Benign Breast Disorders Flashcards
Sentinel nodes are
axillary nodes that receive most of the drainage from the breast
what nodes are most frequently involved with breast cancer metastases
sentinel nodes (axillary nodes)
Breast development in puberty is driven by
estrogen
What hormone is responsible for milk secretion and smooth muscle contraction to allow for milk ejection
oxytocin
Mastitis is the top cause of _____ in a postpartum female
fever in a postpartum female
What receptors in the nipple are activated with baby suckling and what does it cause
mechanoreceptors in the nipple activate the release of more oxytocin
Risk factors of Mastitis
first time nursing
difficulty nursing
blockage of milk duct
oversupply of milk
maternal stress or fatigue (excessive)
illness of mother or child
cracks and nipple sores
If recurrent mastitis in the same location or does not respond to appropiate treatment you must
r/o breast cancer
Mastitis dx/workup
mostly clinical
bx not usually needed
if persistent culture midstream milk sample
Mastitis is
an infection of the breast - breast cellulitis most commonly casued by staph aureus
Mastitis ssx/ clinical presentation
typically unilateral
indurated, erythematous, tender area on breast
fever is common
pain including and beyong the indurated area
other complaints: myalgia, chills, malaise
Mastitis treatment (supportive)
supportive measures - breastfeeding (not harmful to baby)
bedrest
beast massage during pumping/feeding
supportive bra
Pain control - acetaminophen or anti-inflammatory agent
mastitis treatment (antibiotics)
dicloxacillin for 7-14 days
Cephalexin for alternative
if MRSA sus or PCN allergy - clindamycin
no improvement –> vancomycin
If there is a palpable mass after infection (mastitis) ressolves you should
bx
Mastitis repeated recurrence or treatment failure then you should
bx
Breast abscesses are uncommon in ______
breast feeding women
Breast Abscess is often secondary to
mastitis if inadequate treatment
Breast Abscesses can occur in women unrelated to
pregnancy and breastfeeding
Breast Abscess is primarily due to
extension/ worsening of mastitis
often due to staph aureus
20% MRSA
Breast Abscess clinical presentation
similar to mastitis plus palpable fluctuant mass
+/- spontaneous drainage
Breast abscess dx/workup
aspiration diagnostic and therapeutic
ultrasound can be used to r/o other lesions
must r/o inflammatory breast cancer
When would you consider bx for a suspected breast abscess
mass remains after treatment
fails to improve after 48hrs of treatment
associated lymphadenopathy
Treatment for breast abscess
drainage - aspiration first, I&D plus wound packing if fails
Abx - bactrim for 5-14 days or clindamycin for 5-14 days or doxycycline 5-14 days
Galactocele AKA _______
milk retention cyst
Most common lesion in lactating women is
Galactocele
Galactocele frequently happen
6-10 months after lactation
can occur during lactation as well
Galactoceles occur when
thickening of secretions –> obstruction of milk duct –> cystic collection of fluid
rarely become infected
Galactocele presentation
palpable mass
soft, nontender, mobile
NOT associated with systemic symptoms
Best imaging of choice for galactocele
US - simple milk cyst or complex mass
Definitive dx for galactocele
needle aspiration (also therapeutic)
Galactocele treatment
may resolve on its own - warm compresses
if not –> aspiration
if developes sx of abscess –> antibiotics
Fibrocystic disease peaks between (what ages)
30-50 years of age
Breast cyst pathophysiology
mostly related to hormones - overproduction of estrogen, suppression of progesterone
Fibrosis of breast tissue - failure in formation of lobules/ ducts
Breast Cyst Clinical Presentation
may have cyclic breast tenderness or pain (cyclic mastalgia)
+/- palpable mass depending on size
SHOULD NOT HAVE pain, erythema, discharge, nipple or skin changes
Best initial test for breast cyst
US - differentiates between cystic and solid
Cystic = round well circumscribed anechoic
Using US is better when
under 35
better for denser breasts
Mammography is better for
older than 35
and looks for suspicious calcifications
Three different types of breast cysts
simple
