Benign Breast Disease Flashcards
Likely cause of granularity, tenderness (usually upper outer quadrant) and pain in bilateral breasts of woman of reproductive age?
Normal menstrual changes of breast
Histological changes of the breast >35 y/o?
- Loss of terminal duct lobular unit, replaced by fibrous tissue in inter-lobular region
- Sclerosis and microcystic formation
- Duct dilatation
- Stagnant secretions
Common age range of fibroadnemoas?
15-30 y/o, most commonly in late teens/early 20s
Most common cause of breast mass in
Fibroadenoma
Most common cause of breast mass in ?45 y/o?
Carcinoma
What to do if uncertain whether breast granularity, pain etc is due to normal menstrual cycle?
If younger pt: ask to return during middle of menstrual cycle, when these changes will be at their lowest
If older pt: mammography +- cytology and histology
What is the role of mammography in benign breast disease?
No primary role in BBD - is used to exclude cancer
When are breast cysts normal?
Microcysts are normal in the involuting breast - normally only histologically apparent though
What to do if palpate a cyst?
- Aspirate cystic fluid until impalpable; only send for cytology if blood-stained
- If fluid contains blood: warning sign;STOP aspirating (else may obliterate cyst and be unable to relocate for further investigation)
- There should be no residual mass after cyst has been drained - investigate further: biopsy
Sinister features following cyst aspiration
- Blood-stained cystic fluid
- Residual mass following aspiration
What proportion of women may experience cyclical (premenstrual) mastalgia during their lifetime?
~50%
What are the important features of mastalgia to distinguish?
- Is it cyclical or not?
- Is it focal or bilateral?
Management of cyclical, bilateral mastalgia?
Thorough examination, reassurance = 90% effective therapy
Severe mastalgia: anti-oestrogen may be used for 3 months e.g. tamoxifen 10mg dly or danazol 100mg dly
May try evening primrose oil 3g dly for 3 months (anecdotal evidence)
Management of postmenopausal or focal breast pain?
Oral or topical NSAIDS
Management of
Reassure
Breast pain chart
Trial of evening primrose oil
Tamoxifen if persistently problematic
Management of >35 y/o with mastalgia and normal examination?
Mammogram Reassure Breast pain chart Trial of evening primrose oil Tamoxifen if persistently problematic
Management of mastalgia with focal mass/abnormality?
Mammogram/ultrasound (where appropriate)
FNAB + core biopsy
When does post-partum breast infection occur?
First few days after childbirth
Which organism is most commonly implicated in post-partum breast infection?
Staphyloccocus aureus - enters via ducts in nipple
Treatment of breast infection?
- Flucloxacillin
- Erythromycin if penicillin allergy
Treatment of large breast abscess?
- Surgical incision and drainage
When does periductal mastitis occur?
- Neonatal period
- Teenagers
- Later in life when ducts are involuting (mammary duct ectasia) (stagnant secretions)
Clinical features of periductal mastitis?
Retro- and peri-areolar inflmmation: pain, redness, tenderness, thickening, oedema, nipple retraction
Thus, may mimic carcinoma - hence do FNAB
Treatment of periductal mastitis?
Co-amoxiclav for 2 weeks, review after 2 weeks
Abscess may form and require drainage/aspiration
Fistula may form - specialist attention
