Benign breast disease Flashcards
Describe a fibroadenoma?
- Usually <30 yrs old, but can be anytime up to menopause
- Benign overgrowth of collagen mesenchyme of one breast lobule
- Firm, smooth, mobile lumb (breast mouse)
- May be multiple and bilateral
Describe the outcomes of fibroadenomas?
- 1/3 regress
- 1/3 stay the same
- 1/3 get bigger
Treatment for fibroadenoma?
- Observation and reassurance
- If in doubt, refer for US +/- FNA
- Surgical excision if large
Describe breast cysts?
- Common >35 yrs old esp. perimenopausal
- Benign fluid-filled rounded lump
- Not fixed to surrounding tissue.
- Occasional painful
Describe the management of breast cysts?
Diagnosis and treatment by fine needle aspiration
Describe Breast abscesses / infective mastitis?
- Infection of mammary duct often associated with lactation
- Usually Staph. aureus
- Painful, hot swelling of breast segment
Treatment for a breast abscess / infective mastitis?
- Antibiotics
- Open incision or percutaneous drainage if abscess
Describe duct ectasia?
- Typically around menopause
- Ducts become blocked and secretions stagnate
- Preseents with nipple discharge (green/bloody/brown)
- +/- nipple retraction +/- lump
Describe the treatment for Duct ectasia?
- Usually no treatment needed
- Advice to stop smoking
Describe fat necrosis of the breast?
- Fibrosis and calcification after injury to breast tissue
- Scarring results in firm lump
Describe the treatment for suspected fat necrosis?
- Refer for triple assessment
- No treatment once diagnosis is confirmed
Describe a papilloma of the breast?
- Women in their 40-50s
- Subareolar region (less than 1cm from the nipple)
- Can present as bloody or clear discharge (larger ones can present as a lump)
- Can be similar to ductal carcinomas on imaging so usually require biopsy
Describe the treatment for a papilloma?
- Microdochectomy
- surgical removal of a lactiferous duct
Describe a lipoma of the breast?
- Soft and mobile benign adipose tumour
- Normally otherwise asympatomatic
- Low malignant potential
Treatment for a lipoma of the breast?
- Only removed if:
- Significantly enlarging
- Symptomatic compression
- Aesthetic issue for the patient
Describe a Phyllodes tumour?
- Rare fibroepithelial tumour
- Composed of epithelial and stromal tissue
- Can grow rapidly
- 1/3 have malignant potential => should be widely excised/mastectomy
General rules for the clinical features of benign breast tumours?
Smooth and mobile
What should all suspicious lumps go under?
Triple assessment then suitable managed thereafter
A 20 year old lady presents with a mobile lump in the upper outer aspect of her right breast. On examination she has a firm mobile mass in the upper qudrant of her right breast?. What is the likely diagnosis?
Fibroadenoma
A 55-year-old women presents with nipple discharge. On examination she has a slit like retraction of the nipple in the centre of this area is a small amount of cheese like material. No discrete mass lesion is palpable in the underlying breast.
What is the likely diagnosis?
Duct ectasia
A 48-year-old lady presents with discomfort in the right breast. On examination she has a discrete soft fluctuant area in the upper outer quadrant of her right breast. A mammogram is performed and a ‘halo sign’ is seen by the radiologist.
What is the likely diagnosis?
Breast cyst
A 49-year-old woman presents with a tender lump around the areola associated with a green nipple discharge.
What is the likely diagnosis?
Mammary duct ectasia
An obese woman presents with an irregular lump on the lateral aspect of her right breast associated with skin tethering. Biopsy excludes a malignant cause.
What is the likely diagnosis?
Fat necrosis
A 35-year-old woman complains of ‘lumpy’ breasts. Her symptoms are worse in the premenstrual period.
What is the likely diagnosis?
Fibroadenosis