complicated
complex
simple breast cyst consists of what components
smooth thin regular walls
completely fluid filled
always benign
Complex breast cyst consists of what components
irregular or scalloped thick walls
some solid components or debris
may be malignant
Complicated breast cyst consists of what components
somewhere between simple and complex
some debris but not real solid components no thick walls
Breast cyst definitive dx with
fine needle aspiration cytology +/- culture
dx and therapeutic
Breast cyst treatment:
Simple Type
Aspiration
+/- excision if recurrent
no monitoring necessary
Breast cyst treatment:
Complicated
Aspiration
+/- cytology/ culture
re-image with US or mammogram and/or bx every 6 months x 2 years
Breast cyst treatment:
Complex
Must do a fine needle aspiration or excisional bx
follow up every 6 months for 2 years
Fibrocystic changes have the same pathophysiology as
breast cysts - mostly related to hormones –> overproduction of estrogen, suppression of progesterone
Fibrosis of breast tissue - failure in formation of lobules/ ducts
Two types of fibrocystic changes
non-proliferative
proliferative
Non-proliferative changes are when
there is no epithelial hyperplasia in ducts
no increase for risk of developing breast cancer
Proliferative changes are when
some ducts have epithelial hyperplasia
if moderate to severe – 1.5-2.0 x higher risk of developing breast cancer
if atypical – (atypical ductal or lobular) 4-5 x higher risk
Fibrocystic changes clinical presentation
cyclical breast myalgia is often the presenting sx
pain is exacerbated by menstruation, chocolate, caffeine
cyclical pain, fluctuation in size and multiplicity of lesions help differentiate these lesions from carcinoma
Dx workup for fibrocystic changes
evaluation with mammogram, US, and/or bx for suspicious lesions
mammogram if > 35
breasts too dense if < 35
patients under 35 should get US
Fibrocystic Changes treatment
reassurance
supportive bra to limit pain
acetaminophen and NSAIDS
symptoms improve at menopause
More severe cases of fibrocystic changes treatment
metformin? - might reduce cell proliferation
tamoxifen or danazol - hormone modulators
Fibroadenoma is the most common
benign tumor of the breast
Fibroadenomas are usually found in
females younger than 30 y/o
commonly found in adolescence - higher rates in women who take OCP before age 20
Fibroadenomas are rare after
menopause
Fibroadenomas are
benign tumors of connective tissue - contain estrogen and progesterone receptors, stromal and epithelial cells
etiology unknown - likely related to estrogen
Fibroadenoma clinical presentation
often discovered by accident
usually solitary but can be multiple - may occur bilaterally
typically upper outer quadrant
round, discrete, mobile, painless mass
rubbery consistency
usually 1-5 cm in diameter
pregnancy and exogenous estrogen increase it size
Best initial test for fibroadenoma
US - differentiates between cystic and solid
will be a well circumscribed uniform solid mass
mammogram if > 35
When would you need a core needle biopsy for a suspicious fibroadenoma
suspicious lesions
women at high risk
r/o malignancy
What testing confirms a fibroadenoma/ treatment
bx - no treatment necessary
will shrink overtime
can excise if large - invading other breast tissue
however surgical excision may disfigure other breast tissue
Intraductal Papilloma are most common between what ages
35-55 years old
What is a intraductal papilloma
benign tumor of ductal epithelial cells
Solitary papilloma - usually central posterior to the nipple, affects the central duct
Multiple papillomas - location in the peripheral ducts
Intraductal Papilloma clinical presentation
if under 35 may be asymptomatic in younger patients
Spontaneous nipple discharge (clear or bloody)
occasionally palpable
Intraductal Papilloma workup
US if < 35 - well circumscribed tumor in dilated duct
mammogram if > 35 - well circumscribed lesion with dilated ducts
Galactography may show filling defect
Core needle bx for definitive dx to r/o malignancy (high risk lesion)
Intraductal papilloma treatment
lumpectomy - because they have the ability to be malignant
Surgical excision of entire mass
