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Breast > Benign Breast Disease > Flashcards

Benign Breast Disease Flashcards

1
Q

1st

A

1st

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2
Q

Which breast is commonly larger?

A

The left

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3
Q

How does breast development start?

A

It may initially be unilateral therefore unilateral breast lump in 9/10 year old is likely a developing breast

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4
Q

Where do benign breast conditions arise from in the breast?

A

The terminal duct lobular unit - the glandular tissue

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5
Q

What are fibroadenomas classified as and what are they technically

A

Classified as benign neoplasms - best considered as aberrations of normal development

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6
Q

Where do fibroadenomas develop from?

A

Whole lobule not a single cell- under same hormonal control as the rest of the breast tissue

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7
Q

In women aged 20 what % of breast lumps are fibroadenomas

A

60%

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8
Q

Development of fibroadenomas over a 2 year period

A

1/10th increase in size, 1/3 get smaller or completely disappear and remainder stay the same

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9
Q

Fibroadenomas during pregnancy

A

Usually increase in size during pregnancy

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10
Q

Management of fibroadenomas

A

Imaging alone is acceptable if patient is young

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11
Q

What are breast cysts?

A

Distended and involuted lobules - epithelial origin

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12
Q

What % of discrete breast masses are cysts

A

15%

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13
Q

How do breast cysts present?

A

Smooth discrete breast lump that can be painful and is sometimes visible

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14
Q

How do cysts appear on imaging?

A

Characteristic halos on mammography

Diagnosed by ultrasonography

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15
Q

Management of breast cysts

A

Only symptomatic or interdeterminate cystic lesions should be aspirated (treatment) or biopsed

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16
Q

Risk with breast cyst

A

Slight increased risk of developing breast cancer

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17
Q

What is duct ectasia?

A

Subareolar ducts dilated with ductal secretions and shorten during involution that occurs with age - common in older women
If leakage occurs can cause periductal mastitis

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18
Q

What can happen (symptoms) with duct ectasia? x3

A

Some women with excessive dilatation and shortening present with nipple discharge (cheesy), nipple retraction (symmetrical and slit like) or a palpable mass

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19
Q

Drug which reduces gynaecomastia

A

Tamoxifen

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20
Q

What are duct papillomas?

A

Aberrations which show minimal malignant potential

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21
Q

Most common symptom of duct papilloma

A

Nipple discharge which is often bloodstained

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22
Q

Management of a papillary lesion

A

Core biopsy cannot readily differentiate between benign papilloma and papillary carcinoma - therefore excision usually performed

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23
Q

What is morphea?

A

Localised scleroderma of the breast - results in thickened white distorted area of skin - most frequently seen in women who have had radiotherapy after breast-conserving surgery for breast cancer - local creams can help

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24
Q

Which systemic conditions can cause breast symptoms? x4

A

Arteritis, sarcoidosis, keloids, wegeners granulomatosis

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25
Q

What is mastalgia?

A

Breast pain

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26
Q

What is the most common type of mastalgia?

A

Pain referred from the chest wall rather than true breast pain - even in women with cyclical breast pain

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27
Q

Signs which indicate that breast pain is actually referred from chest wall? x4

A

Unilateral
Brought on by activity
Very lateral or medial in the breast
Can be reproduced by pressure on a specific area of the chest wall

28
Q

Examination of mastalgia

A

Palpate the breast and do it with woman on her side so that breast falls away and can palpate the chest wall

29
Q

Management of mastalgia

A 
NSAIDs are usually effective - can use topical agents 
Modify lifestyle (often recent changes of activity eg. with heavy lifting)
Local injections of steroids if one specific point is very painful
30
Q

Management of chronic breast pain following surgery

A

Exclude recurrence

Gabapentin, pregabalin or amitryptiline - recommended in all forms of neuropathic pain

31
Q

What is true breast pain often associated with?

A

Cyclical swelling and nodularity - worse week before menstruation and better with onset - therefore believed to be related to hormones - also alters with hormonal treatment

32
Q

Management of true breast pain

A

Reassurance
Evening primrose oil (gammalinoleic acid)
Soft supportive bra to help pain at night
Danazol (gonadotrophin supressor prevents LH surge and inhibits ovarian steroid formation)(luteal phase)
Tamoxifen (luteal phase)

33
Q

What age group does breast infection commonly affect

A

Between 18 and 50

34
Q

Two types of breast infection

A

Lactational and non-lactational (non-puerperal) infection

35
Q

4 guiding principles in treating breast infection

A

Antibiotics given early to reduce likelihood of abscess development
Hospital referral if infection does not settle rapidly following antibiotics course
Suspected abscess should be confirmed by ultrasonography, aspiration or both before surgical drainage considered
Breast cancer should be excluded in patients with inflammatory lesion if it is solid on ultrasonography

