benign breast conditions Flashcards
what is fibrocystic change
the stroma ducts and lobules of the breast respond to oestrogen and progesterone and become fibrous and cystic
why do the symptoms of fibrocystic change fluctuate
because the changes are in response to oestrogen and progesterone which fluctuate with the menstrual cycle
how does fibrocystic change present
lumpiness
mastalgia
fluctuation of breast size
how do you manage fibrocystic change
wear supportive bra NSAIDs avoid caffiene apply heat danazol (GnRH inhibitor) tamoxifen (anti-oestrogen)
what is a fibroadenoma
benign tumour of stromal/epithelial cells of breast
what age group are fibroadenomas common in
adolescents
young adults
why do fibroadenomas regress in menopause
they respond to oestrogen and progesterone which decline in menopause
how does fibroadenoma present
small mobile lump painless well circumscribed firm up to 3cm
what is an intraduct papilloma
benign tumour of milk duct
how does an intraduct papilloma present
lump
discharge
pain
what age group is usually effected by intraduct papillomas
middle aged
what investigations could you do in intraduct papilloma
FNA - epithelial hyperplasia
how do you manage intraduct papilloma
excision
what is fat necrosis of the breast
localised degeneration and scarring of fat tissue creates a benign lump
can be associated with an oil cyst
can cause fibrosis and necrosis
what causes fat necrosis
triggered by trauma
how does fat necrosis present
painless, firm, irregular lump
fixed
skin dimpling
nipple retraction
what investigations could you do in fat necrosis
FNA - foamy cytoplasm
how do you manage fat necrosis
conservative management
surgical removal if needed
what is duct ectasia
dilation of large ducts in breasts
inflammation leads to discharge
and spooning leads to forking
what are symptoms of duct ectasia
discharge tenderness pain nipple retraction lump
how could you manage duct ectasia
exclude breast cancer reassure supportive bra warm compress antibiotics if needed surgical excision if needed
what is phyllodes tumour
tumour of stroma cells in breast
large and fast growing
what age group is phyllodes tumour common in
40-50yrs
what are complications of phyllodes tumour
can metastasise - this requires chemo +/- surgical removal
what are symptoms of phyllodes tumour
firm painless fast growing lump
what is gynaecomastia
enlargement of glandular breast tissue in males
what causes gynaecomastia
imbalance between oestrogen and androgens
what are conditions that cause gynaecomastia by increasing oestrogen levels
obesity (oestrogen stored in fat cells) testicular cancer - leydig cell tumours liver cirrhosis/failure hyperthyroidism hCG secreting tumour
what are conditions that cause gynaecomastia by decreasing testosterone
testosterone deficiency in old age hypothalamus or pituitary conditions that decrease FSH and LH klinefelter syndrome orchitis testicular damage
what are drugs that cause gynaecomastia
dopamine agonists anabolic steroids digoxin spironolactone GnRH analogues opiates marijuana alcohol
how do you differentiate between gynaecomastia and fat on examination
gynaecomastia has firm tissue behind the areolas
fat is softer
how do you manage gynaecomastia
bloods and imaging to find and treat underlying cause
tamoxifen and surgery in problematic cases
