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PC Ado > Benign breast DOs > Flashcards

Benign breast DOs Flashcards

1
Q

Types of benign breast disorders

A

asymmetry, fibroadenoma, fibrocystic changes, gynecomastia

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2
Q

Composition of the breast

A

A ducts

B lobules

C dilated section of duct to hold milk

D nipple

E fat

F pectoralis major muscle

G chest wall/rib cage

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3
Q

Is breast asymmetry “normal”?

A

Normal for some female adolescents and women to exhibit a moderate amount of breast asymmetry

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4
Q

What counseling can you give to an adolescent w/breast asymmetry?

A

Reassurance
75% resolves by adulthood

always ask if they’re concerned – they won’t tell you.

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5
Q

What is a fibroadenoma?

A

Benign mass which develops from the ducts and stroma of the terminal portion of the mammary system

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6
Q

What causes a fibroadenoma?

A

unknown, probably abnormal sensitivity to estrogen

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7
Q

What can you counsel adolescents about fibroadenoma - incidence and timing?

A
  • Most common breast mass (56-94% of all)
  • Peak incidence 17-20 years

May see younger if they got period earlier

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8
Q

Characteristics of a fibroadenoma

A
  • Asymptomatic rubbery, firm, non-tender
  • freely mobile
  • clearly demarcated
  • oval or irregularly shaped
  • enlarges slowly over weeks to months
  • unilateral, 25% bilateral (not exact location)

“like a grape”

not under areola

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9
Q

DDx for fibroadenoma

A
  • Juvenile (giant) fibroadenoma
  • other fibroadenoma variants
  • breast cysts variation w/cycle
  • fibrocystic change
  • virginal hyperplasia
  • breast abscess or mastitis uncommon w/teens unless bfing or piercing. Signs of inflammation, not clearly demarcated.
  • cystosarcoma phylloides
  • adenocarcinoma
  • intraductal papilloma
  • fat necrosis
  • lipoma
  • hematomapainful, +/- bruising, Hx of trauma, not clearly demarcated
  • gynecomastia
  • mestastatic disease (leukemia, lymphoma, ovarian cancer)
  • Miscellaneous:
  • mammary duct ectasia
  • nipple adenoma
  • interstitial (parenchymal)fibrosis
  • ductal adenocarcinoma
  • nipple keratoma
  • intraductal granuloma
  • sclerosing adenosis
  • angiosarcoma
  • dermatofibromatosis
  • neurofibromatosis
  • tuberous mastitis
  • hemangioma
  • papilloma sarcoidosis
  • granular cell myoblastoma
  • lymphangioma
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10
Q

MGMT of fibroadenoma in an adolescent

A
  • Reassure that incidence of breast cancer is < 1% in females <20 years old - take it seriously nonetheless!
  • < 3 cm - measure and observe mass 2-4 months

If remains unchanged 4-6 months or enlarges excision can be performed – caution: no guarantee won’t get another. Consult on scars.

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11
Q

fibroadenoma: what will you see on U/S?

A

U/S will show smooth margins, hypoechoic and homogeneous

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12
Q

What are fibrocystic changes to the breast?

A

Firm, mobile cord-like nodularities diffusely throughout breasts

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13
Q

Etiology of fibrocystic changes

A

estrogen excess, progesterone deficiency, increased prolactin levels

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14
Q

In what population are fibrocystic changes more common?

A

caucasian females

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15
Q

Characteristics of fibrocystic changes

A
  • Premenstrual tenderness
  • change in breast size during cycle
  • cord-like nodularities and cysts with a hx of enlarging and resolving during cycle
  • nodules or lumps have a vague outline
  • upper outer quadrant most common area affected, can happen anywhere in breast
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16
Q

DDx for fibrocystic changes

A
  • Physiological mastodynia
  • Simple breast cysts

Breast tenderness: consider teens never get fitted for bras. Pay attention to lines and where their pain is. Tell them to get measured by pro, or if they won’t go to YouTube.

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17
Q

MGMT of fibrocystic changes

A
  • Watch over the course of several cycles
  • heat
  • firm supporting brassiere
  • mild analgesics (Ibuprofen)
  • low dose OCPs consistent E and P throughout cycle, so fewer hormonal fluctuations
18
Q

Pt has “bump” on breast. Noticed over weekend. What would you want to ask?

A

Having period now? Change with cycle? OCPs? Pain - before or after you discovered it (may be poking often). Discharge? Trauma? Sx inflammation? FHx BC or fibrocystic changes? What are you worried it is?

19
Q

Gynecomastia: what is it?

A
  • Visible & palpable breast tissue development of males
20
Q

Gynecomastia: size

A

May be as small as 1 cm and disc-like or as large fully developed female breast

21
Q

gynecomastia: etiology

A
  • Etiology unknown, probably related to increasing testosterone levels and the balance between estrogen and testosterone levels
22
Q

Gynecomastia vs obesity - how can you tell the difference?

