Benign Breast Disease

Question 0

At what age does fibroadenoma usually occur?

Answer 0

Can occur at any age after puberty, most common in third decade.

Most common benign breast lump.

Question 1

What percentage of patients in the breast clinic have benign breast disease?

Answer 1

90%

Question 2

What is a fibroadenoma made up of?

Answer 2

Both connective and glandular tissue

Question 3

How is a lactating fibroadenoma managed?

Answer 3

Conservatively

Question 4

What are the clinical features of a fibroadenoma?

Answer 4

• Susceptible to oestrogen - grow rapidly in pregnancy
• Defined rubbery mass, well defined borders, can be lobulated and lumpy
• Usually unifocal, can be multifocal
• Usually subject to same cyclical changes as other glandular breast tissue - may be more tender at particular time of the month
• Mobile (old nick name is breast mouse)
• Usually 10-40mm in size but can be larger
• No potential to become malignant (although sometimes a constituent part of a breast carcinoma can be a fibroadenoma)

Question 5

How is a fibroadenoma managed?

Answer 5

• If 4cm, remove

Question 6

What is a juvenile fibroadenoma?

Answer 6

Found in young teenage girls, more common in African races.

Tend to be larger than normal fibroadenomas (50-100mm) and grow rapidly.

Can be confused with a phyllodes tumour due to their rapid growth.

Question 7

What is a Phyllodes tumour?

Answer 7

A breast neoplasm.

1% of breast cancer, 1:40 incidence to fibroadenoma. Rare in young women.

Leaf like tumour, rapidly growing.

Usually benign, difficult to decide if malignant therefore excise.

Question 8

Differential of nipple discharge if

A) blood stained
B) green, multi duct
C) creamy discharge

Answer 8

A) consider fibrostoma
B) consider physiological
C) consider duct ectasia

Ask: induced/spontaneous, bilateral, colour, consistency, one duct or multiple

Question 9

What is mastalgia?

Answer 9

Pain in the breast.

Differentiate true vs referred.

• with referred NSAIDs help and often unilateral
• with true tends to be worse up to period then less

Question 10

What are the clinical features of duct papilloma?

Answer 10

• 80% have bloody nipple discharge
• most common cause of nipple discharge
• most will have a palpable mass - will typically feel like an elongated mass - along the lumen of a duct. Can also be more spherical in shape in which case the duct lumen will be enlarged.
• usually found within 4cm of the nipple, due to their ductal nature
• usually solitary
• tend to occur in middle aged women but can be seen in younger and older patients
• less common than fibroadenomas
• rise from ductal epithelium
• not a form of pre-malignancy

Question 11

How are breast cysts managed?

Answer 11

• microcysts -> insignificant
• can be appocrine or non appocrine, if appocrine then reassure
• if large/painful -> aspirate
• if blood stained -> send to cytology
• if palpable mass after aspiration -> examine

Only really treated if symptomatic. Aspirating usually helps. Can reoccur, aspirate again and have higher level of suspicion for sending cytology.

7% of women get a cyst

Question 12

What are three types of breast adenomas?

Answer 12

Tubular adenomas - 1-4cm diameter, most common in third decade

Lactating adenomas - tubular adenomas which may begin secreting during pregnancy

Nipple adenomas - a solitary nodule under the nipple, can occur at any age, may ulcerated and be mistaken for Paget’s disease of the nipple, may cause a bloody discharge, well defined borders

Adenomas are generally rare