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23 y female patient complains of dull aching breast pain and breast lump in the left breast , pain increases pre-menstrually and decreases with onset of the menstruation, what is the most possible diagnosis?

A- Fibroadenoma
B- Ductal papilloma
C- Fibroadenosis
D- Breast cancer
E- Duct papilloma
 

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Fibroadenoma is the most common breast tumor found in adolescent and young females.

You definitely don't expect Breast Ca in a 23yo female, so choice D is wrong.

Intraductal papilloma usually presents as bloody nipple discharge and is expected in clearly older women, thus A should also be incorrect.

Fibroadenosis is a more generalized condition than fibroadenoma (probably a "reactive" pattern of the breast in response to aging of the tissue) and one should expect its peak incidence around 35-50yo.

This clinical presentation in a woman around 30-40yo would indicate fibrocystic disease (cyclical pain pattern), but this is not the case here.

So, I think that the correct answer is A-fibroadenoma.
 

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You are right the clinical scenario is suggestive of fibrocystic changes. But it's there in the options. Fibroadenosis is one of the histopathologic features of fibrocystic disease of the breast.
 

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I totally agree with you, Dr. YoramFishke, but the age of this patient is not consistent with fibrocystic disease. After having taken both Step 1 & 2CK, I have figured out that the examiners put extra weight in the demographic parameters of the presented cases. Even though the clinical presentation per se is strongly indicative of fibrocystic disease, I think that we should take into serious consideration that she is only 23.:)
 

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Fibrocystic disease: most common cause of "breast lumps" from age 25 to menopause (...) --> First Aid Step 1 2008, p. 451.

Mammary dysplasia (fibrocystic disease, cystic mastitis) is seen in the thirties and forties (goes away with menopause)(...) -- Kaplan Notes 08-09, Surgery, p. 41.

Fibrocystic Change: (...) It is common in women 35 to 55 years of age but rare in postmenopausal women not taking hormone therapy(...) --> Novak Gynecology 14th Ed. 2007, p. 652

After all, we may both be right!:) Many sample questions are not well designed!
 

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i have not seen anywhere in Goljan / FA / KAPLAN mentioning that fibradenomas change by mensturation cycle. I wonder why FCD is not in options.
either the q is not well written or i am missing something here :confused:
 

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i have not seen anywhere in Goljan / FA / KAPLAN mentioning that fibradenomas change by mensturation cycle. I wonder why FCD is not in options...
Hana, meet YoramFishke :shakehands:
You are right the clinical scenario is suggestive of fibrocystic changes. But it's there in the options. Fibroadenosis is one of the histopathologic features of fibrocystic disease of the breast.
 

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definitely fibrocystic disease of the breast. Not fibroadenoma - the point of the question may be to check if we think about the disease first or the demographics. cyclical mastalgia is a CLASSIC sign of fibrocystic disease.
 
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