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REGUB > 29. Benign Breast Disease > Flashcards

29. Benign Breast Disease Flashcards

1
Q

What is a lobe in the breast?

A

Single lactiferous duct with all its branches, the end point being lobules

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2
Q

What is the functional unit of the breast?

A

Terminal duct lobular unit:
Terminal branches of ducts
Lobules
Surrounding connective tissue

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3
Q

Describe the layers of duct and lobule walls from inside out

A

Epithelial layer
Myoepithelial layer
BM

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4
Q

What is the composition of the breast pre-puberty?

A

Branching ducts connected to nipple

No glands

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5
Q

What is the composition of the breast post-puberty?

A

Terminal ducts give rise to lobules

Formation of interlobular connective tissue (fibrofatty)

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6
Q

How does the menstrual cycle change the structure of the breast?

A

Epithelial proliferation in follicular phase (oestrogen)
Luteal phase (progesterone) increased number of acini, oedema
Menstruation causes involution

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7
Q

What are the causes of galactorrhoea?

A

Nipple stimulation
Prolactinoma
Drugs

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8
Q

Where can supernumery nipples or breasts be found?

A

Milk line: axilla to perineum

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9
Q

What lumps should be sent for follow up?

A 
New
Persistant asymmetric nodularity
Unresolving inflammation
Other symptoms/features
Cyst returning after aspiration
Family history breast cancer
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10
Q

What is the clinical assessment of the breast?

A

Inspection and palpation
Ultrasound
Mammography
MRI

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11
Q

Why is mammography not as sensitive in young women?

A

Breast tissue is denser

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12
Q

What are the indications for MRI of of the breasts?

A

Implants
Stage lobular carcinoma
Evaluate high risk patients
Monitor those on chemo

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13
Q

What is a triple assessment?

A

Clinical exam
Radiology
Pathology
Used to determine whether benign or malignant; negative on all 3 the lump will be left alone

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14
Q

What is Breast Check?

A

Used to detect non-palpable breast cancers that are asymptomatic
Females aged 50-69 have a mammogram every 2 years, or younger women at high risk

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15
Q

What are the signs of malignancy on a mammogram?

A

Densities
Calcifications that are small, irregular and clustered
Architectural distortion
Asymmetry

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16
Q

What steps are taken after a mammogram appears abnormal?

A

Clinical exam
Additional mammogram
Ultrasound

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17
Q

What is the method of choice for getting a sample for a pathological diagnosis?

A

Needle core biopsy

18
Q

What are the advantages of FNA vs Needle core biopsy?

A

Needle core shows architecture and FNA doesn’t
FNA is quicker, cheaper and doesn’t require anaesthetic
Needle core requires local anaesthetic

19
Q

What is acute mastitis?

A

Cracked nipple in lactation allows bacteria to enter

20
Q

What are the common pathogens in acute mastitis?

A 
Staph= local
Strep= diffuse
21
Q

What are the symptoms of acute mastitis?

A

Pain
Purulent discharge
Sometimes systemic

22
Q

What is the treatment for acute mastitis?

A

Antibiotics

Rarely drainage

23
Q

What is periductal mastitis?

A

Smoking causes squamous metaplasia, resulting in keratin production
Keratin blocks ducts, causing inflammation

24
Q

What are the symptoms of periductal mastitis?

A

Painful mass
Inverted nipple
Duct can become dilated and rupture; granulomatous inflammation

25
Q

What is the treatment of periductal mastitis?

A

Surgical excision of the involved duct

26
Q

What is mammary duct ectasia?

A

Thick secretions block large ducts and may rupture into stroma

27
Q

What can be seen on histology in mammary duct ectasia?

A

Chronic inflammation
Plasma cells
+/- granulomas

28
Q

What are the symptoms of mammary duct ectasia?

A

Palpable mass
green nipple discharge
Mimics carcinoma clinically and on mammogram

29
Q

What are the causes of fat necrosis of the breast?

A

Trauma
Biopsy
More common in obese or post menopausal women

30
Q

What patient group is most associated with lymphocytic mastitis?

A

T1DM

31
Q

What is the pattern in lymphocytic mastitis?

A

Palpable mass subareolar

Bilateral

32
Q

What are the causes of granulomatous mastitis?

A

Idiopathic

Sarcoidosis

33
Q

What is a galactocoele?

A

Cystic dilation of duct in lactation
Can be infected causing acute mastitis
May form an abscess

34
Q

What patient group do fibrocystic changes occur in?

A

Half of all women

Age 20-40

35
Q

What are the symptoms of fibrocystic change?

A

Asymptomatic
Cyclical dyscomfort
Lumpy breast
Nipple discharge

36
Q

What is the appearance of fibrocystic change under the microscope?

A

Fibrosis of stroma
Cysts, dilation of ducts and lobules
Apocrine metaplasia (more like sweat gland)

37
Q

What proliferative changes can be seen in fibrocystic change?

A

Adenosis: increased number of acini per lobule
Epitheliosis: increased number of layers in wall of ducts

38
Q

How is epitheliosis classified?

A

Atypia vs non-atypia
Non atypical: mild increased risk of cancer
Atypical: moderate increased risk

39
Q

What is an intraductal papilloma?

A

benign papillary growth within lactiferous duct

seen in pre-menopausal women

40
Q

What are the symptoms of an intraductal papilloma?

A

Serous or bloody nipple discharge

41
Q

What is the treatment for an intraductal papilloma?

A

Surgical excision: will recur if not adequate

42
Q

What are the causes of gynaecomastia?

A

Oestrogen excess eg. cirrhosis, testicular tumours
Drugs: alcohol, weed, heroin
Prolactinoma

REGUB (31 decks)

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