36
Q

Management of breast abscess

A

Repeated aspiration (every 2-3 days is required for larger abscesses) or incision and drainage

37
Q

Most common organism in breast infection

A

Staph aureus in lactational and in non-lactational its staph aureus or anaerobes

38
Q

How do you reduce risk of lactating infection

A

Maternal and infant hygiene

39
Q

When is lactating infection most commonly seen

A

Following first child and within first 6 weeks of breastfeeding

40
Q

Presentation of lactating infection

A

Pain, swelling and tenderness - usually a history of cracked nipple or skin abrasion

41
Q

Treatment of lactating infection

A

Promotion of milk drainage and early antibiotic therapy (flucloxacillin)
Ice packs and cabbage leaves help
Surgical - daily needle aspiration, formal incision and drainage for abscesses larger than 5cm - wound can be left open with daily packing or primary closure
Breastfeeding continue with other breast

42
Q

Which antibiotics should not be used to treat lactating infection

A

Tetracycline, ciprofloxacin and chloramphenicol - as they will enter the breast milk and can harm the baby

43
Q

Treatment of multiple areas of lactating breast infection

A

Stopping milk production with cabergoline 2.5mcg BD for 2 days

44
Q

Two types of non-lactating infections

A

Those that occur centrally in periareolar region and those that affect peripheral breast tissue

45
Q

In whom is periareolar infection most commonly seen

A

In young women mean age 32

46
Q

What occurs histologically with periareolar infection - periductal mastitis

A

Active inflammation around NON-DILATED subareolar breast ducts (as opposed to duct ectasia where there is duct dilatation)

47
Q

What is an important risk factor for periductal mastitis

A

Smoking - abscesses often recur because patients carry on smoking

48
Q

Associated features of periductal mastitis x3

A

Central breast pain, nipple retraction at site of diseased duct and nipple discharge

49
Q

Management of periductal mastitis

A

Antibiotics - flucloxacillin and metronidazole (for anaerobes)
Drainage of abscess
Avoid open drainage - carried out through small incision

50
Q

What is a mammary duct fistula?

A

Communication between the skin and subareolar breast duct after periductal mastitis abscess drainage

51
Q

What can peripheral non-lactating breast abscesses be associated with?

A

Underlying can condition such as diabetes, RA, steroid treatment etc, but majority have no underlying cause

52
Q

In whom are skin breast infections common

A

Overweight women with large breasts or poor hygiene - typically affects lower 1/2 of breast

53
Q

Role of fungi and antifungals in breast infection

A

No role has been proven therefore should not be used

54
Q

What is polymastia

A

Accessory breast tissue due to incomplete involution of the mammary ridge

55
Q

What is polythelia?

A

Accessory nipples

56
Q

What is amastia

A

Absence of breast development

57
Q

What is Poland syndrome?

A

Unilateral hypoplasia of breast, hemithorax and pectoral muscles

58
Q

What is Tietze’s syndrome?

A

Costo-chondritis - cause of non-cyclical mastalgia

59
Q

Difference between fibroadenoma and fibrocystic breast change

A

Fibroadenoma is a defined, singular mobile mass- made of glandular and fibrous tissue - more common in women younger than 30 - painless and well-circumscribed
Fibrocystic is more “lumpy breasts” pain which varies with menstrual cycle - changes in breast epithelium - fluid filled and more common women 30-50

60
Q

Aetiology of lactational breast abscess

A

Milk stasis associated with staph a infection

61
Q

Systemic features of breast abscess

A

Tachycardia and pyrexia - less common in non-lactational abscess

62
Q

Investigations of breast abscess

A

Ultrasound + aspiration for microscopy, culture and sensitivity of pus samples

63
Q

Cellular morphology of fat necrosis

A

Irregular and necrotic adipocytes, amorphous material and inflammatory cells (including foreign body giant cells)

64
Q

What is sclerosing adenosis?

A

Aberration of normal involution - proliferative lesion of cells within breast lobules - usually benign - can cause pain or small lump

65
Q

Association of benign breast disease and OCP

A

Less common with OCP

66
Q

Relationship with breast cysts and age

A

More common 40-50 and usually disappear after menopause unless on HRT

67
Q

What is Hadfield’s or Adairs operation

A

Surgical removal of all lactational ducts below the nipple in duct ectasia

Breast (3 decks)

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