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Woman's Health > Benign Breast Disorders > Flashcards

Benign Breast Disorders Flashcards

1
Q

Sentinel nodes are

A

axillary nodes that receive most of the drainage from the breast

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2
Q

what nodes are most frequently involved with breast cancer metastases

A

sentinel nodes (axillary nodes)

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3
Q

Breast development in puberty is driven by

A

estrogen

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3
Q

What hormone is responsible for milk secretion and smooth muscle contraction to allow for milk ejection

A

oxytocin

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3
Q

Mastitis is the top cause of _____ in a postpartum female

A

fever in a postpartum female

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3
Q

What receptors in the nipple are activated with baby suckling and what does it cause

A

mechanoreceptors in the nipple activate the release of more oxytocin

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4
Q

Risk factors of Mastitis

A

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

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5
Q

If recurrent mastitis in the same location or does not respond to appropiate treatment you must

A

r/o breast cancer

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5
Q

Mastitis dx/workup

A

mostly clinical
bx not usually needed
if persistent culture midstream milk sample

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5
Q

Mastitis is

A

an infection of the breast - breast cellulitis most commonly casued by staph aureus

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5
Q

Mastitis ssx/ clinical presentation

A

typically unilateral
indurated, erythematous, tender area on breast
fever is common
pain including and beyong the indurated area
other complaints: myalgia, chills, malaise

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5
Q

Mastitis treatment (supportive)

A

supportive measures - breastfeeding (not harmful to baby)
bedrest
beast massage during pumping/feeding
supportive bra
Pain control - acetaminophen or anti-inflammatory agent

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5
Q

mastitis treatment (antibiotics)

A

dicloxacillin for 7-14 days
Cephalexin for alternative
if MRSA sus or PCN allergy - clindamycin
no improvement –> vancomycin

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5
Q

If there is a palpable mass after infection (mastitis) ressolves you should

A

bx

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6
Q

Mastitis repeated recurrence or treatment failure then you should

A

bx

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7
Q

Breast abscesses are uncommon in ______

A

breast feeding women

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8
Q

Breast Abscess is often secondary to

A

mastitis if inadequate treatment

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9
Q

Breast Abscesses can occur in women unrelated to

A

pregnancy and breastfeeding

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10
Q

Breast Abscess is primarily due to

A

extension/ worsening of mastitis
often due to staph aureus
20% MRSA

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11
Q

Breast Abscess clinical presentation

A

similar to mastitis plus palpable fluctuant mass
+/- spontaneous drainage

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12
Q

Breast abscess dx/workup

A

aspiration diagnostic and therapeutic
ultrasound can be used to r/o other lesions
must r/o inflammatory breast cancer

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13
Q

When would you consider bx for a suspected breast abscess

A

mass remains after treatment
fails to improve after 48hrs of treatment
associated lymphadenopathy

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14
Q

Treatment for breast abscess

A

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

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15
Q

Galactocele AKA _______

A

milk retention cyst

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16
Q

Most common lesion in lactating women is

A

Galactocele

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17
Q

Galactocele frequently happen

A

6-10 months after lactation
can occur during lactation as well

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18
Q

Galactoceles occur when

A

thickening of secretions –> obstruction of milk duct –> cystic collection of fluid
rarely become infected

19
Q

Galactocele presentation

A

palpable mass
soft, nontender, mobile
NOT associated with systemic symptoms

20
Q

Best imaging of choice for galactocele

A

US - simple milk cyst or complex mass

21
Q

Definitive dx for galactocele

A

needle aspiration (also therapeutic)

22
Q

Galactocele treatment

A

may resolve on its own - warm compresses
if not –> aspiration
if developes sx of abscess –> antibiotics

23
Q

Fibrocystic disease peaks between (what ages)

A

30-50 years of age

24
Q

Breast cyst pathophysiology

A

mostly related to hormones - overproduction of estrogen, suppression of progesterone
Fibrosis of breast tissue - failure in formation of lobules/ ducts

