Benign Breast Lumps

Question 1

Abnormalities of normal development and involution 
What
Symptoms 
Who
How

Answer 1

Spectrum of proliferative and regressive changes within the breast
-cyst formation
-epitheliosis
-fibroadenosis
Areas of general or focal nodularity
Gameloic acid relieves cyclic symptoms in 50%
Danazol or bromocripine for more severe pain 70%

Men:

• Young hormone related
• old-> digoxin, spiranolactone, cimetidine, cirrhosis

Question 2

Fibroadenosis 
What 
Symptoms 
Who
How

Answer 2

Normal hormone reaction 
Single lump which is discrete and mobile or area of lumpiness
Painful and tender premenstrually 
35-45y 
>35 mammogram

Question 3

Cyst formation 
What 
Symptoms 
Who 
How

Answer 3

Develop from lobules in response to hormones -> flatten epithelium, may under go apocrine metaplasia 
Single lump
-smooth
-round
-tense
-fluctuant
May be tender
>40 and peri menopausal
Aspirated, should not be blood stained, lump disappears
Mammography and USS
Reassess if suspicious

Question 4

Fibroadenoma 
What
Symptoms 
Who
How

Answer 4

Arise from a single lobule and are made up of epithelial and fibrous cell proliferation
Undergo involution in peri menopausal years 85-90%
Single lump
-firm
-rounded
-mobile
-rest normal
-1-4cm
15-30y
Afro Caribbean
Triple asses and reassure *investigate if large

Question 5

Duct papilloma
What
Symptoms
How

Answer 5

Localised areas of epithelial proliferation
Usually solitary in main lactiferous duct
Not premalignant
Spontaneous blood stained or clear water discharge from a single duct
Rest of breast normal
Excise the duct-> diagnose and treat

Question 6

Traumatic fat necrosis
What
Symptoms
How

Answer 6

Trauma to breast causes bruising-> inflammatory response results in fibrosis 
Lump
-hard
-irregular
-skin dimpling
Pain
Resolves with time

Question 7

Mastitis 
What
Symptoms 
Who
How

Answer 7

Lactation related:

• staph aureus
• segmental pain
• cracked nipple
• retention of secretions may predispose

Periductal

• via bloodstream
• tender area on areolar
• diffuse cellulitis or abcess
• local or systemic infection
• smoking/diabetes

Antibiotics and aspiration
Biosylmamogram
Can destroy breast tissue if not treated early

Question 8

Duct ectasia 
What
Symptoms
Who
How

Answer 8

Dilation and shortening of major lactiferous ducts in exaggeration of normal process around menopause 
Spontaneous multiple duct discharge
- creamy to blue green
-often bilateral
Nipple retraction
Lumpiness/palpable mass
Eczematous changes 
May rupture causing chronic inflammation 
Mammogram if >35
Reassure or remove ducts