Breast Surgery Practice Questions

Q: Which of the following statements is wrong regarding phyllodes tumor of the breast? (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* - Phyllodes tumor (also known as cystosarcoma phyllodes) typically presents as a large, rapidly growing breast mass with a bosselated surface. - 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 wide local excision or simple mastectomy when adequate margins cannot otherwise be achieved* - 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 where adequate margins cannot be achieved, a **simple mastectomy** 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: A 24-year-old female patient presents with a right breast mass. On physical examination this breast mass is hyper mobile and soft. The mammogram is shown below. Ultrasound of the right breast demonstrates an oval, circumscribed, parallel, hypoechoic solid mass. What is the most possible diagnosis?

Fibroadenoma. ***Fibroadenoma*** - The patient's age (24 years old), right-sided location, **hypermobile** and **soft** mass on physical examination, together with the typical appearance on mammogram (well-circumscribed, oval lesion) and ultrasound findings of an oval, circumscribed, parallel, hypoechoic solid mass are characteristic of a **fibroadenoma**. - Fibroadenomas are **benign solid tumors** most common in young women, often appearing as distinct, movable lumps. *Breast cyst* - While breast cysts can be soft and mobile, they are typically **fluid-filled** and would appear as a **smooth, anechoic (dark) lesion on ultrasound**, not as a hypoechoic solid mass as seen in this case. - Cysts are often associated with hormonal changes and can fluctuate in size; the ultrasound findings here confirm a solid lesion. *Ductal carcinoma in situ* - **Ductal carcinoma in situ (DCIS)** is a non-invasive form of breast cancer most commonly presenting as **suspicious grouped microcalcifications** on mammography. - The described mass is hypermobile and soft, and the mammographic and ultrasound appearance of the lesion in the image provided are not typical of DCIS. *Lobular carcinoma* - **Lobular carcinoma** (in situ or invasive) often presents as architectural distortion, an area of thickening, or as an insidious mass that is **poorly defined** and **difficult to detect** clinically or mammographically. - It is known for its "stealth" nature, often not forming a palpable lump or a distinct mass with the well-defined borders and hypermobility described. *Phyllodes tumor* - **Phyllodes tumors** are rare fibroepithelial tumors that can present as mobile breast masses in young women, but they typically grow **rapidly** and are often **larger** (>3-5 cm) at presentation. - The **typical mammographic and ultrasound appearance** favor fibroadenoma, as phyllodes tumors may show heterogeneous density with areas of necrosis or cystic change.

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: In the MRI breast shown below, a 4 cm mass is present with no nodal metastasis and no distant metastasis. Biopsy confirms invasive breast carcinoma. What is the anatomic stage of this 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. - In this case, biopsy confirms **invasive breast carcinoma**, 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 distant metastasis**, 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 phyllodes tumor of the breast? (Recent NEET Pattern 2016-17)

Accepted Answer

Fixed to chest wall

Answer

Cystosarcoma phyllodes

Answer

Can metastatise to lungs

Answer

Has a leaf-like architecture on histology

Answer

It is treated by wide local excision or simple mastectomy when adequate margins cannot otherwise be achieved.

Question 3

A 24-year-old female patient presents with a right breast mass. On physical examination this breast mass is hyper mobile and soft. The mammogram is shown below. Ultrasound of the right breast demonstrates an oval, circumscribed, parallel, hypoechoic solid mass. What is the most possible diagnosis?

Accepted Answer

Fibroadenoma

Answer

Phyllodes tumor

Answer

Lobular carcinoma

Answer

Ductal carcinoma in situ

Answer

Breast cyst

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 absorbable monofilament with relatively rapid loss of tensile strength suture would you choose for buried superficial skin closure?

Accepted Answer

Monocryl

Answer

Vicryl Plus

Answer

Mersilk

Answer

Nylon

Answer

Vicryl

Question 6

A 28-year-old woman presents with a painless breast lump. Ultrasound shows a solid, oval, circumscribed, hypoechoic mass; core-needle biopsy confirms fibroadenoma. Which of the following is not an objective medical indication for excision in this condition?

Accepted Answer

Patient's decision after informed counseling

Answer

Complex type with discordant imaging and biopsy findings

Answer

Recurrence with rapid growth or diagnostic uncertainty

Answer

Size more than 5 cm

Answer

Rapid increase in size

Question 7

In the MRI breast shown below, a 4 cm mass is present with no nodal metastasis and no distant metastasis. Biopsy confirms invasive breast carcinoma. What is the anatomic stage of this breast cancer?

Accepted Answer

Stage II

Answer

Stage III

Answer

Stage IV

Answer

Stage I

Answer

Stage 0

Breast Surgery — MCQs

Breast Surgery — MCQs

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