Benign breast disease Flashcards by Manaal Arif

Name some benign breast diseases

Fibroadenoma
Breast cyst
Mastitis
Mammary duct ectasia
Mammary dysplasia
Phyllodes
Intraduct papilloma
fat necrosis

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Fibroadenoma
What is it?
Example of a case?

Arises from stromal and epithelial connective tissue
benign tumour
30y/o with mobile ‘mouse’ unilateral breast lump

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What do fibroadenomas respond to?

Oestrogen + progesterone

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When are fibroadenomas MC and regress?

MC in young women and regress after menopause

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Sx of a fibroadenoma?
describe the lump?

Painless non tender lump
Rounded with smooth edges
firm, mobile
<3cm diameter

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Dx and Tx for fibroadenoma?

Triple assessment

lumpectomy

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What is the prognosis for fibroadenoma if left alone?

1/3 shrink
1/3 stay same
1/3 enlarge

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What is the MC cause of breast lumps?

Breast cysts

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What is a breast cyst?
age it occurs?

Fluid filled lumps
40-60

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describe a benign breast cyst?

non blood stained fluid
No residual lump
doesn’t continuously refill

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What colours can breast cysts be and what does that mean?

White = galactorrhoea
Green = simple
Blood = bad :(

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What is the typical description of a breast cyst?

smooth, well circumcised, mobile +/- size fluctuation +/- painful

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What is the diagnosis of a breast cyst?

triple assessment +/- aspiration/imaging

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Tx for a breast cyst?

aspiration
surgical
Oral contraceptive Pill

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What is Mastitis?

Inflammation of the breast tissue +/- infection

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What 2 groups can mastitis be in?

lactational
Non lactational

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How does lactation cause mastitis?

obstruction in ducts = milk accumulation

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How does non lactational mastitis occur?

bacteria enters nipple, back tracts into ducts and causes infection and inflammation

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What is the causative organism of mastitis?
What fraction of women get mastitis?

s.aureus

1/10 women

mastitis postpartum can be called?

lactational mastitis
puerperal mastitis

Sx of mastitis?

(wedge shaped distribution)
Tender painful hot red swollen breast +
systemic Sx (eg. rigours, fevers, headache)

Dx of mastitis?

clinical Hx and exam
+/- milk MC+S

Tx for lactational mastitis?

Flucoxacillin/erythromycin

Flucloxacillin 500 mg 4xday for 10–14 days
If allergic to penicillin then Give:
erythromycin 250–500 mg 4xday
or
clarythromycin

Tx for non lactational mastitis?

flucoxacillin/erythromycin
and
Metronidazole

Can a mum continue to breastfeed while having mastitis?

Yes

what is mammary duct ectasia?

A milk duct beneath the nipple widens. The duct walls may thicken and fill with fluid, becoming blocked or clogged with a sticky substance. Inflammation and dilation of the large breast ducts occurs

Sx of mammary duct ectasia?

Sticky brown/green nipple discharge (clogged ducts)

Dx and Tx of mammary duct ectasia?

Dx = triple assessment Tx = watch and wait

What is mammary dysplasia?

It is Sx due to an increase in the number of cells or by the growth of abnormal cells in the breast ducts or lobes

Typical Px with mammary dysplasia?

40-45 y/o with 'lumpy grain of rice' breasts Bilateral fibrocystic changes (cysts in breasts) Cyclical mastalgia (breast pain linked to periods)

Tx for mammary dysplasia?

Supportive bra NSAIDS COCP?

Phyllodes tumour Typical Px and Sx?

30-40y/o rapidly growing fibroadenoma (shiny skin, erythema)

Phyllodes tumour How many develop into cancer and which type? what is seen on biopsy?

10% sarcomas leaf like architecture on biopsy

What is an intraductal papilloma?

A benign, wart-like tumors that grow within the milk ducts of the breast

Typical Px and Sx of an intraductal papilloma?

35-55 y/o with bloody-watery nipple discharge

Dx and Tx for intraduct papilloma?

Urgent Triple assessment Surgery

What is fat necrosis In breasts?

Death of adipose tissue within the breast, after trauma, typically leading to the formation of a lump

What is pages disease of the breast?

Nipple eczema persisting after 2+ weeks steroid/anti fungals Subareolar mass most of the time (Presence of cancer cells in the skin of the nipple. This disease often suggests an underlying ductal carcinoma in situ (DCIS) or invasive breast cancer)

Sx of pages disease of the breast?

Nipple and areolar eczema, then rest of breast +/- straw coloured discharge, nipple inversion Painful and red nipple

Dx for pagets of the breast? what will be detected?

Triple assessment +ve for paget cells (90% HER2 Positive)

Tx for pagets?

like breast ca, mastectomy or wide local excision

What are the 2 types of breast reconstruction?

external and internal

what is external reconstruction?

Put shaped mould in bra so appear normal in clothes

what Is an internal reconstruction?

Implant and expander latissimus dorsi flap and implant

what are 3 complications of silicone implants?

-Rupture -Capsular contractures (harden breast around implant) -BIA-ALCL - REMOVE ASAP [1:20,000 risk] (breast implant associated anapaestic large cell lymphoma)