Benign Breast Conditions - Clinical

Question 1

Which benign breast condition is usually diagnosed as a palpable mass in the early reproductive years?

Answer 1

Fibroadenoma

Question 2

How is a diagnosis of fibroadenoma confirmed?

Answer 2

Ultrasound guided core needle biopsy

Question 3

Is a fibroadenoma painful?

Answer 3

No

Question 4

How would you describe the mass of a fibroadenoma?

Answer 4

Firm, mobile, smooth with distinct borders

Question 5

What is the relationship between fibroadenoma and carcinoma?

Answer 5

No significant predisposition to carcinoma, very rarely certain histological changes in the fibroadenoma or surrounding stroma could convey an increased risk

Question 6

Once a fibroadenoma has been definitely diagnosed, what is the management?

Answer 6

Usually nothing, only excise if it is growing or changing

Question 7

What happens to a fibroadenoma after the menopause?

Answer 7

Usually become non-palpable and decrease in size

Question 8

Some women will choose to have a fibroadenoma excised, how can this be performed electively?

Answer 8

Open lumpectomy or percutaneous vacuum assisted core biopsy

Question 9

What other uncommon condition can resemble fibroadenoma in clinical presentation and cytology?

Answer 9

Phyllodes tumour

Question 10

What are 3 factors which would make you more suspicious of a Phyllodes tumour over a fibroadenoma?

Answer 10

They will be bigger (3-6cm), occur in older women and tend to increase in size

Question 11

What is the definitive test to tell between a fibroadenoma and Phyllodes tumour?

Answer 11

Histopathology

Question 12

How should a Phyllodes tumour be managed?

Answer 12

Excised with 1cm clear margins and carefully followed up

Question 13

Mastalgia is a common breast symptom for women when?

Answer 13

During the reproductive years

Question 14

Mastalgia is usually cyclic - when is it the most intense?

Answer 14

During the immediate premenstrual stage

Question 15

Is cyclic mastalgia more likely to be bilateral or unilateral?

Answer 15

Bilateral

Question 16

Describe non-cyclic mastalgia?

Answer 16

Usually localised, often persistent and less responsive to treatment

Question 17

Clinically, it is important when a patient presents with mastalgia that it is definitely coming from the breast and not where?

Answer 17

Anterior chest wall

Question 18

What is the association between mastalgia and malignancy?

Answer 18

It is rarely associated with malignancy unless there is a palpable mass

Question 19

What is the appropriate investigation for a woman presenting with mastalgia?

Answer 19

Complete evaluation and examination, including a mammogram for a woman aged 35+

Question 20

After investigation of a woman with mastalgia, what is usually the management?

Answer 20

Reassurance

Question 21

There is good evidence that simple measures such as what are useful for mastalgia?

Answer 21

Using a well-fitting firm bra and regular exercise

Question 22

Palpable breast cysts most commonly occur when?

Answer 22

During the later reproductive years

Question 23

How would you describe the mass of a breast cyst?

Answer 23

Soft, mobile, smooth and with well-defined borders

Question 24

What is the main difference between a cyst and fibroadenoma on palpation?

Answer 24

A cyst is soft while a fibroadenoma is firm

Question 25

Are breast cysts painful?

Answer 25

They can be tender, especially before menstruation

Question 26

What is the most effective way of both investigating and treating a breast cyst?

Answer 26

FNA, aspire as much fluid as possible

Question 27

Should FNA fluid from a breast cyst be sent for cytological evaluation?

Answer 27

Only if it is bloody

Question 28

What should you do after FNA for a breast cyst?

Answer 28

Palpate the area of the cyst to be certain there is no residual mass

Question 29

If there is bloody fluid on FNA for a breast cyst, what could this be indicative of?

Answer 29

Papilloma or intracystic carcinoma

Question 30

If there is a solid lesion within a breast cyst or an irregular cystic wall, what investigation should be performed?

Answer 30

Ultrasound guided core biopsy

Question 31

What is physiologic nipple discharge?

Answer 31

Clear, yellow, watery discharge can be elicited from the nipples of most women of reproductive age

Question 32

What is pathological nipple discharge?

Answer 32

Bloody discharge, especially from a single duct

Question 33

What is the most common aetiology of spontaneous nipple discharge? Are these benign or malignant?

Answer 33

Intraductal papilloma, benign

Question 34

What is the association between nipple discharge and malignancy?

Answer 34

Discharge is rarely a sign of malignancy, unless there is an associated palpable mass

Question 35

What is the management of all intraductal lesions? Why is this?

Answer 35

Excision and histological evaluation, not to miss rare, intraductal carcinoma

Question 36

What are some investigations which may be done on a patient presenting with nipple diacharge?

Answer 36

Mammography, ultrasound

Question 37

What condition may present as an erythematous, weeping lesion on the surface of the nipple and areola OR a dry, scaly erythematous lesion?

Answer 37

Paget's disease of the nipple (DCIS)

Question 38

How is the diagnosis of Paget's disease of the nipple made?

Answer 38

Histological biopsy (incisional or punch)

Question 39

What is often found underlying a diagnosis of Paget's disease of the nipple?

Answer 39

A palpable mass or radiological abnormality

Question 40

What is the most common causative organism for puerperal mastitis?

Answer 40

Staph Aureus

Question 41

What antibiotics can be given for puerperal mastitis?

Answer 41

Flucloxacillin or augmentin

Question 42

When should antibiotics be administered for puerperal mastitis?

Answer 42

As soon as clinical signs appear e.g. fever, erythema, tenderness, swelling

Question 43

How often should a patient with mastitis be examined and why?

Answer 43

Every 3 days to assess response to treatment and make sure there isn't an abscess developing

Question 44

What should be done if there is no response to treatment in a person with mastitis?

Answer 44

Try a different antibiotic

Question 45

What advice should you give to a patient with mastitis about breastfeeding?

Answer 45

Should be continued if already started, and/or the infected breast can be pumped until the infection clears

Question 46

How does a breast abscess present?

Answer 46

A floculent, sometimes bulging mass usually in the central area of the mastitis

Question 47

What imaging technique is used to assess a breast abscess?

Answer 47

Ultrasound

Question 48

What are the management options for a breast abscess?

Answer 48

Aspiration, or surgical drainage if this doesn't work

Question 49

Should antibiotics be given for a breast abscess?

Answer 49

Yes, they should be continued until evidence of inflammation has cleared

Question 50

What antibiotics are first and second line for non-puerperal mastitis?

Answer 50

Augmentin and cephalexin

Question 51

Chronic mastitis can be associated with what? What can this lead to?

Answer 51

Sub-areolar abscess, can lead to periareolar fistula

Question 52

What should you consider if a case of mastitis is unresponsive to therapy or if it seems to spread all over the entire breast?

Answer 52

Inflammatory carcinoma

Question 53

What is a galactocele?

Answer 53

A palpable milk filled cyst

Question 54

How can a galactocele be diagnosed and drained?

Answer 54

FNA

Question 55

What is Mondor's disease?

Answer 55

Phlebitis and sebsequent clot formation in the superficial veins of the breast

Question 56

Mondor's disease is usually caused by what?

Answer 56

Trauma to the breast e.g. surgery

Question 57

How is Mondor's disease treated?

Answer 57

It will resolve spontaneously within 8-12 weeks