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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
Most common lesion in lactating women is
Galactocele
17
Galactocele frequently happen
6-10 months after lactation can occur during lactation as well
18
Galactoceles occur when
thickening of secretions --> obstruction of milk duct --> cystic collection of fluid rarely become infected
19
Galactocele presentation
palpable mass soft, nontender, mobile NOT associated with systemic symptoms
20
Best imaging of choice for galactocele
US - simple milk cyst or complex mass
21
Definitive dx for galactocele
needle aspiration (also therapeutic)
22
Galactocele treatment
may resolve on its own - warm compresses if not --> aspiration if developes sx of abscess --> antibiotics
23
Fibrocystic disease peaks between (what ages)
30-50 years of age
24
Breast cyst pathophysiology
mostly related to hormones - overproduction of estrogen, suppression of progesterone Fibrosis of breast tissue - failure in formation of lobules/ ducts
25
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
26
Best initial test for breast cyst
US - differentiates between cystic and solid Cystic = round well circumscribed anechoic
27
Using US is better when
under 35 better for denser breasts
28
Mammography is better for
older than 35 and looks for suspicious calcifications
29
Three different types of breast cysts
simple complicated complex
30
simple breast cyst consists of what components
smooth thin regular walls completely fluid filled always benign
31
Complex breast cyst consists of what components
irregular or scalloped thick walls some solid components or debris may be malignant
32
Complicated breast cyst consists of what components
somewhere between simple and complex some debris but not real solid components no thick walls
33
Breast cyst definitive dx with
fine needle aspiration cytology +/- culture dx and therapeutic
34
Breast cyst treatment: Simple Type
Aspiration +/- excision if recurrent no monitoring necessary
35
Breast cyst treatment: Complicated
Aspiration +/- cytology/ culture re-image with US or mammogram and/or bx every 6 months x 2 years
36
Breast cyst treatment: Complex
Must do a fine needle aspiration or excisional bx follow up every 6 months for 2 years
37
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
38
Two types of fibrocystic changes
non-proliferative proliferative
39
Non-proliferative changes are when
there is no epithelial hyperplasia in ducts no increase for risk of developing breast cancer
40
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
41
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
42
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
43
Fibrocystic Changes treatment
reassurance supportive bra to limit pain acetaminophen and NSAIDS symptoms improve at menopause
44
More severe cases of fibrocystic changes treatment
metformin? - might reduce cell proliferation tamoxifen or danazol - hormone modulators
45
Fibroadenoma is the most common
benign tumor of the breast
46
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
47
Fibroadenomas are rare after
menopause
48
Fibroadenomas are
benign tumors of connective tissue - contain estrogen and progesterone receptors, stromal and epithelial cells etiology unknown - likely related to estrogen
49
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
50
Best initial test for fibroadenoma
US - differentiates between cystic and solid will be a well circumscribed uniform solid mass mammogram if > 35
51
When would you need a core needle biopsy for a suspicious fibroadenoma
suspicious lesions women at high risk r/o malignancy
52
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
53
Intraductal Papilloma are most common between what ages
35-55 years old
54
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
55
Intraductal Papilloma clinical presentation
if under 35 may be asymptomatic in younger patients Spontaneous nipple discharge (clear or bloody) occasionally palpable
56
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)
57
Intraductal papilloma treatment
lumpectomy - because they have the ability to be malignant Surgical excision of entire mass

Woman's Health (13 decks)

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