Q_D_Breast

A 59-year-old woman who had been diagnosed with infiltrating ductal carcinoma 2years prior presents with pain of her right breast. The breast is swollen, tender on palpation, and is diffusely indurated with a “peau d’orange” appearance. Multiple axillary lymph nodes are palpable in the lower axilla. A skin biopsy from her breast reveals extensive invasion of dermal lymphatics. What is the best diagnosis?

Vous voyez lors de votre visite en suite de couches une femme de 29 ans qui a accouchéà terme d'un garçon de 3500 grammes. A J3 post-partum, votre patiente est fébrile à 38°5 et présente une mastodynie. Quel diagnostic est le plus probable?

Vous voyez lors de votre visite en suite de couches une femme de 29 ans qui a accouché à terme d'un garçon de 3500 grammes. A J5, elle présente une mastodynie droite, un placard inflammatoire avec 39° de fièvre, signe de Budin négatif. Quel est le diagnostic le plus probable?

Vous voyez lors de votre visite en suite de couches une femme de 29 ans qui a accouché à terme d'un garçon de 3500 grammes. A J5, elle présente une mastodynie droite, un placard inflammatoire avec 39° de fièvre. Quelle est la prochaine étape la plus utile pour votre diagnostic?

A 43-year-old G2P2 comes to your office complaining of an intermittent right nipple discharge that is bloody. She reports that the discharge is spontaneous and not associated with any nipple pruritus, burning, or discomfort. On physical examination, you do not detect any dominant breast masses or adenopathy. There are no skin changes noted. Which of the following conditions is the most likely cause of this patient’s problem?

A 65-year-old woman presents to the physician’s office for a second opinion on the management options for recently diagnosed breast cancer. She presents with a 2.5-cm mass in the upper outer quadrant of the left breast associated with a palpable axillary node suspicious for metastatic disease. The remainder of her examination is normal. Mammography demonstrates the cancer and shows no other suspicious lesions in either breast. Chest x-ray, bone scan, and blood test panel, including liver function tests, are normal. Family history is positive for breast cancer diagnosed in her sister at age 65. Past history is unremarkable. The first physician recommended modified radical mastectomy. Which of the following is the most appropriate management option for locoregional control yielding results equally effective as mastectomy?

During a routine breast self-examination,a 35-year-old woman is concerned because her breasts feel“lumpy.” She consults you as her primary care physician. After performing an examination, you reassure her that no masses are present and that the “lumpiness” is due to fibrocystic changes.Which of the following pathologic findings is a type of nonproliferative fibrocystic change?

A 51-year-old man presents with bilateral enlargement of his breasts. Physical examination is otherwise unremarkable, and the diagnosis of gynecomastia is made. Which of the following histologic features is most likely to be seen when examining a biopsy specimen from this man’s breast tissue?

A 51-year-old woman returns to clinic for a follow-up visit. You recently sent her for a routine mammogram, which shows a small, calcified mass that the radiologist labels as “probably benign finding—short-interval follow-up suggested.” The patient is extremely concerned because, although no one in her family has breast cancer, a close friend recently died of it. Breast examination reveals no abnormalities, and her physical examination is normal. Which of the following is the most appropriate course of action?

A 35-year-old woman comes to the clinic because of a left breast “thickness.” She noted this 5months ago and it has not receded. She has no family history of breast cancer. There is no drainage. She denies any pain. She has no other medical issues. She takes no birth control pills or any other medication. Examination shows a palpable mass in the left breast at 9 o’clock. A mammogram is nondiagnostic. Which of the following is the appropriate course of action?

A 35-year-old woman at 30 weeks’ gestation discovers a lump in her left breast. Examination reveals a 2–3 cm, firm nodule in the upper outer quadrant. Which of the following is the most appropriate next step in the management of this patient?

A 1-cm carcinoma of the breast is diagnosed by an excisional biopsy in a 36-year-old woman at 14 weeks’ gestation. The axillary nodes are negative. Which of the following is the best management of this patient?

A 56-year-old woman presents to the physician’s office with complaints of a new left breast mass. She denies any pain, nipple discharge, or skin dimpling. She has a prior history of breast cysts 5 years ago, treated by aspiration at that time. Her last mammogram was at age 53. Past history is pertinent for a 30 pack-year smoking history, priortotalabdominal hysterectomy bilateral salpingo-oophorectomy (TAH-BSO) at age 54 for leiomyomas, and current use of hormone replacement therapy (HRT). Family history is negative for breast disease.Examinationrevealsafirm,welldefined,1.5-cm nodule in the upper outer quadrant of the left breast without any regional lymphadenopathy. Which ofthe following isthemost appropriate nextstep in management?

A 52-year-old postmenopausal woman presents for her first screening mammogram. Within Commented [lh9]: Although mastectomy and mastectomy + postoperative radiotherapy are accepted treatment options for DCIS, wide local excision + postoperative radiotherapy is now frequently offered to women with tumours less than 40 mm in diameter of not an aggressive grade. Wide local excision attempts to conserve the unaffected breast tissue, thus avoiding the need for complete mastectomy, which carries greater psychological trauma to the patient. Mastectomy + postoperative radiotherapy is offered when DCIS is found in multiple areas of the breast, the tumour grade is aggressive, the size of the tumour is greater than 40 mm and if the oestrogen receptor status is negative. Ductal carcinoma in situ implies that the tumour is still confined to the basement membrane and has not broken through the latter. Thus axillary lymph nodes are at a greater chance of being affected once the tumour has broken through the basement membrane. With some exceptions, axillary staging and clearance is performed when multiple foci of extensive and aggressive DCIS are found. Commented [lh10]: The patient has a unifocal 2.5 cm malignant tumour in the right breast. The most appropriate management would be to perform a wide local excision of the breast tumour and it is essential to establish whether axillary disease is present or not. To assess disease positivity/negativity in the axilla, sentinel node biopsy should be performed. If the axillary sentinel lymph node is involved with metastatic tumour deposits originating from the primary breast tumour (e.g. macrometastases; tumour deposits. 2 mm), depending on the level of involvement of the axilla, the patient will undergo axillary clearance. This involves removing level 1–3 axillary lymph nodes to remove residual malignancy. It is not common practice for a patient diagnosed with breast cancer to undergo axillary clearance if the axilla has not been assessed. In some cases, an axillary lymph node FNA cytology assessment may be performed if there is palpable axillary disease. If the result confirms malignant disease, then the patient will undergo axillary clearance. Otherwise, sentinel node biopsy is usually performed to plan, whether the patient requires axillary clearance. The main indications for mastectomy are patients who have large tumours (>5 cm) that are unresponsive to chemotherapy, multifocal ... The right upper outer quadrant, there is a 2-cm well-defined, oval mass that has dense “popcorn” calcification within it and is surrounded by a thin radiolucent rim. On ultrasound, the mass is well defined and hyperechoic with areas of acoustic shadowing due to contained calcification. What is the most likely diagnosis?

Actuellement, la thérapeutique généralement conseillée en France dans un cancer du sein survenant chez une femme de 45 ans, porteuse d’un cancer inférieur à 1 cm du quadrant supéroexterne sans ganglion axillaire palpable: