Fearsome

Female Reproductive System & Breast


Step 1: View Clinicals

A 23-year-old woman presents with a painless lump in her right breast. She discovered the lump a few days ago, when doing a breast self-examination. She has no other symptoms. There is no history of trauma to the breast, or of previous breast lumps.


Her medical and surgical histories are unremarkable. She is not on any medications. Her family history is also unremarkable. She is nulliparous. Her menarche was at the age of 13 and her menstrual cycles are regular, with a 28-day duration. She is not on contraceptives currently.


Step 2: Order Relevant Investigations

1. Breast ultrasound

check

There is a well-circumscribed ovoid mass in the upper outer quadrant of the right breast. The mass is 1.7 x 1.9 cm in size, with a sharp and smooth contour and uniform hypoechogenicity.


The left breast is sonographically normal.

2. Mammography

clear

You realize that a better alternative exists.

3. MRI breasts

clear

You realize that this investigation is not indicated here.

4. Core needle biopsy

check

There is hyperplasia of the epithelial and stromal components and proliferation of the intralobular stroma with compression of the epithelium (i.e., a peri-canalicular pattern). There is no cytological atypia and the basement membrane is intact.

Step 3: Select Appropriate Management

1. Offer observation (watchful waiting)

check

2. Offer surgical excision

check

3. Offer mastectomy

clear

4. Offer hormone therapy

clear