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Benign breast lesions Flashcards

1
Q

What is the embryological origin of benign breast lesions?

A

Ectodermal mammary ridge (groin to axilla)

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2
Q

What is the surface anatomy of the breasts?

A

2nd to 6th rib MCL

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3
Q

How many lobes does the breast consist of?

A

15-20 lobes

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4
Q

Name the breast nerves

A

Pectoralis
Long thoracic
Thoracodorsal

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5
Q

What is the function of the Montgomery glands?

A

Lubrication at the nipple area

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6
Q

Discuss the microscopy of the breast

A

A network of thousands of terminal ductal lobular units per lobe which lead to the lactiferous sinus and drain to the nipple

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7
Q

Name the cells of the breast

A 
Ductal epithelial
Acinar milk 
Secreting cells
Myoepithelial cells
Stem cells
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8
Q

What are the interpectoral lymph nodes also known as?

A

Rotter’s lymph nodes

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9
Q

Name the 5 groups of axillary breast lymph nodes

A 
Apical (subclavicular)
Central
Anterior (pectoral/external mammary)
Lateral (brachial)
Posterior (subscapular)
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10
Q

Name the non-axillary breast lymph nodes

A

Parasternal (internal mammary)

Infraclavicular (deltopectoral)

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11
Q

Where is the sentinel lymph node usually located in the breast?

A

External mammary group

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12
Q

How is the lobule different to the interlobular stroma?

A

Interlobular stroma contains larger breast ducts, blood vessels and fat

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13
Q

Describe normal breast development

A
  1. Prepubertal
  2. Pubertal (9-12yo)
  3. Menarche (12-13yo)
  4. Post-pubertal
  5. Pregnancy
  6. Menopause (40-55yo)
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14
Q

Describe normal prepubertal breast development

A
  • dense fibrous tissue with scattered epithelial lined ducts
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15
Q

Describe normal pubertal breast development

A
  • develop pubic hairs
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16
Q

Describe normal breast development in menarche

A
  • menstruation begins under pituitary gonadotropins -> increased oestrogen
  • oestrogen causes new ducts to elongate and branch (thelarche)
  • visible breast buds
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17
Q

Describe normal postpubertal breast development

A
  • mature breast that undergoes cyclical changes under hormonal stimulation
  • hypertrophy predominates
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18
Q

Describe normal breast development in pregnancy

A
  • formation of new TDLU
  • breast enlargement
  • less fibrous tissue
  • increased blood flow
  • milk production
  • areolar pigmentation
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19
Q

Describe normal breast development in menopause

A
  • ovarian function ceases
  • breast involution and decreased epithelial elements
  • increased fat
  • TLDUs disappear
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20
Q

Define ANDI

A

Aberration in the Normal Development and Involution of breasts

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21
Q

When can ANDI occur?

A
  1. Development
  2. Cyclical change
  3. Epithelial activity
  4. Pregnancy
  5. Lactation
  6. Involution
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22
Q

Define fibrocystic breast disease

A

A spectrum of clinical, mammographic and histological findings due to exaggerated stromal and epithelial response to circulating hormones and local growth factors

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23
Q

What is the pathology in fibrocystic breast disease?

A

Microcysts
Macrocysts
Solid elements (adenosis, sclerosis, epithelial metaplasia, hyperplasia)

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24
Q

Classify hyperplasia in fibrocystic breast disease

A
  1. Non-proliferative
  2. Proliferative without atypia
  3. Proliferative with atypia
  4. Combination
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25
Q

What is the pathogenesis of breast cysts?

A

Destruction and dilation of lobules and terminal ducts influenced by ovarian hormones (vary with menstrual phase and decline with menopause)

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26
Q

Name the clinical features of breast cysts

A

Palpable mass

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27
Q

Discuss the management of breast cysts

A

U/S

Aspiration for cytology

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28
Q

Define a fibroadenoma

A

A benign, solid stromal and epithelial tumour

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29
Q

How are fibroadenomas classified?

A 
<5cm = juvenile fibroadenoma  
>5cm = giant fibroadenoma
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30
Q

Name the clinical features of breast fibroadenoma

A

<30yo (common in teenagers)

Firm, mobile mass (breast mouse)

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31
Q

Discuss the management of fibroadenomas

A

Reassure
Excise if
- increasing size
- patient request

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32
Q

Define a phyllodes tumour

A

Biphasic proliferation of stromal connective tissue and mammary epithelium

33
Q

What was the historical name of phyllodes tumour and why did it change?

A

Cystosarcoma phyllodes

  • 90% are benign
  • 10% are malignant
34
Q

Discuss the classification of phyllodes tumour

A

Based on increased cellularity, margin invasion and sarcomatous appearance

  1. Benign phyllodes
  2. Intermediate/borderline phyllodes
  3. Frankly malignant phyllodes
35
Q

Describe a benign phyllodes tumour under the classification

A

Firm, lobulated mass usually >5cm
Similar histology to fibroadenoma but whorled stroma have larger clefts lined with epithelium and resemble leaf-like structures
Increased cellularity than fibroadenoma
Very few mitosis

36
Q

Discuss the management of a benign phyllodes tumour

A

Triple assessment
Mammogram
Biopsy (Trucut preferred over FNAB)
Excise and F/U for >2 years

37
Q

Describe an intermediate phyllodes tumour under the classification

A

> cellularity

> mitosis

38
Q

Discuss the management of an intermediate phyllodes tumour

A

Wide excision with 1cm margin

Strict F/U

39
Q

Describe a malignant phyllodes tumour under the classification

A

Pronounced cellular atypia
Higher mitotic rate
Stromal overgrowth
Hematogenous metastases

40
Q

Where do malignant phyllodes tumors metastasize to?

