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General Surgery > Benign Breast Disease > Flashcards

Benign Breast Disease Flashcards

1
Q

Likely cause of granularity, tenderness (usually upper outer quadrant) and pain in bilateral breasts of woman of reproductive age?

A

Normal menstrual changes of breast

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2
Q

Histological changes of the breast >35 y/o?

A
  • Loss of terminal duct lobular unit, replaced by fibrous tissue in inter-lobular region
  • Sclerosis and microcystic formation
  • Duct dilatation
  • Stagnant secretions
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3
Q

Common age range of fibroadnemoas?

A

15-30 y/o, most commonly in late teens/early 20s

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4
Q

Most common cause of breast mass in

A

Fibroadenoma

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5
Q

Most common cause of breast mass in ?45 y/o?

A

Carcinoma

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6
Q

What to do if uncertain whether breast granularity, pain etc is due to normal menstrual cycle?

A

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

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7
Q

What is the role of mammography in benign breast disease?

A

No primary role in BBD - is used to exclude cancer

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8
Q

When are breast cysts normal?

A

Microcysts are normal in the involuting breast - normally only histologically apparent though

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9
Q

What to do if palpate a cyst?

A
  • 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
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10
Q

Sinister features following cyst aspiration

A
  • Blood-stained cystic fluid

- Residual mass following aspiration

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11
Q

What proportion of women may experience cyclical (premenstrual) mastalgia during their lifetime?

A

~50%

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12
Q

What are the important features of mastalgia to distinguish?

A
  • Is it cyclical or not?

- Is it focal or bilateral?

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13
Q

Management of cyclical, bilateral mastalgia?

A

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)

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14
Q

Management of postmenopausal or focal breast pain?

A

Oral or topical NSAIDS

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15
Q

Management of

A

Reassure
Breast pain chart
Trial of evening primrose oil
Tamoxifen if persistently problematic

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16
Q

Management of >35 y/o with mastalgia and normal examination?

A 
Mammogram
Reassure
Breast pain chart
Trial of evening primrose oil
Tamoxifen if persistently problematic
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17
Q

Management of mastalgia with focal mass/abnormality?

A

Mammogram/ultrasound (where appropriate)

FNAB + core biopsy

18
Q

When does post-partum breast infection occur?

A

First few days after childbirth

19
Q

Which organism is most commonly implicated in post-partum breast infection?

A

Staphyloccocus aureus - enters via ducts in nipple

20
Q

Treatment of breast infection?

A
  • Flucloxacillin

- Erythromycin if penicillin allergy

21
Q

Treatment of large breast abscess?

A
  • Surgical incision and drainage
22
Q

When does periductal mastitis occur?

A
  • Neonatal period
  • Teenagers
  • Later in life when ducts are involuting (mammary duct ectasia) (stagnant secretions)
23
Q

Clinical features of periductal mastitis?

A

Retro- and peri-areolar inflmmation: pain, redness, tenderness, thickening, oedema, nipple retraction
Thus, may mimic carcinoma - hence do FNAB

24
Q

Treatment of periductal mastitis?

A

Co-amoxiclav for 2 weeks, review after 2 weeks
Abscess may form and require drainage/aspiration
Fistula may form - specialist attention

25
Q

Management of breast fistula?

A

Biopsy

TB and MC&S cultures

26
Q

What is a fibroadenoma?

A

Endocrine-dependent fibrous overgrowth of a single breast lobule

27
Q

Usual size of fibroadenomas?

A

~2cm

>5cm = giant fibroadenoma –> rare

28
Q

Examination features of fibroadenoma?

A
  • Well-defined
  • Painless
  • Very mobile
29
Q

Management of fibroadenoma

A

6 monthly follow up x2 if no increase in size

Reassure

30
Q

What is the triple assessment?

A
  • Clinical examination
  • Radiological assessment: mammogram
  • Tissue investigations: FNAB, core biopsy
31
Q

Management of fibroadenoma >4cm in

A

Excise under GA

32
Q

Management of fibroadenoma

A

FNAB or U/S
6 monthly follow-up x2 if no increase in size
Excise under local if pt requests

33
Q

Management of fibroadenoma >4cm in 20-25 y/o

A

Excise under local/general anaesthetic, depending on size

34
Q

Management of fibroadenoma

A

U/S then FNAB and Trucut
6 monthly follow-up x2 if no increase in size
Excise under local if pt requests

35
Q

Management of fibroadenoma >4cm in 25-35 y/o

A

U/S then FNAB and Trucut

Excise under local/general anaesthetic, depending on size

36
Q

Management of fibroadenoma >4cm in >35y/o

A

Mammogram, FNAB, Trucut biopsy

Excise under local/general anaesthetic, depending on size

37
Q

Management of nipple discharge only when squeezing breast, with normal examination?

A

Desist from squeezing breasts

Return in several weeks if discharge continues

38
Q

Management of bilateral/multiductal spontaneous nipple discharge?

A

Usually benign, return in several weeks if it persists

39
Q

Management of unilateral/single ductal spontaneous nipple discharge?

A

More likely to be Ca: may have clear or bloody fluid
Mammography
FNAB/Trucut
If no identifiable cause: ductal excision (microdochectomy)

40
Q

Causes of multiple duct/benign nipple discharge?

A
  • Pregnancy
  • Lactation
  • Drugs
  • Ectasia
  • Prolactinoma
41
Q

Causes of single duct nipple discharge?

A
  • Intraductal Ca
  • Papilloma
  • Epitheliosis
  • Ectasia
42
Q

Causes of gynaecomastia?

A
  • Drugs (oestrogen, digoxin, steroids)
  • Liver disease
  • Physiological (neonatal, puberty, old age)
  • Genetic syndromes e.g. Klinefelter syndrome
  • Endocrine disturbances
  • Rare tumours (adrenal, testicular)

General Surgery (15 decks)

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