BENIGN BREAST DISEASE Flashcards
What are the commonly seen causes of benign breast lesions or lumps?
Fibroadenoma
Fibroadenosis / fibrocystic breast disease
Sclerosing adenosis
Breast cysts
Epithelial hyperplasia
Fat necrosis
Duct papilloma
Mammary duct ectasia
What are fibroadenomas?
Tumours of stromal and epithelial tissue that arise in the terminal duct lobular unit of the breast
What is the lay term sometimes used to describe fibroadenomas of the breast?
Breast mice - due to their mobility
What are the risk factors for developing fibroadenomas of the breast?
15-25 years old
Black race
What are the clinical features of fibroadenomas?
Highly mobile
Firm
Non-tender
Usually under 3 cm
Usually solitary
Slow growing
What percentage of all breast masses do fibroadenomas make up?
12%
What is the increase in risk of malignancy with fibroadenomas?
None - they are not pre-cancerous
What percentage of fibroadenomas will regress in size over 2 years?
30%
How do we manage a painless, highly mobile breast lump suggestive of fibroadenoma?
Imaging to confirm diagnosis
If more than 3 cm can be surgically resected
What age group are most commonly affected by fibroadenosis or fibrocystic breast disease?
Middle age, pre-menopausal
Affect 50% of women of child bearing age
What are the clinical features of fibrocystic breast disease?
Lumpy / cobblestone texture to breasts
Pain which is often periodically related to menstrual cycle
May be tender breasts
May be itchy
Are fibrocystic breast lesions pre-cancerous?
No, however, they may increase risk of morbidity and mortality from breast cancer by inhibiting more cancerous lumps from being detected
How do we manage a lady with a periodically painful breast lumps suggestive of fibrocystic breast disease?
Triple assessment to rule out cancer
Treated on a symptomatic basis with NSAIDs, but Danazol and Tamoxifen may be used to block oestrogen input into cyclical pain.
Closer follow up may be required to make sure no cancerous lumps are being missed.
What are the clinical features of sclerosing adenosis?
Multiple lumps
Small
Firm
Painful
Cause mammographic changes that may mimic carcinoma
Are sclerosing adenosis breast lesions pre-cancerous?
They are part of a group of diseases that fall under the heading of borderline breast disease:
“group of conditions while being not completely malignant are still concerning”
How do we manage a lady who presents with multiple small painful lumps in her breast suggestive of sclerosing adenosis?
Triple assessment - need biopsy to exclude malignant potential
Excision is not mandatory
What percentage of Western women will present with a breast cyst?
7%
What are the clinical features of breast cysts?
Smooth lump
Discrete
Fluctuant
Often come on very quickly
Are breast cysts pre-cancerous?
They can be. More likely to be malignant if found in younger patients.
How do we manage a lady who presents with smooth discrete fluctuant lumps suggestive of cysts?
Triple assessment
Cysts should be aspirated - those which are blood stained or persistently refill should be biopsied or excised.
What is epithelial hyperplasia of the breast?
Increase in number of the cells in the lining of the ducts (ductal hyperplasia) or lobules (lobular hyperplasia) in the breast.
What are the clinical features of ductal or lobular hyperplasia?
Variable presentation
Sometimes generalised lumpiness
Sometimes discrete lumps
Often asymptomatic and picked up on mammogram screening
Is ductal or lobular hyperplasia of the breast pre-cancerous?
Those found to have atypical features on histology can be
How do we manage a lady who is found to have ductal or lobular hyperplasia?
Triple assessment
Those found to have atypical features should have close monitoring or excision
What are the risk factors for developing fat necrosis of the breast?
40% have a traumatic aetiology
Surgery
Obesity
Large breasts
What are the clinical features of fat necrosis in the breast?
Initial inflammatory response
Lesion is typical firm and round
May develop into a hard, irregular breast lump
Mimics features of carcinoma so further assessment is required.
How do we manage an obese woman who presents with an irregular hard lump following surgery to the breast suggestive of fat necrosis?
Triple assessment - mimics carcinoma so needs fully investigating with core biopsy
What are the clinical features of duct papillomas?
Wart like lump
Usually develops near or behind the areolar
Nipple discharge
Non-tender
Do women with duct papilloma have an increased chance of developing cancer?
Intraductal papillomas generally don’t increase the risk of developing breast cancer. However, when an intraductal papilloma contains atypical cells (cells which are abnormal but not cancer), this has been shown to slightly increase the risk of developing breast cancer in the future.
How should we manage a women with a warty lump behind the areolar and nipple discharge suggesting duct papilloma?
Triple assessment
Microdochectomy - surgical excision
What is mammary duct ectasia?
Dilatation of large breast ducts due to blockage
What are the risk factors for mammary duct ectasia?
Peri-menopausal / post-menopausal women are most at risk
What are the clinical features of mammary duct ectasia?
Painful lump
Around the areolar
Green nipple discharge
Can rupture and cause local inflammation
What do we call rupture mammary duct ectasia?
Plasma cell mastitis
Is mammary duct ectasia pre-cancerous?
No.
How do we manage a women who presents with green nipple discharge and a painful areolar lump suggestive of mammary duct ectasia?
Triple assessment - can mimic carcinoma so requires biopsy
Excision not required
What are the two main types of mastitis?
Lactational mastitis
Periductal mastitis
What proportion of breast feeding women develop mastitis?
10%
What is the organism most commonly responsible for lactational mastitis?
S. aureus
What are the clinical features of lactational mastitis?
Tender areolar
Erythema
Warm
Fever
What are the indications for treating mastitis with antibiotics?
Systemically unwell
Presence of nipple fissures
If symptoms do not improve after 12-24 hours of milk removal
If blood cultures are positive
What is the first line antibiotic for mastitis?
Flucloxacillin for 10-14 days
Should a mother continue to breast feed if she is found to have mastitis?
Yes
What are the complications of untreated lactational mastitis?
Breast abscess
What are the features of breast abscess?
Tender
Fluctuant mass
Lactating woman
Necrotic tissue overlying abscess
What investigations should be done in a woman who presents with a suspected breast abscess?
FBC
CRP
USS
How do we manage a patient with a breast abscess?
USS guided drainage
Surgical debridement if patient has necrotic tissue
What is the main risk factor for developing periductal mastitis?
Smoking
What are the clinical features of periductal mastitis?
Inflammation
Abscess
Mammary duct fistula
