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Y3 - Repro > Benign Breast > Flashcards

Benign Breast Flashcards

1
Q

What are the types of benign breast lump?

A 
Fibroadenoma
Adenoma
Duct papilloma
Lipoma
Phyllodes tumour
Sclerosing adenosis
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2
Q

What are the inflammatory breast conditions?

A

Breast cystitis
Fat necrosis
Duct ectasia
Mastitis

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3
Q

What are the breast conditions associated with breastfeeding?

A

Blocked duct/galactocele
Nipple candidiasis
Engorgement
Raynaud’s disease of the nipple

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4
Q

What are the general features that differentiate benign and malignant breast lumps?

A 
Benign:
- more mobile
- smooth borders
- multiple masses
Malignant
- craggy surfaces
- firm consistency
- fixed to surrounding tissue
- single mass
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5
Q

What is a fibroadenoma?

A

Proliferation of stroll epithelial tissue of duct lobules

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6
Q

What is the most common benign breast lump?

A

Fibroadenoma

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7
Q

What is a fibroadenoma also known as, and why?

A

‘Breast mouse’ because it is so mobile

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8
Q

Who most commonly present with fibroadenomas?

A

Women of reproductive age (peak in 3rd decade)

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9
Q

What is the presentation of fibroadenoma?

A

Painless
Smooth, firm, well-defined, rubbery, highly mobile
Most <5cm in diameter
Can be multiple and bilateral

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10
Q

What are the features of fibroadenoma on mammogram?

A

Oval or round
Circumscribed
May have coarse calcification

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11
Q

What are the features of fibroadenoma on biopsy?

A

Biphasic component - stroll and epithelial component

Circumscribed edge

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12
Q

What are the management options for fibroadenoma?

A

Routine follow up

Surgical excision

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13
Q

When are fibroadenomas routinely followed up?

A

Asymptomatic

If low malignant potential

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14
Q

Why can fibroadenomas just be routinely followed up?

A

Low malignant potential

30% will get smaller over 2 years

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15
Q

When are fibroadenomas excised?

A

> 3cm in diameter
Symptomatic
Increasing size of other changes
Patient choice

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16
Q

What is a breast adenoma?

A

Benign tumour of ductal glandular tissue

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17
Q

Who most commonly present with breast adenomas?

A

Older females

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18
Q

What is the presentation of breast adenomas?

A 
Painless
Slowly enlarging 
Well circumscribed, mobile
Nodular
Can mimic malignancy
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19
Q

What are intraductal papillomas?

A

Growth of papilloma in breast ductal tissue

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20
Q

What is the presentation of intraductal papillomas?

A

Clear or blood-stained discharge originating from a single duct
Lump or multiple lumps in subareolar region - usually <1cm away from nipple

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21
Q

What is included in triple assessment for breast lumps?

A

Clinical examination
Imaging - US or mammography
Biopsy

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22
Q

What is seen on biopsy in intraductal papillomas?

A

Papillary growth pattern

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23
Q

What is the management for intraductal papillomas, and why is it done?

A

Microdochectomy - surgical excision of duct

Done because of increased risk of breast cancer with multi-ductal papilloma

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24
Q

What is a lipoma?

A

Benign adipose tumour

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25
Q

What is the presentation of a breast lipoma?

A

Soft and mobile

Can feel under it on palpation

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26
Q

What are the features of breast lipoma on mammography?

A

Thin smooth border

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27
Q

What is seen on biopsy of breast lipoma?

A

Only adipose cells

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28
Q

What is the management of breast lipoma?

A

May require excision to confirm diagnosis

Excise if significantly enlarging, causing symptomatic compression or aesthetic issues

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29
Q

What is a phyllodes tumour?

A

Rare fibroepithelial tumours

Comprised of both epithelial and stromal tissue

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30
Q

What is the malignant potential of a phyllodes tumour?

A

Majority benign

1/3 have malignant potential

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31
Q

Who are most likely to present with a phyllodes tumour?

A

Older - 40-60

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32
Q

What is the presentation of a phyllodes tumour?

A 
Larger
Well delineated 
Unilateral 
Grow rapidly
Firm lump
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33
Q

What is the management for phyllodes tumour?

A

Wide local excision

Mastectomy for larger tumours

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34
Q

What is sclerosing adenosis?

A

Includes radial scars and complex sclerosing lesions

Distortion of the distal lobular with or without hyperplasia

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35
Q

What is the difference between radial scars and complex sclerosing lesions?

A

Radial scars - distortion of the distal lobular unit without hyperplasia
Complex sclerosing lesions - if hyperplasia is present

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36
Q

What is the presentation of sclerosing adenosis?

A

Breast lump or breast pain

Asymptomatic incidental finding

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37
Q

What is the management of sclerosing adenosis?

