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Year 3 Breast > Benign breast disease > Flashcards

Benign breast disease Flashcards

1
Q

What is mastitis?

A

Inflammation of breast tissue with or without infection

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2
Q

What are the types of mastitis?

A
  • INFECTIVE LACTATIONAL: post-natal
  • INFECTIVE NON-LACTATIONAL
  • NON-INFECTIVE: idiopathic granulomatous inflammation
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3
Q

What is a breast abscess?

A

Localised area of infection with a walled-off collection of pus. It may be associated with mastitis.

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4
Q

What is the aetiology of breast infections?

A

Most commonly Staph. aureus. It is not uncommon for breast infections to also be polymicrobial with aerobes such as Staph., Strept., Enterobacteriaceae, and E. coli, as well as anaerobes such as Bacteroides, Clostridium and Peptostreptococcus. TB can also cause tubercular mastitis!

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5
Q

What is the aetiology of non-infective mastitis? (x2)

A

Mostly idiopathic. Can also be due to underlying duct ectasia (dilated ducts) and foreign material such as PIERCINGS.

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6
Q

What is the pathophysiology of lactational mastitis?

A

Milk stasis or milk overproduction, coupled with bacteria entering from a traumatised nipple can lead to mastitis.

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7
Q

What is the pathophysiology of duct ectasia?

A

Dilated ducts associated with inflammation and squamous metaplasia of lactiferous ducts. This causes obstructive mastopathy (blockage), inflammation and infection.

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8
Q

What are risk factors for non-lactational mastitis?

A

Smoking, systemic diseases such as diabetes, corticosteroid use.

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9
Q

What is the epidemiology of mastitis and breast abscesses: Age?

A

More common in women between 15 and 45, especially those who are lactating.

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10
Q

What are the signs and symptoms of mastitis/breast abscess? (x6) Onset?

A
  • Tend to present acutely
  • Fever
  • Breast warmth, redness, firmness and tenderness. Lactational mastitis may involve more peripheral, wedge-shaped areas. Pain is typically sharp, shooting or throbbing
  • Decreased milk outflow
  • Breast mass in localised mastitis or breast abscess
  • Nipple discharge is often associated with duct ectasia. Purulent discharge is usually indicative of infection
  • Fistula: associated with draining sinus from underlying abscess
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11
Q

What are the investigations for mastitis/breast abscess? (x5)

A
  • Mastitis typically clinical diagnosis
  • BREAST USS: first investigation; hypoechoic lesion that is well-circumscribed and irregular; identify abscess
  • DIAGNOSTIC NEEDLE ASPIRATION DRAINAGE: abscess
  • CYTOLOGY, CULTURE & SENSITIVITY: of nipple discharge or sample from aspiration, can show infection or underlying malignancy
  • BIOPSY: can identify infection, granulomatous inflammation or malignancy
  • PREGNANCY TEST: if mastitis develops unexpectedly
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12
Q

How is lactational mastitis managed?

A
  • SYMPTOMS MILD/NOT PROLONGED: effective milk removal through breast pump or massage
  • SYMPTOMS SEVERE/PROLONGED: empirical antibiotics – flucloxacillin, cloxacillin, or dicloxacillin. MRSA is treated with clindamycin instead if confirmed by C&S
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13
Q

How is non-lactational mastitis managed?

A

Empirical antibiotics: flucloxacillin, cloxacillin, or dicloxacillin. Unless MRSA is confirmed by culture.

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14
Q

How is granulomatous mastitis treated?

A

Glucocorticosteroids

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15
Q

How are breast abscesses treated?

A

SURGICAL INTERVENTION: needle aspiration with local anaesthesia can be used to drain an abscess. May need repeat aspiration if not cleared. Plus IV/oral antibiotics

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16
Q

What are the complications of mastitis? (x7)

A

Abscess, sepsis, scarring, functional mastectomy (breast unable to effectively lactate as a complication of tissue damage from infection), breast hypoplasia, necrotising fasciitis, fistula.

17
Q

What is breast duct ectasia?

A

It is a type of non-lactational mastitis unrelated to pregnancy and breast feeding, characterised by duct inflammation. See above flashcards for more information.

18
Q

What is papilloma?

A

AKA intraductal papilloma. Benign lesions of the breast that form from abnormal proliferation of the epithelial cells lining the breast ducts.

19
Q

What is the aetiology and risk factors of intraductal papilloma? (x3)

A

Idiopathic. Risk factors: OCP, HRT and FH.

20
Q

What are the types of intraductal papilloma? (x2)

A
  • CENTRAL: develop near the nipple, solitary lump
  • PERIPHERAL: arise in the peripheral ducts and there are often multiple. Associated with higher risk of malignancy
21
Q

What is the epidemiology of intraductal papilloma: Prevalence? Age? Type and age?