25
Q

Breast Cyst Clinical Presentation

A

may have cyclic breast tenderness or pain (cyclic mastalgia)
+/- palpable mass depending on size
SHOULD NOT HAVE pain, erythema, discharge, nipple or skin changes

26
Q

Best initial test for breast cyst

A

US - differentiates between cystic and solid
Cystic = round well circumscribed anechoic

27
Q

Using US is better when

A

under 35
better for denser breasts

28
Q

Mammography is better for

A

older than 35
and looks for suspicious calcifications

29
Q

Three different types of breast cysts

A

simple
complicated
complex

30
Q

simple breast cyst consists of what components

A

smooth thin regular walls
completely fluid filled
always benign

31
Q

Complex breast cyst consists of what components

A

irregular or scalloped thick walls
some solid components or debris
may be malignant

32
Q

Complicated breast cyst consists of what components

A

somewhere between simple and complex
some debris but not real solid components no thick walls

33
Q

Breast cyst definitive dx with

A

fine needle aspiration cytology +/- culture
dx and therapeutic

34
Q

Breast cyst treatment:
Simple Type

A

Aspiration
+/- excision if recurrent
no monitoring necessary

35
Q

Breast cyst treatment:
Complicated

A

Aspiration
+/- cytology/ culture
re-image with US or mammogram and/or bx every 6 months x 2 years

36
Q

Breast cyst treatment:
Complex

A

Must do a fine needle aspiration or excisional bx
follow up every 6 months for 2 years

37
Q

Fibrocystic changes have the same pathophysiology as

A

breast cysts - mostly related to hormones –> overproduction of estrogen, suppression of progesterone
Fibrosis of breast tissue - failure in formation of lobules/ ducts

38
Q

Two types of fibrocystic changes

A

non-proliferative
proliferative

39
Q

Non-proliferative changes are when

A

there is no epithelial hyperplasia in ducts
no increase for risk of developing breast cancer

40
Q

Proliferative changes are when

A

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

41
Q

Fibrocystic changes clinical presentation

A

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

42
Q

Dx workup for fibrocystic changes

A

evaluation with mammogram, US, and/or bx for suspicious lesions
mammogram if > 35
breasts too dense if < 35
patients under 35 should get US

43
Q

Fibrocystic Changes treatment

A

reassurance
supportive bra to limit pain
acetaminophen and NSAIDS
symptoms improve at menopause

44
Q

More severe cases of fibrocystic changes treatment

A

metformin? - might reduce cell proliferation
tamoxifen or danazol - hormone modulators

45
Q

Fibroadenoma is the most common

A

benign tumor of the breast

46
Q

Fibroadenomas are usually found in

A

females younger than 30 y/o
commonly found in adolescence - higher rates in women who take OCP before age 20

47
Q

Fibroadenomas are rare after

A

menopause

48
Q

Fibroadenomas are

A

benign tumors of connective tissue - contain estrogen and progesterone receptors, stromal and epithelial cells
etiology unknown - likely related to estrogen

49
Q

Fibroadenoma clinical presentation

A

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

50
Q

Best initial test for fibroadenoma

A

US - differentiates between cystic and solid
will be a well circumscribed uniform solid mass
mammogram if > 35

51
Q

When would you need a core needle biopsy for a suspicious fibroadenoma

A

suspicious lesions
women at high risk
r/o malignancy

52
Q

What testing confirms a fibroadenoma/ treatment

A

bx - no treatment necessary
will shrink overtime
can excise if large - invading other breast tissue
however surgical excision may disfigure other breast tissue

53
Q

Intraductal Papilloma are most common between what ages

A

35-55 years old

54
Q

What is a intraductal papilloma

A

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

55
Q

Intraductal Papilloma clinical presentation

A

if under 35 may be asymptomatic in younger patients
Spontaneous nipple discharge (clear or bloody)
occasionally palpable

56
Q

Intraductal Papilloma workup

A

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)

57
Q

Intraductal papilloma treatment

A

lumpectomy - because they have the ability to be malignant
Surgical excision of entire mass

Woman's Health (13 decks)

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