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Gen Surgery > Benign Breast Diseas > Flashcards

Benign Breast Diseas Flashcards

1
Q

What are usually the cyclical menstrual changes in the breast

A
  • usually experienced bilaterally as granularity, pain and tenderness often in the upper, outer quadrant of the breast
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2
Q

What changes occur in the breast with age

A
  • in late twenties and thirties the firmness and granularity becomes more marked and localized in the upper quadrant
  • progressive loss of breast tissue under the Areola (retro-areolar cavity) and subsequently throughout the breast
  • residual firm ridge of fat at the inferior fold of the breast in a post-menopausal woman
  • histological: loss of the terminal duct lobular unit with replacement by fibrous tissue in the inter- lobular region and sclerosis and microcystic formation together with duct dilatation and formation of stagnant secretions
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3
Q

Describe the concept of ANDI- abnormalities of normal development and involution

A

The 4 reproductive phases of a woman’s life (development, cyclical changes, pregnancy and involution) are related to normal processes which might proceed to disorders and occasionally, disease

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4
Q

What is the normal process, disorder and disease associated with development phase

A
  • normal : lobular growth
  • disorder: fibro adenoma
  • disease: giant fibro adenoma
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5
Q

What is the disorder associated with cyclical changes

A

Mastalgia, nodularity

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6
Q

What is the normal process and disorder associated with pregnancy

A
  • normal: lactation

- disorder: galactocoele

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7
Q

What is the normal process, disorder and disease associated with involution

A
  • normal: lobular, ductal, epithelial hyperplasia
  • disorder: cysts, ectasia, epitheliosis
  • disease: cysts, periductal mastitis
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8
Q

When do fibro adenomatous usually present

A

They are found between the ages of 15 and 30, the majority being encountered in the late teens and early twenties

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9
Q

When is mastalgia and varying lumpiness of the breast found?

A

Late twenties, early thirties

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10
Q

When do cystic changes present

A

After childbirth or in the thirties and forties

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11
Q

Describe physiological thickening of the breast

A

Tender, granular and resembles the state of the breast during the 24 hours prior to menstruation. It is usually extensive, taking the contours of the breast

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12
Q

If you’re unsure whether a patient is presenting with physiological thickening, what should you do ?

A
  • young patient: see her during the middle of the cycle

- older: mammography with or without histological investigation

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13
Q

What features found on cyst aspiration suggest carcinoma (sinister features)

A
  • cyst fluid blood stained

- residual mass

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14
Q

If sinister features are found on cyst aspiration what is the next step?

A

Cytology and mammography are essential

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15
Q

What is mastalgia

A

Refers to any pain, or tenderness, fullness, aching, felt in the breast

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16
Q

What are the two types of mastalgia

A
  • cyclical bilateral

- non cyclical focal

17
Q

Management of cyclical mastalgia

A
  • thorough examination and reassurance
  • severe case: anti- oestrogen (danazol- 100 mg daily for 3m; tamoxifen- 10 mg daily for 3m)
  • placebo: evening primrose oil tablets- 3 g daily for 3 m
18
Q

Treatment of post menopausal or focal breast pain?

A

Oral NSAIDs if diffuse or in topical gel form if focal pain

19
Q

Which organism is usually responsible for post partum breast infection and how does it gain access

A

Staph aureus which has gained access by way of the nipple

20
Q

What are signs of early stages of breast infection and how do you treat?

A
  • localized pain and tenderness

- treatment with flucloxacillin or erythromycin (if penicillin allergic)

21
Q

Treatment of breast infection with abcess formation

A

Surgical drainage under general anaesthetic

22
Q

What are clinical features or periductal mastitis

A

Clinical features are of retro and peri- areolar inflammation (pain, tenderness, redness, thickening) in some cases accompanied by oedema and nipple retraction. Many cases mimic carcinoma and these should be aspirated

23
Q

Treatment of periductal mastitis

A
  • oral antibiotics- usually amoxicillin/ clavulanic acid, patient reviewed after two weeks
  • abscess may require drainage
  • fistula may require specialist attention
24
Q

What are fibro adenoma a

A

Fibrous overgrowths of a single lobule

25
Q

What are giant fibro adenomas

A

> 5 cm

26
Q

How should a fibro adenoma < 4 cm be managed in patient under the age of 20

A
  • these can be treated conservatively as most would regress and disappear over time
  • need follow up to exclude any increase in size when excision would be indicated
27
Q

Management of fibro adenomas for patients between the age of 20 and 25

A
  • follow up for small fibro adenomas
  • excision of lesions >4cm
  • cytology with cytological diagnosis of fibro adenoma first (FNAB)
28
Q

Management of fibro adenomas in a patient over the age of 25

A
  • all patients need a triple test (clinical exam, breast ultrasound or mammogram, and a cytological/ histological diagnosis of fibro adenoma)
  • lesion can be removed as a minor procedure under local anaesthetic
29
Q

When is trucut biopsy used in suspected fibro adenoma

A
  • aspiration cytology has failed to produce a diagnosis

- older patients, where the diagnosis of phylloides tumour needs to be ruled out

30
Q

How are suspicious areas in the breast managed

A
  • best assessed wth clinical examination, cytology and mammography
  • if any of these areas is suggestive of suspicious of carcinoma, a Tru cut biopsy should be performed or the area should be excision
31
Q

What is usually the cause of suspicious areas of breast once carcinoma has been ruled out

A

It is usually a manifestation of fibrocystic disease; sclerosing Adenosis, fibrosis, radial scar or fibro- adenomatoid nodule

32
Q

Management of non- spontaneous discharge

A

Patient advised to desist from squeezing the breast and return if the discharge persists

33
Q

What do need to determine in a patient with spontaneous nipple discharge

A

Whether the discharge is from multiple ducts and/or bilateral or whether from single duct

34
Q

Possible causes of nipple discharge from multiple ducts and/or bilateral

A
  • pregnancy
  • lactation
  • drugs
  • ectasia
  • prolactinoma
35
Q

What are possible causes of a single duct discharge

A
  • intra ductal carcinoma, papilloma, epitheliosis or ectasia
36
Q

Management of single duct nipple discharge

A

Cytology, mammography –> microdocotomy

37
Q

Causes of gynaecomastia

A
  • physiological: neonatal, puberty, old age
  • drugs: oestrogens, digoxin, steroids
  • liver failure
  • rare tumours: testis, adrenal

Gen Surgery (31 decks)

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