Benign breast disease

Question 1

Describe a fibroadenoma?

Answer 1

• 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

Question 2

Describe the outcomes of fibroadenomas?

Answer 2

• 1/3 regress
• 1/3 stay the same
• 1/3 get bigger

Question 3

Treatment for fibroadenoma?

Answer 3

• Observation and reassurance
• If in doubt, refer for US +/- FNA
• Surgical excision if large

Question 4

Describe breast cysts?

Answer 4

• Common >35 yrs old esp. perimenopausal
• Benign fluid-filled rounded lump
• Not fixed to surrounding tissue.
• Occasional painful

Question 5

Describe the management of breast cysts?

Answer 5

Diagnosis and treatment by fine needle aspiration

Question 6

Describe Breast abscesses / infective mastitis?

Answer 6

• Infection of mammary duct often associated with lactation
  
  • Usually Staph. aureus
• Painful, hot swelling of breast segment

Question 7

Treatment for a breast abscess / infective mastitis?

Answer 7

• Antibiotics
• Open incision or percutaneous drainage if abscess

Question 8

Describe duct ectasia?

Answer 8

• Typically around menopause
• Ducts become blocked and secretions stagnate
• Preseents with nipple discharge (green/bloody/brown)
  
  • +/- nipple retraction +/- lump

Question 9

Describe the treatment for Duct ectasia?

Answer 9

• Usually no treatment needed
• Advice to stop smoking

Question 10

Describe fat necrosis of the breast?

Answer 10

• Fibrosis and calcification after injury to breast tissue
• Scarring results in firm lump

Question 11

Describe the treatment for suspected fat necrosis?

Answer 11

• Refer for triple assessment
• No treatment once diagnosis is confirmed

Question 12

Describe a papilloma of the breast?

Answer 12

• 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

Question 13

Describe the treatment for a papilloma?

Answer 13

• Microdochectomy
  
  • surgical removal of a lactiferous duct

Question 14

Describe a lipoma of the breast?

Answer 14

• Soft and mobile benign adipose tumour
• Normally otherwise asympatomatic
• Low malignant potential

Question 15

Treatment for a lipoma of the breast?

Answer 15

• Only removed if:
  
  • Significantly enlarging
  • Symptomatic compression
  • Aesthetic issue for the patient

Question 16

Describe a Phyllodes tumour?

Answer 16

• Rare fibroepithelial tumour
• Composed of epithelial and stromal tissue
• Can grow rapidly
• 1/3 have malignant potential => should be widely excised/mastectomy

Question 17

General rules for the clinical features of benign breast tumours?

Answer 17

Smooth and mobile

Question 18

What should all suspicious lumps go under?

Answer 18

Triple assessment then suitable managed thereafter

Question 19

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?

Answer 19

Fibroadenoma

Question 20

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?

Answer 20

Duct ectasia

Question 21

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?

Answer 21

Breast cyst

Question 22

A 49-year-old woman presents with a tender lump around the areola associated with a green nipple discharge.

What is the likely diagnosis?

Answer 22

Mammary duct ectasia

Question 23

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?

Answer 23

Fat necrosis

Question 24

A 35-year-old woman complains of ‘lumpy’ breasts. Her symptoms are worse in the premenstrual period.

What is the likely diagnosis?

Answer 24

Fibroadenosis

Question 25

Medications which are suitable when a woman is breastfeeding

Answer 25

Question 26

A teenage girl is investigated for primary amenorrhoea, despite having developed secondary sexual characteristics. On examination she has well developed breasts with scanty pubic hair and a blind-ending vagina.

What is the most likely diagnosis?

Answer 26

Androgen insensitivity syndrome

Question 27

A 30 year old breastfeeding mother presents to the GP with a 3 day history of a left inflamerd nipple. There is mild tenderness around the nipple but she is continuing to breastfeed. She is afebrile and vital signs are within normal range.

What do you tell her?

Answer 27

Advise the lady to keep breasteeding normally

Question 28

What does snowstorm sign on US indicate?

Answer 28

• Breast implant rupture
• Leakage of silicone which then drains via the lymphatic system

Question 29

What does unilateral bood niplpe discharge often indicate?

Answer 29

Papillome of the breast

Question 30

Name a tumour marker for breast cancer?

Answer 30

Ca 15-3