by rapid onset of redness, swelling, and warmth in the breast, often mistaken for an infection. - Although it can occur in men, it is not the most common type and represents a very small fraction of male breast cancer diagnoses.
Question 10: Gold standard investigation for breast carcinoma screening in a patient with silicone breast implants
- A. Mammography
- B. CT scan
- C. USG
- D. MRI (Correct Answer)
Explanation: ***MRI*** - **MRI** is considered the **gold standard** for breast cancer screening in patients with silicone breast implants due to its superior ability to visualize breast tissue through the implant and detect subtle lesions. - It offers **high sensitivity** in detecting both implant rupture and early malignancies, often providing better clarity than mammography in augmented breasts where implants can obscure tissue. *Mammography* - While a standard screening tool, **mammography** can be limited in patients with silicone implants because the implants can **obscure adjacent breast tissue**, making detection of small masses challenging. - Special views (e.g., **Eklund views**) can be used, but sensitivity is still reduced compared to MRI in augmented breasts. *CT scan* - **CT scans** are not routinely used for primary breast cancer screening due to their use of **ionizing radiation** and lower sensitivity for detecting early breast lesions compared to MRI. - CT is more commonly used for **staging** advanced cancers or evaluating complex masses detected by other modalities. *USG* - **Ultrasound (USG)** is a valuable complementary tool, especially for evaluating palpable lumps or clarifying findings from mammography, but it is **operator-dependent** and has a lower overall sensitivity for general screening compared to MRI. - It is particularly useful for differentiating between **cystic and solid masses** and detecting implant ruptures but is not the gold standard for comprehensive screening in augmented breasts.
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