Benign Breast Disease Flashcards
Patient Pathway in breast disease
Notice a problem–> GP referral –> One-stop clinic –> Multi-disciplinary meeting (MDM) –> Results clinic
Triple assessment of breast lumps
(1) Clinical assessment of the lump
(2) Radiological assessment (Mammography, USS, MRI
(3) Tissue diagnosis (needle biopsy, FNA or core)
Diagnostic Grading like the bi-rad
Multiple methods (exam, mammography, USS, cytology or biopsy) all graded 1-5 1--> Normal 2--> Benign 3--> Probably benign 4--> Suspicious 5--> Malignant
Cytological Diagnosis
C1--> Acellular or insufficient C2--> Benign C3--> Probably Benign C4--> Suspicious C5--> Malignant
Mastalgia
Breast pain –> can be cyclic (related to menstruation) or non-cyclic (rarer)
Common (70% will have it) most people seek help due to fear of breast cancer–> low risk if only symptom
Cyclic mastalgia
Normal or physiological breast pain for 1-4 days is premenstral and can have swelling and lumpiness. More severe pain for >7 days is cyclic mastaglia which effects 10-20% of women. Tends to be dull/heavy and diffuse, bilateral and upper, outer quadrant but can be more severe in one breast
Causes of Cyclic Mastalgia
Often related to Sleep, work or stress problems
More common in younger women who have had previous investigations
Non-cyclic Mastalgia
1/3 of breast pain –> usually unilateral & localized
presents in 40s/50s or post-menopause
Causes of non-cyclic Mastalgia
Usually idiopathic–> more likely anatomical than hormonal –> can be related to Drugs
Can be due to pregnancy, mastitis, trauma, thrombophelbitis, cysts, tumours or cancer
Drugs associated with Non-cyclic mastalgia
16-32% of women report mastalgia with oestrogen containing hormonal therapies
Antidepressants including venlafaxine & mirtazapine
Cardio drugs including diogoxin & spirolactone
Metronidazole and cimetidine
Extramammary breast pain
Is usually felt in the breast but from chest wall or skeletal –> Tietze’ syndrome (costo-chondritis)
Breast Lumps
Most likely to be benign Fibroadenoma or cysts. If smooth and mobile, with regular borders and is solid or cystic–> benign. If firm, irregular and fixed to underlying tissue. May be skin changes or nipple retraction–>malignant
Management of Cyclic mastalgia
Reassurance is usually enough–> check bra fit (soft sleeping bra) and analgesia is 1st line
Topical NSAIDs, particularly Diclofenac
If severe consider changing from COC
20-30% spontaneously resolve but 60% recurrence
Management of severe mastaglia
Danazol (anti-gonadotropin) Tamoxifen (oestrogen receptor blocker) Goserelin injections (blocks gonadotropin release) Ormeloxifene (selective oestrogen receptor modulator
Management of non-cyclic mastaglia
Resolves spontaneously in 50% of women
Chest wall pain often responds to NSAIDs
Trigger spots can respond to LA or steroid injections
Better bras can help or acupuncture
Breast Cysts
Can be simple or complex
The diagnosis is clinical (examination) with radio-logical confirmation–> can treat by aspirating fluid and if suspicious or fail to aspirate send to cytology
Fibroadenoma (FA)
A benign tumor (20% multifocal) which is common in young women
Complex or multiple FA double breast cancer risk
Hyperplasia of single terminal duct unit–> usually stop at 2-3cm but can get bigger, and regress at the rate of 10%/yr or after menopause
Occur in 50% of women given Ciclosporin after renal transplant
Management of FA
USS in younger patients, or mammogram if >50yrs
Biopsy or excision is often used for peace of mind
Pt should be advised to check regularly and note changes–> may need excision or aspiration
Phyllodes Tumour (also known as Brodie’s disease)
A rare tumour effecting women 40-50, can be benign or malignant
Treat with wide excision–> benign tumour may re-appear after excision and become malignant
Should have 2-yearly mammograms afterwards
Intraductal papilloma
A benign, warty lesion behind the areola
Notice a small lump or bloody discharge (70%)
Young women may have multiple lesions, and 40yos just 1–> Aspiration or biopsy can be used
Atypical Hyperplasia
Benign hyperplasia can occur in ducts or lobes–> may lead to carcinoma–> do not need excision but require annual mammograms
Risk is higher if there is family history
Sclerosing adenosis
A benign condition causing sclerosis within lobules
May cause a lump, pain or be an incidental finding
Hard to exclude malignancy so biopsy is needed
Fat necrosis
Usually following trauma in large, fatty, obese breasts –> usually painless, with red, bruised or dimpled skin. Biopsy to confirm diagnosis but no further management is required
Mastitis
An infection of the breasts usually associated with lactation but can occur without it
Mastitis with lactation
Duct ectasia
Mastitis without lactation
Can be due to Complicated duct ectasia
Periductal mastitis
Mammary fistula
Features of pathological nipple Discharge
Spontaneous
Unilateral
Related to a single duct
Bloody
Common causes of nipple discharge
Intra-ductal papilloma
Duct ectasia
FCC (fibrocystic change)
Cancer
Cancer risk associated with nipple discharge
about 5% (usually DCIS if it is)
DCIS
Ductal carcinoma in situ
Male breast disorders
True or pseudo gynaecomastia
Benign breast lumps
Benign lumps on the chest wall (lipoma, fibroma, epidermal cysts)
