[mosallam]

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

 

[ath.pantelis]

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.

 

[khanar]

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.

 

[ath.pantelis]

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.

 

[khanar]

It's still fibrocystic

I think that we should take into serious consideration that she is only 23.

Fibrocystic disease is seen between 20-50 years of age
Ref: Kaplan Step 1 Notes

 

[ath.pantelis]

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!

 

[hana]

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

 

[1TA2B]

Fibroadenoma is a painless condition to my knowledge.

 

[Mondoshawan]

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.

 

[rsin21]

m sure its C

fibroadenosis is also known as cyclical mastalgia with nodularity.

 

[drarnab]

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.