Benign breast conditions Flashcards
What could cause a breast lump?
Cancer- painless
Cyst- painful, well circumscribed
Fibroadenoma- painless, well circumscribed
Fat necrosis- painful, history of trauma and bruising
What could cause mastalgia?
Fat necrosis- pain with history of trauma and bruising, and lump
Infection- pain and systemically unwell
Cyst- painful lump
Fibroglandular/fabrocystic change- diffuse change
Cyclical mastalgia
What could cause unilateral discharge?
Cancer- blood stained and lump
Duct ectasia- smoker with large volume discharge
Intraductal papilloma- pinpoint nipple discharge
What is the most common cause of a breast lump?
Cyst
What is the presentation of a cyst?
Smooth, discrete lump
May be fluctuant or painful
What is the management of a cyst?
Aspiration
Persistent/blood stained= excision and biopsy
What is a fibroadenoma?
Proliferation of epithelial and stromal elements of breast with distorted and/or elongated ducts
What are the types of fibroadenoma?
Intracanalicular= stromal proliferation compressing epithelial structures into clefts Pericanalicular= stromal proliferation around epithelial ducts
What is the presentation of a fibroadenoma?
Circumscribed, mobile, non painful lump
Often in women of child bearing age
What is the management of a fibroadenoma?
No increased cancer risk so can be left and may regress
>3cm= surgical excision offered
When is a tubular adenoma seen?
Less commonly and in young women
What is the presentation of a tubular adenoma?
Discrete freely mobile masses
Uniform sized ducts
Who are intraductal papillomas seen in?
Middle aged women
What is the presentation of an intraductal papilloma?
Unilateral pinpoint discharge, which may be bloody
If very large, can be a mass
What is the management of an intraductal papilloma?
Excision
What is the most common cause of fat necrosis of the breast?
Trauma, either surgical or blunt force
What is the presentation of fat necrosis?
History of trauma and bruising
Pain
Lump, area of thick skin
What investigations are done for fat necrosis?
Mammography
Histology
What is seen on mammography and histology with fat necrosis?
Fibrosis and calcifications
Histocytes with foamy cytoplasm
What causes duct ectasia?
Lactiferous duct becomes blocked/clogged
What is the risk factor for duct ectasia?
Smoking
What is the presentation of duct ectasia?
Large volume discharge
Green/grey coloured often
What is the presentation of a breast abscess?
Pain
Systemically unwell
Often breastfeeding or history of trauma
What would blood stained discharge make you think?
Cancer
What would pain make you think?
Usually benign
What would a large volume discharge in a smoker make you think?
Duct ectasia
What would pinpoint nipple discharge make you think?
Intraductal papilloma
What is the presentation of cyclical mastalgia?
Tender and lumpy breasts occuring cyclically with the menstrual cycle, normally just before the period
What is the management of cyclical mastalgia?
1st line- NSAIDs and gamolenic acid
Supportive bra
What is the presentation of mastitis in breastfeeding?
Tender, red, hot breast
What is the management of mastitis in breastfeeding?
Continue breastfeeding
Oral flucloxacillin 10-14 days
