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General surgery > Approach to a breast mass > Flashcards

Approach to a breast mass Flashcards

1
Q

Differential diagnosis

A 
Fibroadenoma
Fibrocystic changes
Fat necrosis
Intraductal papilloma
Breast abscess
Atypical ductal/lobular hyperplasia
DCIS
Invasive breast cancer
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2
Q

Percentage of women presenting with a breast mass that are malignant

A

10%

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3
Q

Triple test

A

Physical examination
Imaging
Biopsy

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4
Q

Most common cause of breast mass

A

Fibroadenoma

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5
Q

Risk of breast cancer in women with fibroadenomas

A

Twice the risk

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6
Q

What does fibrocystic disease encompass, and when is it more common

A

Pre/perimenopauses

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7
Q

Are breast cysts common in post-menopausal

A 
Cysts
Epithelial hyperplasia
Apocrine metaplasia
Cystic dilation
Fibrosis
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8
Q

Bloody nipple discharge, typical of what lesion

A

Intraductal papilloma

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9
Q

When are breast abscess more common

A

Breastfeeding

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10
Q

Types of premalignant breast lesions

A

Atypical ductal hyperplasia

Atypical lobular hyperplasia

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11
Q

What causes dimpling of the skin in breast cancer

A

Malignant infiltration of fibrous contraction of coopers ligaments

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12
Q

Arterial supply of the breast

A

Axillary artery

Internal thoracic

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13
Q

Lymphatic drainage of the breast

A 
Axillary:
Apical= infraclavicular
Anterior= pectoralis major
Posterior= subscapular
Lateral= axillary vein
Cantral= axillary fat

Internal mammary:
Drains medial breast

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14
Q

Proliferative (non-neoplastic) changes in breast

A 
Metaplasia
Adenosis
Simple cysts
Diabetic fubrous matopathy
Fibrocystic
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15
Q

Management of likely benign lesion on USS

A

Clinical and ultrasonographic surveillance every 6 months for 2 years, to document stability
Core needle biopsy to make a definitive diagnosis while leaving the lesion in situ
Surgical removal of the mass, particularly if the lesion is bothersome to the patient.

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16
Q

Benign neoplastic proliferations

A

Fibroadenoma
Atypical ductal/lobular
Sclerosing adenosis
Ductal papilloma

17
Q

What imaging method is preferred in women >30 and

A

Mammography preferred in women >30 yo

USS preferred in women

18
Q

BIRADS categories, description and recommmendation

A 
0= need more info, further imaging
1= normal, routine screening mammography
2= benign, routine screening mammography
3= probably benign, short term f/u in 6 months
4= highly suspicious, biopsy
5= malignant, biopsy
6= known cancer, treat malignancy
19
Q

Algorithm for breast USS

A

Solid–>

  1. Suspicious= biopsy
  2. Probably benign= biopsy or f/u

Cystic–>

  1. Simple= follow or aspirate
  2. Complex= biopsy
20
Q

Main types of biopsy

A

FNA
Core needle
Excisional

21
Q

FNA advantages and disadvantages

A

A: easy, painless, office, small needle
D: expert cytopathologist, cannot evaluate histology

22
Q

Core needle advantages and disadvantages

A

A: easy, painless, office, histopathology, tissue, receptor status
D: slightly larger needle

23
Q

Excisional advantages and disadvantages

A

A: histopathology, tissue architecture, receptor status
D: need OT, larger incision, painful

24
Q

When would cystic fluid be sent for cytology

A

When blood

25
Q

Investigations for fibroadenoma

A

In women physical

In >35-> U/S, biopsy

26
Q

Biopsy in fibroadenoma, when to review and management if stable vs growing

A

Review in 3 months

Stable->USS and review in 12/12->stable = d/c. Growth->refer for surgical

Growth->surgical opinion

27
Q

Progress of fibroadenoma

A

Usually doesn’t change
Hormone responsive
Not in itself pre-malignant

28
Q

What is phylloides tumor

A

Intralobular stroma, leaf like protrusions
+Cellularity, mitosis, pleomorphism, +infiltration
Does not regress
8% malignant

29
Q

Causes of nipple discharge

A 
Physiologic->pregnancy, lactation
Galactorrhea
Duct ectasia
Ductal papilloma
Cyst
Malignancy
Idiopathic
30
Q

Relative risk of malignant breast disease when presenting with benign breast disease

A

Moderately increased risk (4–5×)
Atypical ductal hyperplasia
Atypical lobular hyperplasia
Radial scar

Slightly increased risk (1.5–2.0×)
Moderate or florid hyperplasia
Multiple papilloma

No increased risk
 Cysts
 Fibroadenoma
 Duct ectasia
 Mild hyperplasia
 Sclerosing adenosis
 Apocrine change
31
Q

When is nipple discharge likely to represent a physiologic process

A

Clear
Yellow or green
Multiple ducts
On nipple stimulation

32
Q

When is nipple discharge more suggestive of a pathalogic process and common etiologies

A

Spontaneous
Persistent
Bloody
Associated with a mass

  1. Ductal papilloma
  2. Ductal ectasia
  3. Cancer
  4. Infection
33
Q

Definition of galactorrhea

A

Discharge of milk/serous fluid in the abscence of parturition or beyond 6 months post partum in a non-breast-feeding woman

34
Q

Etiology of galactorrhea

A

stress,
physical irritation,
hypothyroidism,
chronic renal failure,
hypothalamic-pituitary disorders,
hormone-secreting neoplasms (most commonly pituitary adenomas), or
may be idiopathic but is not associated with breast cancer.
can block dopamine and histamine receptors, deplete dopamine stores, inhibit dopamine release, and stimulate lactotrophs.
Common medications and classes
of medications: SSRIs, TCAs, atenolol,
verapamil, antipsychotics, H2 histamine blockers (cimetidine), and opiates,
Estrogen in oral contraceptives can cause galactorrhea by suppressing the hypothalamic secretion of prolactin inhibitory factor and by direct stimulation of the pituitary lactotrophs

35
Q

Investigations in galactorrhea

A 
Discontinue offending agents
UEC
TSH
Prolactin
Pregnancy test in reproductive age
MRI if ++prolactin
36
Q

Management of glactorrhea

A

Manage underlying conditions

Bromocriptine is preferred treatment for hyper-prolactin induced anovulatory infertility

General surgery (36 decks)

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