A

2-3% of humans. Most common in women aged 20-40. Central papilloma arises most commonly in women just before menopause, while peripheral papilloma arises in younger women.

22
Q

What are the signs and symptoms of intraductal papilloma? (x2)

A
  • Too small to be palpated, though central papilloma is larger
  • If palpable, they are round, well-circumscribed
  • Bloody or clear nipple discharge
23
Q

What are the investigations for intraductal papilloma? (x4)

A
  • USS: dilated duct with oval mass
  • GALACTOGRAM: definitive diagnosis. X-ray following radiopaque injection into breast ductal system.
  • BIOPSY: Core needle is preferred as fine needle aspiration (thinner needle) may acquire insufficient tissue. Histopathology shows fibroVASCULAR core co vered with epithelial and myoepithelial cells, associated with sclerosis, hyperplasia and atypical proliferation
  • MAMMOGRAPHY: most do not show due to their small size
24
Q

What is a mammogram?

A

Low energy x-ray.

25
Q

What is a breast cyst?

A

AKA fibrocystic breast. Non-specific term describing a fibrocystic change of the breast characterised by ‘lumpiness’ associated with pain, tenderness, that fluctuate with the menstrual cycle (cyclical mastalgia).

26
Q

What are the risk factors for breast cysts? (x5)

A

History of pregnancy (due to high proliferation of breast epithelium which may contribute to fibrocystic changes), later age at first childbirth, late menopause, HRT, obesity

27
Q

What is the epidemiology of fibrocystic breast: Age? Common?

A

Incidence increases with age, peaking at 30s-40s before menopause, and then usually disappears after menopause. Fibrocystic changes are VERY common but not all manifest with symptoms.

28
Q

What are the signs and symptoms of breast cysts? (x4)

A
  • Mastalgia: usually cyclical with pain onset preceding menses and ceasing shortly after. Pain is constant, dull, BILATERAL and diffuse. Localisation of pain is associated with rupture of a cyst
  • Diffuse, symmetrical lumpiness through both breasts
  • Nipple discharge common: very small amounts, milky, green, grey or black which may be unilateral or bilateral
  • Palpable breast mass: in patients who have a dominant mass. Smooth, rubbery, non-tethered, well-circumscribed. Increases in size just before menses
29
Q

What are the investigations for breast cysts? (x4)

A
  • USS: first investigation and diagnostic; well-circumscribed, anechoic (meaning no echo, black), and retrotumoural acoustic enhancement (see photo), unless complex which will instead have a solid component and wall thickening.
  • MAMMOGRAPHY: dense breasts, circumscribed density
  • FINE NEEDLE ASPIRATION: if patient symptomatic; straw-coloured fluid. Cyst usually resolves thereafter
  • CORE NEEDLE BIOPSY: if aspirate is bloody; to exclude breast cancer
30
Q

What is fibroadenoma of the breast?

A

Benign breast tumours of the breast lobules (milk-producing) characterised by mixture of stromal (mesenchymal) and epithelial tissues.

31
Q

What are the types of fibroadenoma? (x3)

A
  • COMPLEX: rapidly growing hyperplastic cells
  • JUVENILE: found in patients between 10-18 and tend to have faster growth rate. Eventually shrink/disappear
  • GIANT: large and often needs excision as it compresses or replaces normal breast
32
Q

What is the aetiology of fibroadenomas?

A

Unknown but believed to be hormone related (oestrogen/progesterone) and genetic. Risk factors: OCP, HRT, history of pregnancy, FH (similar to cysts)

33
Q

What is the epidemiology of fibroadenoma of the breast: Common? Age?

A

Most common cause of breast mass. Most commonly in younger women.

34
Q

What are the signs and symptoms of fibroadenoma?

A

Palpable mass: painless, smooth, rubbery, highly mobile (often referred to as breast mice). Unilateral, solitary, and more common in the UPPER OUTER QUADRANT. Shrink after menopause

35
Q

What are the investigations for fibroadenoma? (x3)

A
  • USS: first investigation under 35 years; well-circumscribed, lobulated, wider than height, black
  • MAMMOGRAM: first investigation over 35 years; well-circumscribed, may have coarse calcifications
  • BREAST BIOPSY: sheets of uniformly distributed epithelial cells arranged in a honeycomb pattern (see photo), hypovascular (unlike malignant), and proliferation of stromal cells around epithelial cells
36
Q

How is fibroadenoma managed?

A

Rarely need treatment as they shrink and disappear over time. SURGICAL EXCISION: indicated if rapid growth, large and compressing on normal breast tissue. Either by excisional biopsy or cryoablation (freeze)

37
Q

What is the prognosis of fibroadenoma?

A

No risk of malignancy and harmless.

Year 3 Breast (3 decks)

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