Benign Breast Disease Flashcards by Sheryl O'Hare

What is involved in triple assessment?

Clinical
Radiology
Cytopathology/histopathology

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Triple assessment - clinical

History

Examination

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Triple assessment - radiology

Mammography - over 40

US - under 40

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Triple assessment - cytopathology / histopathology

FNA - uncommon 
Needle core biopsy - common
Vacuum assisted biopsy 
Skin biopsy
Incisional biopsy

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Gynaecomastia - definition

Breast development in the male

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Gynaecomastia is related to breast cancer. True or false?

False

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Gynaecomastia - lobular/ductal growth without lobular/ductal development

DUCTAL growth without LOBULAR development

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Gynaecomastia - causes

Cannabis
Hormones
Prescription drugs: spironolactone
Liver disease

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Fibrocystic change - who gets it

Commonest cause of a breast lump in women age 30-50

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Fibrocystic change - is it related to the menstrual cycle?

Yes, usually occurs at the end of period when breast fills up with fluid

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Fibrocystic change - how does it occur?

During the evolution of breast tissue, the breast changes

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Fibrocystic change usually persists through menopause. True or false?

False

- often resolves after menopause

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Fibrocystic change - clinical features

Clearly defined
Palpable 
Soft 
Tender
Smooth lump 
Menstrual cycle related pain

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Fibrocystic change - what do the cysts look like?

vary in size (from 1mm -> several cm).
Blue domed with pale fluid.
Usually multiple and bilateral

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Fibrocystic change - investigation

FNA

aspirate as much fluid as possible
only grossly bloody fluid needs to be sent for cytological evaluation

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Fibrocystic change - routine management is to excise. True or false?

False

- only need to reassure patient that it is nothing to worry about

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Hamartoma - definition

Collection of normal breast structures that present in an abnormal and disorganised distribution

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What is the most common cause of a breast lump in under 30 year olds?

Fibroadenoma

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Fibroadenoma - clinical presentation

Painless 
Palpable mass
Firm
Smooth
Mobile mass

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Fibroadenoma - pathology

Well rounded
Rubbery 
Soft appearance 
Grey-white colour 
Biphasic tumour/lesion

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Fibroadenoma investigations in under 40 year old

US (looks solid)

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Fibroadenoma investigations in over 40 year old

Mammography

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Fibroadenoma - routine management is excision. True or false?

False

reassure patient
commonly becomes non-palpable after menopause

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Fibroadenoma - what are 2 methods of excision?

Lumpectomy

Vacuum assisted core biopsy

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Sclerosing lesions - what are the 2 types?

Sclerosing adenosis | Radial scar

Sclerosing adenosis - clinical features

Pain Lumpiness May be asymptomatic

Sclerosing adenosis - who commonly gets it?

20-70 year olds

Radial scar - clinical features

Often an incidental finding Central puckering Radiating fibrosis

In situ or invasive carcinoma may occur within radial scars. True or false?

True

Which clinical condition may mimic a carcinoma radiologicallly?

Radial scar

Radial scar - routine management is to excise. True or false?

True

What is mastalgia?

Breast pain

Mastalgia is not usually related to the menstrual cycle. True or false?

False | - it is

Mastalgia in a patient over 35

Investigate with mammogram

Mastalgia - management

Well fitting bra | Regular exercise

How does fat necrosis occur?

When there is damage and disruption of adipocytes -> Infiltration by acute inflammatory cells -> subsequent fibrosis and scarring

What causes fat necrosis?

Local trauma (eg seatbelt injury)

Duct ectasia - definition

Peri-ductal inflammation which affects sub-areolar ducts

Duct ectasia - clinical features

Pain Acute episodic inflammatory changes Bloody and/or purulent discharge

Duct ectasia - management

Treat acute infection with antibiotics Exclude malignancy Excise ducts

Duct ectasia - what is it associated with?

Smoking

What are the 2 causes of acute mastitis?

Duct ectasia | Pregnancy/lactation

Duct ectasia - causative organisms

Mixed organisms | Anaerobes

Duct ectasia - which antibiotics do you use?

Metronidazole

Pregnancy/lactation related acute mastitis - what are the causative organisms?

Staph aureus | Strep pyogenes

Pregnancy/lactation related acute mastitis - breast feeding should not be continued. True or false?

False | - breast feeding should be continued

Acute mastitis - clinical features

Fever Erythema Tenderness Swelling

Acute mastitis - management

US guided drainage Antibiotics Incision and drainage

Pregnancy/lactation related acute mastitis - which antibiotics should you use?

Flucloxacillin for 7 days

Abscess - definition

Floculent mass usually located in the central area of mastitis

Abscess - investigations

US - reveals a fluid filled (pus) centre

Abscess - management

US guided drainage | Aspiration with an 18 gauge needle

Phyllodes tumour - definition

Slow growing unilateral breast mass Biphasic tumour Stromal overgrowth

Phyllodes tumour - why must it be adequately excised?

It is prone to local recurrence

What other benign breast condition does a phyllodes tumour resemble?

Fibroadenoma

Phyllodes tumour is only benign and has no malignant potential. True or false?

False | - there are benign, intermediate and malignant types

Phyllodes tumour - management

Excision with wide 1cm clear surgical margins

Intraduct papilloma affects which ducts?

Sub-areolar ducts

Intraduct papilloma - clinical features

Bloody nipple discharge

Intraduct papilloma - possible features on screening

Calcification

Intraduct papilloma - pathology

Cauliflower like extension of a cyst | May have cancer cells inside of it

Intradcut papilloma - investigations

Mammography | US guided core needle biopsy

50 year old presents with bloody nipple discharge - most likely to be which condition?

Intraduct papilloma

45 year old presents with a unilateral breast mass. Pathology report reveals a stream overgrowth. What is the likely diagnosis?

Phyllodes tumour

32 year old female develops a red, swollen, tended left breast. She is currently breast feeding. What is the likely diagnosis? How should she be managed?

Acute mastitis Management - antibiotics: flucloxacillin - continue breast feeding or use pump to express until mastitis clears

Which benign breast disease is commonly associated with smoking?

Duct ectasia

Post menopausal female with greenish nipple discharge and associated mastalgia. Her nipple looks distorted. What is the likely diagnosis?

Duct ectasia

Star shaped breast mass which has central puckering. What is the diagnosis?

Radial scar

Which benign breast disease is most likely to mimic cancer?

Radial scar

27 year old female presents with a painless palpable, smooth, firm mobile mass. What is the likely diagnosis?

Fibroadenoma

40 year old woman with breast lump. What is the most likely diagnosis?

Fibrocystic change (breast cyst)