A

Lung
Mediastinum
Abdominal viscera
Bone

41
Q

Discuss the management of a malignant phyllodes tumour

A 
Mammogram
U/S
Biopsy (Trucut preferred) 
Metastatic workup 
Mastectomy
Radiotherapy
Chemotherapy
- cyclophosphamide
- vincristine
- dacarbazin 
- imatinib (in trials)
42
Q

How does a malignant phyllodes tumour appear on U/S?

A

Discrete structure with cystic spaces

43
Q

What do you need to establish concerning nipple discharge?

A
  1. Unilateral vs bilateral
  2. Single vs multiple duct
  3. Colour (bloody, milky, purulent)
44
Q

Define a galactocele

A

A milk-filled cyst due to obstruction by inspissated milk usually 6-10m after breastfeeding

45
Q

Discuss management of galactoceles

A

Aspiration

Excision

46
Q

Give the aetiology of traumatic fat necrosis

A

Trauma
Surgery
Radiotherapy

47
Q

Name the two types of traumatic fat necrosis

A

Type 1: Elderly ecchymosis

Type 2: Young, cystic and tender

48
Q

How does a type 1 traumatic fat necrosis appear on mammography?

A

Resembles a carcinoma

49
Q

How does a type 2 traumatic fat necrosis appear on mammography?

A

Translucent cystic masses

50
Q

Discuss the management of type 1 traumatic fat necrosis

51
Q

Discuss the management of type 2 traumatic fat necrosis

A

Triple assessment

Excision w/wo histology

52
Q

Which micro-organism is common in lactational abscess?

A

Staphylococcus aureus

53
Q

Name the clinical features of lactational abscess

A

Swollen
Tender
Erythematous

54
Q

Discuss the management of a lactational abscess

A

Nipple hygiene
Flucloxacillin
I&D

55
Q

Which micro-organism is commonly involved in non-lactational abscess

A

Mixed aerobic and anaerobic

56
Q

Name the clinical features of non-lactational abscess

A

Smoker/diabetic
Skin/nipple retraction (chronic)
Subareolar fistula
Mass due to infection

57
Q

Discuss the management of non-lactational breast abscess

A

Antibiotics
Emotional/psychological support
I&D
Biopsy/excise abscess wall

58
Q

Name the types of TB breast and their cause

A 
Primary
Secondary
- retrograde lymphatic spread from the lungs 
- infant suckling with infected tonsils
- rarely from bones and joints
59
Q

Name the clinical features of TB breast

A

Breast abscess
Nipple discharge
May mimic breast carcinoma

60
Q

Discuss the management of TB breast

A

U/S guided needle biopsy

RIPE treatment

61
Q

Name the types of mastalagia

A

Cyclical

Non-cyclical

62
Q

Discuss the aetiology of cyclical mastalgia

A

Ovarian hormones 3-7d before and with menstruation

Relieved by menopause

63
Q

Discuss the aetiology of non-cyclical mastalgia

A

Complex hormonal

Caffeine

64
Q

Discuss the management of non-cyclical mastalgia

A 
Pain chart
NSAIDs
Evening primrose oil
If severe
- Danazol
- Bromocriptine
- Tamoxifen
65
Q

Name causes of gynecomastia

A

Idiopathic
Physiological
Pathological

66
Q

What is the pathology of gynecomastia?

A

Ductal and stromal hyperplasia

67
Q

Name pathological causes of gynecomastia

A
  1. Endocrine tumours
    - adrenal
    - leydig cell
    - pituitary
  2. Non-endocrine tumours
    - bronchial carcinoma
    - lymphoma
  3. Hepatic disease
    - cirrhosis
    - haemochromatosis
  4. Drugs
    - oestrogen
    - ARVs
    - cimetidine
  5. Primary testicular failure
    - anorchia
    - cryptorchidism
    - mumps orchitis
  6. Secondary testicular failure
    - hypopituitarism
    - GnRH
68
Q

Discuss the triple assessment

A
  1. Clinical
  2. Imaging
  3. Biopsy
69
Q

Name receptors found on breast biopsy

A

ER
PR
HER2
Ki67

70
Q

Define solitary papillomas

A

Polyps of epithelial lined breast ducts

71
Q

Describe the locations of solitary papillomas

A

Close to areola
Usually <1cm but can grow to 5cm
Lining cysts
Lining expanded ducts

72
Q

Is there an increased risk of cancer in solitary papillomas?

73
Q

What clinical feature of solitary papillomas is noteworthy?

A

Bloody nipple discharge

74
Q

Discuss the management of solitary papillomas

A

Microdochectors

75
Q

In which population group does papillomatosis usually occur?

A

Younger women

76
Q

Define papillomatosis

A

Hyperplastic epithelium in ducts w/o stalk-like polyps

77
Q

Define sclerosing adenosis

A

Increased TDLUs associated with stromal proliferation

78
Q

Discuss the appearance of sclerosing adenosis on mammography

A

Calcium deposition similar to cancer due to irregular speculation in surrounding stroma
But no significant cancer risk!

79
Q

Define a radial scar

A

A group of complex sclerosing lesions with moderate risk of breast cancer

  • microcysts
  • hyperplasia
  • adenosis
  • central sclerosis

MBChB Surgery (38 decks)

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