Benign Breast Disorders Flashcards
Fibroadenoma big 5
Etiology: benign growth
Epidemiology: women < 30
Patho: excessive CT growth
H+P: mass = firm, smooth and rubbery, does NOT change with menstrual cycle
Dx: US initially, biopsy to confirm (not always done)
Tx: observation, surgical excision/removal if symptomatic or large
Breast cyst big 5
Etiology: fluid filled sacs, often hormonal
Epidemiology: women aged 35-50
Patho: blocked breast glands
H+P: mass = palpable, smooth, and mobile, +/- tenderness
Dx: US = first line (findings: hypoechoic, fluid filled, well demarcated mass)
Tx: oftentimes no treatment, aspiration if symptomatic
Fibrocystic changes big 5
Etiology: hormonal fluctuations cause a constellation of breast changes
Epidemiology: women aged 20-50
Patho: cysts and fibrosis in breast tissue
H+P: mass = lumpy, tender, fluctuates with cycle
Dx: mostly clinical, imaging often not needed
Tx: nothing, if pt is symptomatic, can use hormonal therapy
Fat necrosis big 5
Etiology: post surgery or breast injury
Epidemiology: anyone w a history of breast surgery or trauma is at risk
Patho: healing after event causes necrosis and fibrosis
H+P: mass = firm, non-tender/painless, non-mobile
Tx: none unless it is causing discomfort
Galactocele big 5
Etiology: milk filled cyst that arises post lactation
Epidemiology: post partum women
Patho: milk retention in ducts
H+P: soft, fluctuant lump, +/- pain
Dx: US, aspriation/biopsy to confirm
Tx: usually self resolves, aspiration drainage if it doesn’t
Lactation mastitis big 5
Etiology: lactating women usually during early lactation (4-6 weeks into breastfeeding)
Epidemiology: anyone who is lactating
Patho: ductal narrowing leads to milk retention –> swelling, edema, and inflammation, and compression of other milk ducts –> stagnant milk becomes infected with bacteria –> infection travels to surrounding breast tissue
H + P: localized swelling and pain, redness; systemic complaints = myalgia, chills, malaise
Dx: mostly a clinical dx
Tx: abx (dicloxacillin or cephalexin if no MRSA risk), continue breast feeding (gets rid of infected milk), warm compress
Breast abscess big 5
Etiology: complication of lactation mastitis (3-11% of cases)
Patho: infected fluid retention
H+P: palpable, tender and well defined fluctuant area of breast
Dx: ultrasound
Tx: abx, US guided drainage
Classifying mastalgia
Cyclic - changes in breast pain concordant with menstrual cycle
Non-cyclic - changes in breast pain do NOT follow menstrual cycle
Extramammary - referred breast pain from some other source (GI, MSK, pulm, etc,)
Cyclic myalgia source associations
Hormonal or menstrual cycle source
Noncyclic myalgia source associations
Meds, infection, trauma, tumors, ligamental pain
Mastalgia workup: what is the first step in working up a patient with breast pain?
Physical exam to look for any palpable masses
Management of a pt with mastalgia and palpable mass?
US or mammogram (depending on age), specialist referral
Management of pt with cyclic mastalgia and no palpable mass?
No imaging recommended (low likelihood of cancer), enact pharmacologic (NSAIDs, Tamoxifen, Goserelin if refractory to other meds) and non-pharmacologic (counsel and educate, reduce stress and anxiety, check bra fit) interventions
Management of a pt with noncyclic mastalgia and no palpable mass?
If pain is FOCAL:
- Targeted US in pts under 30
- Diagnostic mammo AND targeted US if pt is > 30
If pain is NONFOCAL:
- No imaging if pt is < 40 OR has no risk factors
- Diagnostic mammo if pt > 40 OR has risk factors
T or F: new masses, visible or palpable changes, nipple discharge, or imaging changes SHOULD always be evaluated
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