Benign Breast Disease Lecture Powerpoint Flashcards
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Mastoplasia
Ropy thickening of breast tissue often in upper outer quadrant persistent thru menstrual cycle
Galactorrhea
Abnormal breast discharge not necessarily milk
Gynecomastia
Swelling of breast tissue in boys or men caused by an imbalance of horomones estrogen and testosterone
Cooper’s ligaments
Fibrous septa that extend from skin to underlying pectoralis fasciae forming triangular lobules radially around the nipple, often when invaded by breast cause dimpling of the skin
Lymphatic drainage of the breast
- 75% axillary
- remaining 25% to internal mammary vessels and direct lymphatics to mediastinum
Breast tenderness 3-4 days prior to menses is due to….
….increased levels of estrogen and progesterone that cause cell proliferation and water retention
Where do most breast cancers start?
Terminal lobular ductal units composed of myoepithelial and epithelial cells
3D breast digitial tomosynthesis/ 3D mammography
A CT like type of digital mammogram that is highly detailed and views breast in slices, unfortunately still considered expeerimental by many insurance companies
When a woman has implants, what kind of breast exam does she need?
Diagnostic for any remaining tissue in the implant
Proper steps to take for all mammography screening
- Screening mammo
- If abnormal, diagnostic mammo
- Breast ultrasound
- Biopsy
Breast Imaging Reporting and Database System (BI-RADS) scale
0 - wasn’t diagnostic due to external error
1 - continue regular screening if >40yrs, its negative
2 - benign, continue regular screening if >40yrs
3 - likely benign, recommend 6 month follow up
4 - suspicious abnormality, do a biopsy just to be safe
5 - likely cancer
6 - def cancer
Breast cancer screening is unneccisary in patients….
…75 or older, or bilateral mastectomy
Of the 2 screening guideline bodies, ACS and USPSTF, which do we follow regarding breast cancer?
ACS
Severe mastodynia treatment
- Tamoxifen (anti estrogen)
- Goserelin (push into menopause)
Topical mastodynia treatment
Diclofenac (solaraze)
Fibrocystic breast changes
General term for benign breast changes that may include mobile lumps or pain but entail poorly defined symptoms and etiology
Diagnostic testing for fibrocysstic changes of the breast
Image directed core needle biopsy - remove a sample of breast tissue
Galactocele
Well circumscribed round milk filled cyst usually found in the central breast, thought to be due to spoiled milk buildup, treated easily with aspiration
Fibroadenoma
Firm freely mobile solid benign solitary breast mass 2nd most common tumor in the breast
What age group is firboadenoma most common?
Woen 15-35, arises in late teens and druing reproductive years
Phyllodes tumor
Rare rapidly growing bulky tumors that distort the breast, may ulcerate thru skin due to pressure necrosis, wide exicsion required unless metastasis has occurred
Intraductal papilloma
Benign growth within the ductal system that presents as bloody nipple discharge (that isn’t cancer), most common cause of unilateral nipple discharge***, relieved upon expression
Diagnosis for an intraductal papilloma
Ductogram
Fat necrosis
Bruised or dead tissue within the breast often due to trauma forming stellate lesions
Fat necrosis diagnosis
Mammography showing stellate area of distortion with calcification
Fat necrosis treatment
Excisional biopsy
Galactorrhea common causes
- breast stimulation
- trauma
- estrogen withdrawal or estrogen therapy
- OCP’s
- Pituitary tumors (keep this in back of head)
- PCOS
How to treat a plugged duct
Moist heat and manual expression
Mastitis and abscess
Most often caused by a staph infection entering thru a cracked nipple in 9-33% of lactating women
Mastitis and abscess treatment
Continue frequent breast feeding, antibiotics, I&D if necessary
Paget’s disease
Appearance of a psoriatic rash that begins on the nipple and spreads off the areola and into the skin of the breast
Peau d’orange
Edema of the skin strongly resembling dimpling of an orange of the breast caused by lymphatic blockage or mastitis
Mastitis and abscess symptoms
-Fatigue, malaise, myalgias, headache, fever, unilateral warmth tenderness, erythema
How do you alleviate breast pain around menstruation?
- Supportive bra
- Eliminate caffeine
- Topical cream
- NSAIDS
For Galactorrhea, what is the first course of action?
Serum for prolactin, do NOT MRI initially
Fibrocystic breast disease age and symptoms
Most common in the 40’s, breast tenderness, smooth tense masses, small mobile lumps,
Fibroadenoma age and symptoms
Freely mobile solid benign breast mast, common in women 15-35 arise in late teens in reproductive years
Fibroadenoma age and symptoms
Freely mobile solid benign breast mast, common in women 15-35 arise in late teens in reproductive years
