Benign Breast Diseas Flashcards
What are usually the cyclical menstrual changes in the breast
- usually experienced bilaterally as granularity, pain and tenderness often in the upper, outer quadrant of the breast
What changes occur in the breast with age
- 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
Describe the concept of ANDI- abnormalities of normal development and involution
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
What is the normal process, disorder and disease associated with development phase
- normal : lobular growth
- disorder: fibro adenoma
- disease: giant fibro adenoma
What is the disorder associated with cyclical changes
Mastalgia, nodularity
What is the normal process and disorder associated with pregnancy
- normal: lactation
- disorder: galactocoele
What is the normal process, disorder and disease associated with involution
- normal: lobular, ductal, epithelial hyperplasia
- disorder: cysts, ectasia, epitheliosis
- disease: cysts, periductal mastitis
When do fibro adenomatous usually present
They are found between the ages of 15 and 30, the majority being encountered in the late teens and early twenties
When is mastalgia and varying lumpiness of the breast found?
Late twenties, early thirties
When do cystic changes present
After childbirth or in the thirties and forties
Describe physiological thickening of the breast
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
If you’re unsure whether a patient is presenting with physiological thickening, what should you do ?
- young patient: see her during the middle of the cycle
- older: mammography with or without histological investigation
What features found on cyst aspiration suggest carcinoma (sinister features)
- cyst fluid blood stained
- residual mass
If sinister features are found on cyst aspiration what is the next step?
Cytology and mammography are essential
What is mastalgia
Refers to any pain, or tenderness, fullness, aching, felt in the breast
What are the two types of mastalgia
- cyclical bilateral
- non cyclical focal
Management of cyclical mastalgia
- 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
Treatment of post menopausal or focal breast pain?
Oral NSAIDs if diffuse or in topical gel form if focal pain
Which organism is usually responsible for post partum breast infection and how does it gain access
Staph aureus which has gained access by way of the nipple
What are signs of early stages of breast infection and how do you treat?
- localized pain and tenderness
- treatment with flucloxacillin or erythromycin (if penicillin allergic)
Treatment of breast infection with abcess formation
Surgical drainage under general anaesthetic
What are clinical features or periductal mastitis
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
Treatment of periductal mastitis
- oral antibiotics- usually amoxicillin/ clavulanic acid, patient reviewed after two weeks
- abscess may require drainage
- fistula may require specialist attention
What are fibro adenoma a
Fibrous overgrowths of a single lobule
