29. Benign Breast Disease Flashcards
What is a lobe in the breast?
Single lactiferous duct with all its branches, the end point being lobules
What is the functional unit of the breast?
Terminal duct lobular unit:
Terminal branches of ducts
Lobules
Surrounding connective tissue
Describe the layers of duct and lobule walls from inside out
Epithelial layer
Myoepithelial layer
BM
What is the composition of the breast pre-puberty?
Branching ducts connected to nipple
No glands
What is the composition of the breast post-puberty?
Terminal ducts give rise to lobules
Formation of interlobular connective tissue (fibrofatty)
How does the menstrual cycle change the structure of the breast?
Epithelial proliferation in follicular phase (oestrogen)
Luteal phase (progesterone) increased number of acini, oedema
Menstruation causes involution
What are the causes of galactorrhoea?
Nipple stimulation
Prolactinoma
Drugs
Where can supernumery nipples or breasts be found?
Milk line: axilla to perineum
What lumps should be sent for follow up?
New Persistant asymmetric nodularity Unresolving inflammation Other symptoms/features Cyst returning after aspiration Family history breast cancer
What is the clinical assessment of the breast?
Inspection and palpation
Ultrasound
Mammography
MRI
Why is mammography not as sensitive in young women?
Breast tissue is denser
What are the indications for MRI of of the breasts?
Implants
Stage lobular carcinoma
Evaluate high risk patients
Monitor those on chemo
What is a triple assessment?
Clinical exam
Radiology
Pathology
Used to determine whether benign or malignant; negative on all 3 the lump will be left alone
What is Breast Check?
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
What are the signs of malignancy on a mammogram?
Densities
Calcifications that are small, irregular and clustered
Architectural distortion
Asymmetry
What steps are taken after a mammogram appears abnormal?
Clinical exam
Additional mammogram
Ultrasound
What is the method of choice for getting a sample for a pathological diagnosis?
Needle core biopsy
What are the advantages of FNA vs Needle core biopsy?
Needle core shows architecture and FNA doesn’t
FNA is quicker, cheaper and doesn’t require anaesthetic
Needle core requires local anaesthetic
What is acute mastitis?
Cracked nipple in lactation allows bacteria to enter
What are the common pathogens in acute mastitis?
Staph= local Strep= diffuse
What are the symptoms of acute mastitis?
Pain
Purulent discharge
Sometimes systemic
What is the treatment for acute mastitis?
Antibiotics
Rarely drainage
What is periductal mastitis?
Smoking causes squamous metaplasia, resulting in keratin production
Keratin blocks ducts, causing inflammation
What are the symptoms of periductal mastitis?
Painful mass
Inverted nipple
Duct can become dilated and rupture; granulomatous inflammation
What is the treatment of periductal mastitis?
Surgical excision of the involved duct
What is mammary duct ectasia?
Thick secretions block large ducts and may rupture into stroma
What can be seen on histology in mammary duct ectasia?
Chronic inflammation
Plasma cells
+/- granulomas
What are the symptoms of mammary duct ectasia?
Palpable mass
green nipple discharge
Mimics carcinoma clinically and on mammogram
What are the causes of fat necrosis of the breast?
Trauma
Biopsy
More common in obese or post menopausal women
What patient group is most associated with lymphocytic mastitis?
T1DM
What is the pattern in lymphocytic mastitis?
Palpable mass subareolar
Bilateral
What are the causes of granulomatous mastitis?
Idiopathic
Sarcoidosis
What is a galactocoele?
Cystic dilation of duct in lactation
Can be infected causing acute mastitis
May form an abscess
What patient group do fibrocystic changes occur in?
Half of all women
Age 20-40
What are the symptoms of fibrocystic change?
Asymptomatic
Cyclical dyscomfort
Lumpy breast
Nipple discharge
What is the appearance of fibrocystic change under the microscope?
Fibrosis of stroma
Cysts, dilation of ducts and lobules
Apocrine metaplasia (more like sweat gland)
What proliferative changes can be seen in fibrocystic change?
Adenosis: increased number of acini per lobule
Epitheliosis: increased number of layers in wall of ducts
How is epitheliosis classified?
Atypia vs non-atypia
Non atypical: mild increased risk of cancer
Atypical: moderate increased risk
What is an intraductal papilloma?
benign papillary growth within lactiferous duct
seen in pre-menopausal women
What are the symptoms of an intraductal papilloma?
Serous or bloody nipple discharge
What is the treatment for an intraductal papilloma?
Surgical excision: will recur if not adequate
What are the causes of gynaecomastia?
Oestrogen excess eg. cirrhosis, testicular tumours
Drugs: alcohol, weed, heroin
Prolactinoma