A

Excision - but not mandatory

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38
Q

What are breast cysts?

A

Epithelial lined, fluid-filled cavities

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39
Q

Why do breast cysts form?

A

When lobules become distended due to blockage

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40
Q

Are breast cysts common?

A

Yes

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41
Q

Who are breast cysts most common in?

A

Peri-menopausal women

42
Q

What is the presentation of breast cysts?

A 
Breast lumps
May be painful and tender
- pain often cyclical, worse before menstruation
Single or multiple, can be bilateral
Character of masses:
- distinct
- smooth 
- fluctuant or solid
- mobile
43
Q

What investigation gives the definitive diagnosis for breast cysts?

A

USS

44
Q

What sign of beast cysts is seen on mammogram?

A

Halo shape

45
Q

What is the management of breast cysts?

A

FNA of persisting, symptomatic or undeterminable lumps

Otherwise none needed

46
Q

What may need to be done post-aspiration of breast cysts?

A

Cytology if aspirated fluid is bloody

Biopsy if any residual lump left after aspiration

47
Q

What is the prognosis of breast cysts?

A

Risk of recurrence

Small increased risk of breast cancer in the future

48
Q

What is fat necrosis?

A

Acute inflammatory response leading to ischaemic necrosis of fat lobules

49
Q

What is the pathophysiology of fat necrosis?

A

Damage and disruption of adipocytes
Infiltration of acute inflammatory cells
‘Foamy’ macrophages
Subsequent fibrosis and scarring

50
Q

Who are most likely to present with fat necrosis?

A

Obese women with large breasts

51
Q

What is the common cause of fat necrosis?

A

Trauma to breast - blunt trauma, previous surgical o radiological intervention, seatbelts in RTA

52
Q

What is the presentation of fat necrosis?

A 
Firm lump
May have associated haematoma
Fluid discharge
Nipple pain and inversion
Skin dimpling
If fibrotic change - solid, irregular lump
53
Q

What are the investigation findings in fat necrosis?

A

USS - hyper echoic mass

Mammogram - can mimic carcinoma - core biopsy needed to rule out malignancy

54
Q

What is the management of fat necrosis?

A

Self-limiting, usually resolves spontaneously

Conservative - reassurance, analgesia

55
Q

What is duct ectasia?

A

The dilation and shortening of the major lactiferous ducts
A normal change occurring during breast involution
Followed by periductal inflammation, fibrosis, scarring and distortion

56
Q

Which breast ducts does duct ectasia affect?

A

Sub-areolar ducts

57
Q

Which benign breast condition is associated with smoking?

A

Duct ectasia

58
Q

What is the presentation of duct ectasia?

A

Lump
Nipple discharge (brown-green/yellow/creamy)
Nipple retraction (slit-like)
Pain - accentuated by acute episodic inflammatory changes
Fistulation

59
Q

What is seen on investigation of duct ectasia?

A

Mammogram - dilated calcify ducts without any other features of malignancy
Biopsy - mass typically containing plasma cells

60
Q

If bloody nipple discharge is seen in a presentation of duct ectasia, what is needed?

A

Triple assessment

61
Q

What is the management of duct ectasia?

A

Conservative
Surgical excision if excessive, unremitting nipple discharge
Treat acute infection

62
Q

What is mastitis?

A

Inflammation of breast tissue

63
Q

What are the classifications of mastitis?

A

Acute vs chronic

Lactational vs non-lactational

64
Q

What is the presentation of mastitis?

A 
Pain
Tenderness
Swelling
Erythema
Pyrexia
Lump
65
Q

What feature on presentation of mastitis suggests abscess?

A

Fluctuant mass

66
Q

What is more common, lactational or non-lactational mastitis?

A

Lactational mastitis

67
Q

What organism is most common in lactational mastitis?

A

Staph aureus

68
Q

Who are affected by lactational mastitis?

A

Breastfeeding women - usually in the first 3 months or during weaning

69
Q

What is lactational mastitis often caused by?

A

Poor feeding technique

70
Q

What is the features presentation of mastitis is specific to lactational mastitis?

A

Cracked nipples and milk stasis

71
Q

What general measures should be taken in lactational mastitis?

A

Continue breastfeeding
Express milk
Massage breast

72
Q

When should breastfeeding be stopped in lactational mastitis, and how should this be done?

A

If persistent or multiple areas of infection

Cessation of breastfeeding by cabergoline (a dopamine agonist)

73
Q

When should antibiotics be given in lactational mastitis, and which one?

A

If:
- systemically unwell
- nipple fissure
- positive culture
- symptoms not improving after 12-24 hours of effective milk removal
If nipple fissure infected - topical fusidic acid
Flucloxacillin

74
Q

Who most commonly get non-lactational mastitis?

