408 Obstetrics and Gynecology Board Review •••
❍ What is the image modality of a postmenopausal patient with a palpable breast mass?
Mammogram. Ultrasound or compression and magnification views to clarify the mammographic image can be
ordered if deemed necessary.
❍ What malignant component is rarely found in fibroadenomas?
Atypical hyperplasia of both ductal and lobular types may be found in <1% of the cases. Very rarely, lobular
carcinoma in situ (LCIS), DCIS, invasive ductal carcinoma (IDC), or invasive lobular carcinoma (ILC) has been
observed in association with a fibroadenoma.
❍ In general, what criteria do you use to evaluate the malignant potential of a cyst aspirate?
Clear or straw-colored fluid is generally considered benign, while hemorrhagic fluid has a higher malignant potential.
❍ What is the treatment of severe mastodynia?
In addition to avoidance of dietary methylxanthines and adhering to a low-fat diet, patients should be instructed to
wear a well-supporting bra and avoid physical activities that exacerbate pain from breast motion. Evening primrose
oil at a dose of 3 g/day has been associated with improvement in mastalgia. Androgen therapy should be considered
a last resort measure.
❍ What is the only androgen approved for the treatment of mastalgia?
Danazol.
❍ What is the dose of Danazol when treating mastalgia?
Initially 100 mg twice daily. The dose may be doubled if no improvement occurs after 2 months.
❍ What are side effects of Danazol?
Oily skin, acne, hirsutism, lowered vocal pitch, hot flashes, abdominal cramps, increased libido, dyspareunia,
headaches, nervousness, depression, and venous thromboembolism.
❍ How common is breast cancer?
One in nine women will develop the disease.
❍ What is the most common congenital abnormality of the breast?
Polythelia (supernumerary nipples).
❍ Where are supernumerary nipples located?
They are identified at birth as 2 to 3 mm pigmented spots that lie on the embryonic milk lines (mammary ridges)
that extend from the axilla to the groin on each side of the thoracoabdominal skin.
❍ What conditions are associated with polythelia?
There is a slight increased association with renal anomalies, vertebral anomalies, and cardiac rhythm abnormalities.
❍ What is microscopically lacking in the male breast to distinguish it from the female breast?
Lobules.