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1. Where do accessory nipples usually develop?
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Correct answer:
Extra nipples or breasts may develop along the primitive milk line. Accessory nipples are usually found just below the normal breast, while the axilla is the commonest site for accessory breast tissue. They are influenced by circulating hormones, and the nipples may discharge during lactation.
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2. What is the significance of hypoplasia or absence of the breast?
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Correct answer:
Although asymmetry of the breasts is normal, complete failure of development of the breast may occur and is often associated with chest wall defects. Bilateral developmental failure may be associated with ovarian failure or Turner's syndrome. Asymmetry can be treated by a combination of ipsilateral breast augmentation and contralateral breast reduction.
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3. What are the main developmental anomalies of the breasts?
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Correct answer:
(1) Accessory nipples and breasts.
(2) Hypoplasia or absence of the breast.
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4. What might be an underlying cause of hypoplasia or absence of the breasts?
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Correct answer:
Ovarian failure or Turner’s syndrome. Hypoplasia or absence of the breast is also often associated with chest wall defects.
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5. What are the five symptoms of breast disease which warrant urgent attention?
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Correct answer:
(1) A new, discrete lump.
(2) Nipple discharge: blood stained or persistent.
(3) Nipple retraction or distortion of recent onset.
(4) Altered breast contour or dimpling.
(5) Suspected Paget's disease. Other common symptoms that require further investigation include persistent asymmetrical nodularity, pain (mastalgia) that interferes with a patient's lifestyle, and a family history of breast cancer.
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6. What are the most common lumps in the breast?
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Correct answer:
(1) Carcinoma of the breast. (2) Cyst. (3) Fibroadenoma. (4) Fibroadenosis.
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7. In addition to carcinoma of the breast, cysts, fibroadenomas and fibroadenosis, what are the less common causes of a breast lump?
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Correct answer:
(1) Trauma: fat necrosis. (2) Other cysts: (a) cystadenoma; (b) retention cyst of the glands of Montgomery; (c) abscess; (d) galactocele. (3) Other tumours: (a) lipoma; (b) ductal papilloma; (c) hamartoma; (d) sarcoma (extremely rare).
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8. What is Mondor’s disease?
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Correct answer:
This is a superficial venous thrombosis of the chest wall. It may occasionally be mistaken for a breast lump.
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9. What uncommon chest wall swellings may rarely be confused with breast swellings?
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Correct answer:
(1) Rib swellings (e.g. tumour or tuberculosis). (2) Superficial venous thrombosis (Mondor’s disease). (3) Eroding aortic aneurysm (syphilitic). (4) Cold abscess (empyema necessitans).
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10. How would you diagnose a discrete breast lump?
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Correct answer:
The diagnosis of discrete breast lumps is based on a triple assessment.
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11. What is the triple assessment of discrete breast lumps?
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Correct answer:
The diagnosis of discrete breast lumps is based on a triple assessment that comprises the following. (1) Clinical examination. (2) Radiological imaging. (a) Mammography, usually in older patients (over 35 years). (b) Ultrasound, usually in younger patients (under 35 years). (c) Magnetic resonance, useful in symptomatic patients with breast implants in whom ultrasound is not diagnostic. It is also used to detect local recurrence when ultrasound and mammography are unhelpful. (3) Biopsy, usually ultrasound guided. (a) Fine-needle aspiration cytology. (b) Core biopsy.
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12. What is the specific role of magnetic resonance imaging in the investigation of breast lumps?
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Correct answer:
This is useful in the investigation of local recurrence, and in patients with breast implants in whom ultrasound is of little value.
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13. What would you suspect if a patient had a blood-stained discharge from the nipple?
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Correct answer:
(1) Duct papilloma, when blood arises from a single duct. (2) Intraduct carcinoma. (3) Paget’s disease. (4) Invasive carcinoma (rare).
