Benign Breast Conditions Flashcards
A 45 year old pre menopausal women presents to her GP as she has found 3 lumps in her breast. She says she sometimes gets sudden pain in them but in general they are not sore. On examination they are smooth discrete lumps. She is otherwise well and has no significant past medical history. What is the most likely diagnosis?
Fibrocystic change
What causes the fibrosis seen in fibrocystic change?
Older cysts that have previously ruptured.
A 45 year old pre menopausal women presents to her GP as she has found 3 lumps in her breast. She says she sometimes gets sudden pain in them but in general they are not sore. On examination they are smooth discrete lumps. She is otherwise well and has no significant past medical history. What should the GP do?
Most likely diagnosis is fibrocystic change but she should still be referred for triple assessment at the one stop breast clinic to exclude malignancy.
What breast pathology is being described here: “Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution”
Hamartoma
A 20 year old student present to her GP after finding a lump in her left breast. It is painless. On examination the lump is firm and mobile. She is otherwise well. What is the most likely diagnosis?
Fibroadenoma
A 20 year old student present to her GP after finding a lump in her left breast. It is painless and mobile and on US looks solid.
Fibroadenoma
What two tissue types are found in a fibroadenoma?
Epithelium
Stroma
A women who was in a car accident last year presents with lumpiness in her breasts. On pathology there is infiltration by acute inflammatory cells and damage and disruption of adipocytes. What is the diagnosis?
Fat necrosis due to local trauma
A 25 year old women has just had surgery to remove a breast lump. On cutting up the lump the pathologist describes it as having a rubbery texture and being a grey colour. What is the most likely classification of this lump?
Fibroadenoma
What are the three aspects of the triple assessment?
- Clinical
- Imaging: Mammogram or US
- Pathology: Histopathology though use of a core biopsy
A 26 year old man presents to your clinic very distressed because he feels he is developing breasts. Describe the parts of the male breast that develop in gynaecomastia?
Ductal growth without lobular involvement.
When does fibrocystic change often resolve?
Around menopause
Describe the pathology of fibrocystic change
- Cysts (Blue domed with pale fluid, usually multiple)
- Fibrosis around these cysts
Does a hamartoma grow faster, slower or at the same rate as the surrounding breast tissue?
At the same rate
Describe the pathology of sclerosing adenosis
Proliferation of the terminal duct lobular units resulting in increased acini
A 40 year old women presents with pain, and lumpiness in her breasts. On pathology you see proliferation of terminal duct lobular units.
Sclerosing adenosis
This is histology report from a women presenting with breast pain: 7mm lesions with a sclerotic centre with radiating fibrosis containg distorted ductules. Epithelial proliferation.
Radial scar
How are radial scars usually treated?
Excised to reduce risk of malignant change
What drug can increase your risk of fat necrosis?
Warfarin
Describe the pathology of fat necrosis?
Damage to adipocytes causing inflammation and infiltration of foamy macrophages and subsequent fibrosis and scarring.
What ducts are affected in duct ectasia?
Sub areloar ducts
A 28 year old women presents with breast pain and purulent discharge from the nipple. On examination her nipple in retracted. She says she has had 2 episodes of this before and it tends to settle down. She is otherwise well and smoke 40 cigarettes a day.
Duct ectasia
A 28 year old women presents with breast pain and purulent discharge from the nipple. On histopathology you see periductual inflammation and periductal fibrosis.
Duct ectasia
What are the 2 aetiologies of acute mastitis and breast abscesses?
Duct ectasia
Lactation
What organisms usually cause an acute mastitis or abscess in duct ectasia?
Mixed organisms
Anaerobes
What organisms usually cause an acute mastitis or abscess during lactation?
Staph aureus
Strep pyogenes
How do you manage an acute mastitis in a breastfeeding women?
- Ensure complete drainage of the breast at each feed
Flucloxacillin
Clindamycin if penicilline allergic
What antibiotic is used to treat acute mastitis in a breastfeeding women?
Flucloxacillin
What antibiotic is used to treate acute mastitis in a breastfeeding women who is penicillin allergic?
Clindamycin
What antibiotic is used to treat a breast abscess in a breastfeeding women?
Flucloxacillin
How do you treat breast thrush?
Miconazole cream for the mother applied to the nipple and areola after each feed
If no improvment Fluconazole orally for at least 10 days
For infant (under 4 months) miconazole oral gel
For infant (over 4 months) nystatin
What is the treatment for non lactational mastitis?
Co amoxiclav
What is the treatment for non lactational mastitis in women who are penicillin allergic?
Erythomycin/ Clarithryomycin + Metronidazole
What is the managment of a breast abscess in a non lactating women?
Drainage
Treatment of underlying cause
Antibiotics
What is the treatment for a phyllodes tumour?
Wide local excision
A 40 year old women presented with a firm lump in her breast. This is her pathology report. Biphasic tumour with a hypercellular mesenchymal component organized in a leaf like patterns around benign epithelial/myoepithelial lined spaces.
Phyllodes tumour
What ducts are affected in intraduct papilloma?
Sub areolar ducts
A 35 year old women presents with bloody nipple discharge. You can feel a small lump just under the nipple. What benign breast condition could this be?
Intraduct papilloma
What is the treatment for intraduct papilloma?
Surgery
What is the most common cause of green discharge from the nipple?
Duct ectasia
What causes duct ectasia?
Blockage of the lactiferous ducts
What lines lactiferous ducts?
Columnar epithelium
What is an intraduct papilloma?
Growth inside the sub areolar ducts
What is the most common cause of bloody discharge from the nipple in younger women?
Intraductal papilloma
A 21-year-old female notices a bloody discharge from the nipple. She is otherwise well. On examination there are no discrete lesions to feel and mammography shows dense breast tissue but no mass lesion.
Intraductal papilloma
In what breast condition do you see a halo sign on imaging?
Breast cyst
