A 29-year-old lady presents with a history of discharge from the nipple of the left breast since 1 month duration. Which one of the following is not warranted in the initial assessment of this patient?
Histo/Cytopathology
The correct answer, that is the test not warranted initially, is histo/cytopathology. Nipple discharge in a 29-year-old woman is usually benign, the commonest causes being duct ectasia, periductal mastitis, intraductal papilloma and fibrocystic change, with drug-induced or prolactinoma-related galactorrhoea also considered. Initial assessment is history and clinical examination followed by imaging. Tissue sampling is not a routine first step: it is reserved for a discrete lump or a suspicious imaging finding, and is then a core biopsy of the lesion, since discharge cytology has poor sensitivity and a negative result cannot exclude carcinoma.
Clinical examination is mandatory in every breast complaint and is the first arm of triple assessment. Ultrasonography is the imaging of choice under 35-40 years because dense breast tissue limits mammographic sensitivity, and it shows dilated ducts and papillary lesions well. Mammography is still legitimately used in pathological discharge to exclude an underlying malignancy or suspicious microcalcification.
Key point: Work up nipple discharge with examination plus imaging first, adding pathology only if findings are suspicious. Red flags are unilateral, single-duct, spontaneous, blood-stained discharge with a mass.
Important Questions from Neck & Breast Surgery
- A midline neck swelling just below the hyoid bone and managed by Sistrunk's operation leads to postoperative need for thyroxine replacement. The most likely diagnosis is
- A 60-year-old lady presents with a recent onset increase in a long standing swelling on the front of the neck. The swelling, which was small, had been present since last 30 years, but has now increased to more than twice the size in the last 2 months. On examination, the swelling is firm to hard in consistency and moves with deglutition. What is the most likely cause of this clinical presentation?
- A 43 year old woman presented with serous discharge from a single duct of the nipple of her right breast which was sent for evaluation. She is unlikely to be suffering from
- Which of the following are included in triple assessment in case of breast?
1. Clinical assessment
2. Radiological assessment
3. Histopathological assessment
4. Sentinel lymph node biopsy
Select the correct answer using the code given below. - A gentleman of 60 years presented with a brawny swelling of the sub- mandibular region with inflammatory oedema of mouth and putrid halitosis. Most likely he is suffering from