A

Smokers

Association with duct ectasia, periductal mastitis

75
Q

How does smoking predispose to non-lactational mastitis?

A

Damage to sub-areolar duct walls

And predisposes to bacterial infection

76
Q

What is the management of non-lactational mastitis?

A

Antibiotics (flucloxacillin/clindamycin)
Simple analgesia
Aspiration, incision, drainage of abscess

77
Q

What is the complication of non-lactational mastitis, and how is it treated?

A

Mammary duct fistula - communication between skin and scubareolar duct
Surgical excision

78
Q

What is a blocked duct/galactocele?

A

Milk bleb - little milk blister on nipple

79
Q

Who most commonly get a blocked duct/galactocele?

A

Recent cessation of breastfeeding

80
Q

What is the presentation of a blocked duct/galactocele?

A

Visible milk bleb

Pain when breastfeeding

81
Q

What is the management of a blocked duct/galactocele?

A

Diagnosis and drainage by FNA

Continue breastfeeding, massage breast

82
Q

What is nipple candidiasis?

A

Fungal infection of the nipple

Candida albicans

83
Q

What is the presentation of nipple candiasis?

A

Pain when breastfeeding

84
Q

What is the treatment for nipple candidiasis?

A

Miconazole cream for mother

Nystatin suspension for the baby

85
Q

What is engorgement?

A

When milk isn’t fully removed front he breast

86
Q

Who most commonly presents with engorgement?

A

Breastfeeding women, usually in the first few days after baby born

87
Q

What is the presentation of engorgement?

A

Bilateral erythema
Breast pain, typically worse just before a feed
Fever may be present, styles within 24 hours
Milk doesn’t flow well - infant finds it difficult to attach and suckle

88
Q

What is the management of engorgement?

A

Moist heat on breasts before feed
Cold compresses after feed to reduce swelling
Gently massage and compress the breasts during breastfeeding when baby pauses between sucks

89
Q

What complications of engorgement can occur?

A

Blocked ducts

Mastitis

90
Q

What is the presentation of Raynaud’s disease of the nipple?

A

Nipples blanch, followed by cyanosis or erythema
Pain during and immediately after feeding
Nipple pain resolves when it returns to normal colour

91
Q

What is the management of Raynaud’s disease of the nipple?

A

Advise to minimise cold exposure
Head packs following breastfeeding
Lifestyle changes - avoid caffeine, stop smoking

92
Q

What is mastalgia?

A

Breast pain

93
Q

What is the management of mastalgia not associated with a breast lump?

A

Reassurance
Recommend better fitting bra or soft-support bra at night
Simple analgesia
Medications to stop (or reduce): COCP, antidepressants, anti-psychotics

94
Q

What is galactorrhoea?

A

Copious bilateral multi-ductal milky discharge

Not associated with pregnancy or lactation

95
Q

What is the normal physiology of breastfeeding?

A

Regulated by prolactin
Polypeptide hormone is produced and secreted by the anterior pituitary gland
Inhibited by dopamine
Stimulated by oestrogen and TRH (thyrotropin releasing hormone)

96
Q

What are the causes of hyperprolactinaemic galactorrhoea?

A

Idiopathic
Prolactinoma
Hypothyroidism
Neurological conditions lowering dopamine - spinal cord injury, varicella zoster
Drugs - SSRIs, antipsychotics, H2 antagonists

97
Q

What is done for investigation of galactorrhoea?

A 
Exclude pregnancy
Serum prolactin (>1000 in absence of drug cause is suggestive of prolactinoma - do MRI head with contrast)
Further endocrine blood tests
98
Q

What is the management of galactorrhoea?

A

Treat underlying cause
Pituitary tumors
- dopamine agonists - cabergoline, bromocriptine
- neurosurgery - trans-sphenoidal surgery

99
Q

What is gynaecomastia?

A

Benign breast tissue growth in males

100
Q

What are causes of gynaecomastia?

A

Physiological - delay in testosterone surge relative to oestrogen at puberty, decreasing testosterone with age
Idiopathic
Medications - digoxin, spironolactone, H2 antagonist, metronizadole, chemotherapy, gosterelin, antipsychotics, anabolic steroids
Lack of testosterone - Klinefelter’s, androgen insensitivity, testicular atrophy, renal disease
Increased oestrogen - liver disease, hyperthyroidism, obesity, adrenal tumours, Lydia cell tumour

101
Q

What is the presentation of gynaecomastia?

A

Insidious onset of rubbery or firm mass
Starts from underneath nipple and spreads outwards over breast region
Uni or bilateral

102
Q

What is the management of gynaecomastia?

A

Treat underlying cause
Medication - tamoxifen (relieves symptoms), danazol
Surgery if later stages and medical treatments have failed

Y3 - Repro (13 decks)

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