A
  • Feels very different from obesity – glandular tissue feels like “uncooked chicken” – rubbery & firm*
  • Can’t tell by looking- must palpate and measure.*
23
Q

What are the types of gynecomastia?

A

Type I, Type II, Type III

24
Q

How much of gynecomastia falls under Type I?

A

60-70%

25
Q

When does Type I gynecomastia occur?

A

Tanner III-IV genital development

26
Q

Describe Type I gynecomastia

A

transient

small disk-like subareola mass
tender

nipple pain from rubbing (t-shirts, sports)

rarely discharge

27
Q

Prognosis for Type I gynecomastia

A

resolves spontaneously within months-yrs

28
Q

Type I gynecomastia w/discharge. What should you check?

A

Some boys want to check / squeeze to get rid of - ask if they do this.. Raises oxytocin / prolactin –>galactorrhea.

Still, get Prolactin level

29
Q

Describe Type II gynecomastia

A

Breast nodules beneath areola but also extending beyond the areolar perimeter

30
Q

Describe Type III gynecomastia

A
  • “macromastia”
  • much more distressing degree of development
  • Tanner III or greater of female development
31
Q

Incidence of Type III gynecomastia

A

incidence 4.5% (of those w/gynecomastia, not overall)

32
Q

Cause of Type III gynecomamastia

A

cause idiopathic, must R/O other causes

33
Q

DDx for gynecomastia

A
  • very long. Some big ones -
  • familial gynecomastia ask dad, + progression
  • Klinefelter’s syndrome always check testes if gynec, e.g., flat m&ms
  • androgen insensitivity
  • thyroid dysfunction
  • cirrhosis of the liver
  • male pseudohermaphroditism
  • Meds!
34
Q

Gynecomastia: what should you do on PE?

A
  • Measurement of breast size – N-S, E-W
  • breast vs adipose tissue – second opinion!
  • HT, WT, BMI
  • blood pressure
  • sexual maturity rating
  • evaluation of genital and testicular size
35
Q

Gynecomastia: what lab tests should you do?

A
  • Karyotype and testosterone level (Klinefelter / psuedohermaphroditism)
  • Prolactin (increased likely tumor)
  • hCG (u/s, likely mass)
  • Thyroid fx tests (high T4 low TSH=hyperthyroid)
  • LH, serum testosterone, estradiol (all normal=idiopathic gynecomastia)
36
Q

MGMT of gynecomastia

A

Management

  • REASSURANCE!!!
  • Counseling for body image issues
  • cosmetic surgery

Talk about practical issues – how can change in gym, navigate problem solving like in “shirts and skins” etc

37
Q

How would you describe fibroadenoma and its mgmt to an ado?

A

fibroadenomas are very common. While we need to continue to monitor it, it is nothing we are very worried about. They are not cancer and do not cause cancer. Fibroadenomas are likely caused by sensitivity to estrogen, which is one of the hormones in your body that helps you develop into a woman. If the fibroadenoma becomes larger than 4-6cm, or is very bothersome to you, we could explore excision (cutting it out)

38
Q

How would you describe fibrocystic changes and their mgmt to an ado?

A

These feel like movable cords in your breast, and are caused by levels are your hormones that are either too high or too low. Because they are related to hormone levels, the pain from them can change during your period (when your hormone levels are changing). These are very normal to get, and while we will continue to monitor them, we are not worried about them causing cancer or anything dangerous. If there is pain you can use heating pads on your breast, take ibuprofen, and make sure you have a bra that fits well (you can go get a bra fitting for free at Victoria’s Secret, etc). We could also look at a birth control pill that might help you with some of the pain/sxs.

39
Q

How would you describe gynecomastia and its mgmt to an ado?

A

I know this is hard for you. A lot of boys have this and many times it goes away on its own. Do you know if your father had this? If so, it might be helpful to ask him…if his went away yours is likely to go away. While we don’t know the exact cause, it is likely caused by an imbalance in estrogen and testosterone in your body. How is this impacting your life – assess for counseling needs…. Treatment we will watch and wait and hope that this gets smaller as you continue to grow. If it bothers you very severely we can explore removal options through surgery, but that would need to be after some time…

40
Q

Describe the proper technique for performing a breast self-exam to an adolescent patient and explain to the adolescent why it is important.

A
  • 1x month
  • 7-10 days after period ends (not before - may have swelling and tenderness)
  • looking and feeling - circular motions armpit - clavicle - top of abdomen
  • Use mirror so you can see your whole chest – look at size and shape, and skin texture both with arms down and then with arms up
  • Here you go: https://www.youtube.com/watch?v=yw8Gx2LKWhA

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