Benign Breast Lumps

Question 1

What are common breast lumps

Answer 1

Fibroadenoma
Fibrocystic change
Breast cyst
Breast abscess
Breast calcification
Periductal mastitis

Question 2

What are less common causes of breast lump

Answer 2

Intraductal papilloma
Duct ecstasia
Fat necrosis
Phyllodes
Hyperplasia 
Mondor's 
Sclerosis

Question 3

What is most common in young

Answer 3

Fibroadenoma

Question 4

What is Mondor’s

Answer 4

Thrombophlebitis of veins

Question 5

What causes breast cyst

Answer 5

Common as breast change due to oestrogen + menstrual
Stop after menopause
Common >35-60

Question 6

What do cysts contain

Answer 6

Ducts fill up with clear fluid

Question 7

How do cysts present

Answer 7

Cyclical pain
Lump - soft / hard / fluctuate
Usually oval or round

Question 8

How do you investigate

Answer 8

Triple assessment 
Examination 
USS
Mammogram
FNA if can easily feel 
FNA. / biopsy

Question 9

What does USS show

Answer 9

Fluid

Question 10

What does mammogram show

Answer 10

Halo

Question 11

What do you do if FNA and no blood

Answer 11

No cytology needed

Question 12

When do you send for biopsy / cytology

Answer 12

Indeterminate

Symptomatic

Question 13

What is most common cause of breast lump in all ages

Answer 13

Fibrocystic change
Related to hormonal changes around menstrual cycle
Usually resolves after menopause

Question 14

How does fibrocystic change present and how do you treat

Answer 14

Micro-cyst in breast
Bilateral lumpy breast
Bilateral breast pain / tenderness
Seen on USS

Rx

• NSAID
• Supportive clothing / bra
• Weight loss
• Hormones may worsen so consider stopping

Question 15

What is fibroadenoma

Answer 15

Proliferation of epithelial and stroll elemenets
ONE BREAST LOBULE (not cell)
Hormone dependent
Can present up to menopause

Question 16

How does fibroadenoma present

Answer 16

Cirumscribed freely mobile
Smooth + rubbery
Firm 
Painless - can have pain
Can have multiple

Question 17

What makes fibroadenoma increase in size

Answer 17

Pregnancy

Question 18

How do you investigate

Answer 18

Routine referral for triple asessment
Examine
USS / mammogram
Core biopsy

Question 19

When do you do biopsy and why

Answer 19

If >3cm - also remove 
Exclude phyllodes (FNA can't differentiate)

Question 20

What is intraductal papilloma

Answer 20

Wart like small lump in lactiferous ducts

Epithelial hyperplasia

Question 21

How does it present

Answer 21

Discharge from single duct
Golden rich colour
Can be blood - found on dipstick if test
Middle age

Question 22

How do you Rx

Answer 22

Remove and assess as difficult to tell if malignant or not from triple assessment
Vigilant breast screening

Question 23

What causes fat necrosis

Answer 23

Fibrosis and calcification after trauma = hard lump 
Trauma
Surgery
RT
Biopsy

Question 24

How does fat necrosis present

Answer 24

Firm round fixed lump
Painless
May cause skin dimpling or nipple inversion
May looked bruised / red / dimpled mimc cancer

Question 25

How do you Dx and Rx

Answer 25

Triple assessment to exclude cancer Looks radiologically similar to cancer Histology shows necrotic fat + lipid filled cyst Rx = conservative or surgery

Question 26

What is a lactating adenoma

Answer 26

Enlarging mass in lactation and pregnancy

Question 27

What is a lipoma

Answer 27

Radiolucent common lesion Benign collection of fat Soft, painless and mobile lump up to 20cm

Question 28

What is a galactocele

Answer 28

Milk fluid filled cyst on aspiration due to occlusion of lactiferous duct No pain / systemic Sx which differentiate from abscess

Question 29

When are galactocele common and how do you Dx

Answer 29

Pregnancy Common after cease breast feeding Increased prolactin Can usually be Dx on clinical alone without need for further investigation if clear history

Question 30

When are haematoma in breast common

Answer 30

``` Trauma Biopsy FNA Anti-coagulant Can bleed into nipple ```

Question 31

Can you feel breast calcification

Answer 31

No Radiologist decide if benign or malignant May need biopsy Can mark so know if been dealt with before

Question 32

What do all lumps require

Answer 32

Triple assessment | Biopsy if unsure

Question 33

What is normal LN

Answer 33

<0.5cm

Question 34

What is a skin cyst

Answer 34

Attached to skin NOT breast

Question 35

Polymastia

Answer 35

Extra breast

Question 36

Polythelial

Answer 36

Extra nipple

Question 37

What is Poland syndrome

Answer 37

Chest wall deformity | Absence of pec muscles so unilateral absence of breast

Question 38

Who is fat necrosis more likely I

Answer 38

Obesity

Question 39

How should you image bloody discharge e.g. intraductal papilloma

Answer 39

USS

Question 40

What else can you get

Answer 40

Lipoma Soft and mobile Excision based on patient prefernec e