Benign Breast Disease

Question 1

3 common benign causes of breast lump(s)?

Answer 1

Fibroadenoma
Breast cysts
Duct ectasia

Question 2

Definition of fibroadenoma?

Answer 2

A benign neoplasm of a lobule, arising from stroma (fibro) and glandular (adenoma) epithelium)

Question 3

Epidemiology of breast fibroadenoma?

Answer 3

Young women of child-bearing age (20-30s)

Most common type of benign breast lump

Question 4

Definition of breast cysts?

Answer 4

Fluid-filled sacs in the breast

Question 5

Epidemiology of breast cysts?

Answer 5

Peri-menopausal women (40-50s)

Often accompanied by pain associated with the menstrual cycle

Question 6

Definition of duct ectasia?

Answer 6

Dilatation of milk ducts due to blockage

Question 7

Epidemiology of duct ectasia?

Answer 7

Peri/post-menopausal women

Smoking is a key risk factor

Question 8

Using the SCTF method of assessing breast lumps (see Breast Clinical Assessment cards), features of fibroadenoma?

Answer 8

S - single, 1-5cm

C - well demarcated, firm consistency, smooth

T - often painless

F - mobile (‘breast mouse’)

Question 9

Using the SCTF method of assessing breast lumps (see Breast Clinical Assessment cards), features of breast cysts?

Answer 9

S - single or multiple (‘lumpy’ breast), unilateral or bilateral

C - well demarcated, clear nipple discharge sometimes seen

T - painless but can be painful, transilluminable

F - fluctuant, mobile

Question 10

Using the SCTF method of assessing breast lumps (see Breast Clinical Assessment cards), features of duct ectasia?

Answer 10

S - sub-areolar mass, nipple inversion

C - firm, thick yellow-green nipple discharge

T - tender

F - fixed

Question 11

Appropriate investigations in benign breast lumps?

Answer 11

USS/mammography (all benign lumps)
Core biopsy (fibroadenoma)
FNA (breast cyst)

Question 12

Management of breast fibroadenoma?

Answer 12

• Observe

- Surgical excision, lumpectomy or cryoablation

Question 13

Management of breast cyst?

Answer 13

• Observe

- FNA to drain fluid if necessary

Question 14

Management of duct ectasia?

Answer 14

• Reassure and discharge

- Surgical excision if necessary

Question 15

Investigation findings for fibroadenoma?

Answer 15

FNA - both epithelial and stromal elements in biopsy

Question 16

Investigation findings for breast cyst?

Answer 16

Mammography can’t distinguish solid from cystic so USS follow-up necessary
FNA - cyst completely drained and fluid is straw-coloured (no need for cytology), if any blood, refer for cytology

Question 17

Investigation findings for ductal ectasia?

Answer 17

Microcalcification on imaging

Question 18

2 other benign breast conditions?

Answer 18

Fat necrosis

Intraductal papilloma

Question 19

Fat necrosis clinical picture?

Answer 19

Normally occurs secondary to trauma, in women of any age

- painful, irregular hard lump with overlying bruising/redness of the skin

Question 20

Intraductal papilloma clinical picture?

Answer 20

Benign neoplasm growing within ducts of the breast
Occurs in peri/post-menopausal women
- subareolar mass (usually small) with bloody or clear nipple discharge