Benign breast disorders Flashcards
What nodes receive most of the drainage from the breast
Axillary (sentinel)
Which nodes are most commonly involved with breast cancer metastases
Axillary nodes
What is the top cause of fever in post partum females
Mastitis
What are some risk factors for mastitis
first time nursing
difficulty nursing
oversupply of milk
maternal stress/fatigue
illness of mother or child
cracks / nipple sores
What is mastitis
infection of the breast
What is the most common cause of mastitis
S. aureus
What are some s/sx of mastitis
unilateral
indurated, erythematous, edematous tender area on breast
fever
How do you diagnose mastitis
Mostly clinical
*if persistent -> culture MIDSTREAM milk sample
How do you treat mastitis
breast feeding
bedrest
breast massage
supportive bra
pain control (NSAIDs / Tylenol)
What is the first line abx for mastitis
Dicloxacillin (7-14 days)
What is the treatment for mastitis if there is a PCN allergy or MRSA is suspected
Clindamycin
What are the risk factors for breast abscess
material age (>30)
Primparity
gestational age +41weeks
mastitis
What are some causes of a breast abscess that are unrelated to breast feeding
DM
Smoker
hidranitis suppurativa
trauma
*inflammatory complication
What is the primary cause of a breast abscess
worsening of mastitis
*S. aureus
What are the s/sx of a breast abscess that are different from mastitis
palpable fluctuant mass
+/- spontaneous drainage
What is diagnostic for a breast abscess
aspiration (possible I&D)
What antibiotics can be used for breast abscess
Bactrim
Clindamycin
Doxycycline
What is a galactocele
Milk retention cyst
When do galactoceles commonly present
typically 6-10 months after lactation
What is the most common lesion in lactating women
galactocele
What are the s/sx of galactocele
palpable mass that is soft, non-tender, and mobile
*no systemic symptoms
What is the imaging test of choice for galactocele
Ultrasound
How can you make a definitive diagnosis of a galactocele
Needle aspiration
How can you treat a galactocele
warm compress (should resolve on own)
*if not = aspiration
What are breast cysts often associated with
larger spectrum of fibrotic disease
When do fibrocystic diseases typically peak
30-50 y/o
What are breast cysts most commonly related to
hormones (overproduction of estrogen)
What is the best initial test for breast cysts
US
*helps differentiate between cystic vs solid
What will a cyst look like on US
round, well circumscribed, anechoic
When should mammography be considered with breast cysts
> 35years old
What are the 3 types of breast cysts
simple
complicated
complex
What are the properties of a simple breast cyst
smooth, thin, regular walls
completely fluid filled
always benign
What are the properties associated with complicated breast cysts
some debris but not real solid and no thick walls
What are the properties of complex breast cysts
irregular or scalloped with thick walls
some solid components and debris
may be malignant
How do you get a definitive diagnosis for breast cysts
FNA
(cytology and culture)
What is the treatment for a simple breast cyst
aspiration +/- excision
*no monitoring necessary
How do you treat complicated breast cysts
Aspiration +/- cytology/culture
Re-image and/or bx q6m x 2 yr
How do you treat complex breast cysts
FNA or excision biopsy
follow-up q6m x 2yr
What are 2 types of fibrocystic changes that can occur
Non-proliferative
proliferative
What are the characteristics of non-proliferative fibrocystic changes
no epithelial hyperplasia in ducts
No increase in risk for Brest cancer development
What is the most common presenting system with fibrocystic changes in the breast
Mastalgia that is exacerbated by menstruation, chocolate, caffeine
How do you assess fibrocystic changes in women >35
mammogram
How do you assess fibrotic changes in women <35 and why
US because the breast tissue is too dense for mammo
What are the treatment options for fibrocystic breast changes
reassurance and a supportive bra
*if more severe, can use tamoxifen
What is the most common benign tumor of the breast
fibroadenoma
Who usually gets fibroadenoma
usually females <30
*higher rates in those who took OCP before age 20
Which breast tissue is usually effected by fibroadenomas
stromal and epithelial cells
Where on the breast do fibroadenomas present
Can be bilateral
*upper/outer quadrant most common
When are core needle biopsies needed for fibroadenomas
suspicious lesion
high risk women
rule out malignancy
Which patients will have a fibroadenoma removed
Rapid growth
uncertain diagnosis
size >2cm
patient request
When are intraductal papillomas general present
35-55years old
What are the risk factors for intraductal papilloma
contraception
hormone replacement therapy
lifelong estrogen exposure
+FH
What is an intraductal papilloma
benign tumor of ductal epithelial cells
Where are solitary papillomas most common
central and posterior to the nipple
*effects central duct
What type of discharge can occur with an intraductal papilloma
bloody or clear and spontaneous
What type of imaging can be done to show a filling defect in the milk ducts
Galactography
What is the treatment for an intraductal papilloma
Lumpectomy due to the high risk of becoming cancerous
