Benign Conditions of the Breast

Question 1

What is the most common congenital breast abnormality?

Answer 1

Ectopic breast tissue. Most often found on the milk line between axilla and groin. The tissue can be lactational

Question 2

Breast hypoplasia is seen in what conditions?

Answer 2

Poland’s syndrome.
Turner’s syndrome,
Congenital adrenal hyperplasia

Question 3

Name some different benign breast conditions

Answer 3

Fibroadenoma
Breast cysts
Mastitis
Intraductal papilloma
Radial scar
Fat necrosis
Fibrocystic breast disease
Mammary duct ectasia

Question 4

Describe features of a fibroadenoma

Answer 4

It is a firm, smooth, painless, well circumscribed, mobile breast lump (usually 3cm) which develops from a breast lobule. They respond to female hormones and are more common in younger woman and regress after menopause.

Question 5

What is fibrocystic breast changes?

Answer 5

Generalised lumpiness of the breast which is considered a normal variation. Changes fluctuate with menstrual cycle and can be pain.
Management: Wearing supportive bra, NSAIDs, applying head pat.

Question 6

Describe features of breast cysts

Answer 6

Benign fluid filled lumps which are smooth, well-circumscribed, mobile and fluctant. Occur most often between ages 30-50.

Question 7

Explain fat necrosis

Answer 7

Benign lump formed by localised degeneration and scarring of fat tissue often in response to trauma. It presents as a painless, firm, irregular mass which may be fixed to local structures, may cause skin dimpling.

Question 8

What is the management of fat necrosis?

Answer 8

Imaging may show similar appearance to breast cancer so histology can confirm diagnosis. Treatment is supportive as it should resolve over time. Surgical excision may be required for symptoms

Question 9

What are lipomas?

Answer 9

Benign tumours of fat tissue. On examination lipomas are soft, painless, mobile.

Question 10

What is a galactocele?

Answer 10

• Occurs in woman after they stop breastfeeding. They are breastmilk filled cysts, often go away on their own but may require drainage. They can become infected in which case require abx.

Question 11

what are Phyllodes tumours?

Answer 11

Similar to fibroadenomas but with more mitotic activity, cytological atypia and an infiltrative border (large and fast growing).
They do require surgical excision with a margin of normal breast tissue as some are malignant/borderline. Chemotherapy can be used.

Question 12

What is the presentation of intraductal papillomas?

Answer 12

• Often asymptomatic but can present with nipple discharge (clear or bloodstained), tenderness and a palpable lump

Question 13

What is the diagnosis of intraductal papilloma?

Answer 13

• Clinical assessment,
• Imaging
• Histology
• Ductography which involves injecting contrast into the duct and performing a mammogram.

Question 14

What is the management of intraductal papilloma?

Answer 14

Surgical excision. Tissue is then examined for atypical hyperplasia or cancer.

Question 15

What is mammary duct ectasia?

Answer 15

Dilation of large ducts in the breast that occurs with age. Typically presents with nipple retraction and creamy nipple discharge.

Question 16

What is the presentation of mammary duct ectasia?

Answer 16

Nipple discharge, tenderness, nipple retraction and breast lump

Question 17

What are the investigations for mammary duct ectasia?

Answer 17

• Clinical assessment
• Imaging (microcalcifications can be seen on mammogram) only if you suspect malignancy
• Histology
• Others: Ductography, nipple discharge cytology and ductoscopy

Question 18

What is the most common bacterial cause of mastitis?

Answer 18

S.aureus

Question 19

What is the presentation of mastitis?

Answer 19

Breast pain and tenderness
Erythema
Local warmth and inflammation
Nipple discharge
Fever

Question 20

What is the management of mastitis?

Answer 20

Conservative - Continue breastfeeding (it won’t harm baby), heat packs, warm showers, simple analgesia
Medical - Flucloxacillin (fluconazole if candidia).
Surgical - Drainage of breast abscess

Question 21

Describe features of candida of the nipple

Answer 21

Often occurs after a course of antibiotics. Associated with oral thrush and nappy rash in the infant
Can present with: sore nipples, flaky, cracked and itchy skin. Baby can have white patches in mouth

Question 22

What it the treatment for candida of the nipple?

Answer 22

Topical miconazole for nipple after every feed
Oral miconazole or nystatin for baby

Question 23

What is sclerosing adenosis?

Answer 23

• Spectrum including radial scars and complex sclerosing lesions.
• Presents as a breast lump +/- pain.
• Can mimic carcinoma on mammogram so must be biopsied.

Question 24

What is diabetic fibrous mastopathy?

Answer 24

Stromal fibrosis which presents as a hard mass. It is associated with type 1 diabetes

Question 25

Describe features of periductal mastitis

Answer 25

Non-pregnancy, chronic inflammation, mastitis that occurs in women who smoke. Complications include nipple inversion, abscess formation, mammary duct fistula

Question 26

What is the treatment of puerperal and non puerperal mastitis

Answer 26

Non-puerperal - Metronidazole and flucloxacilin or co-amox (however get swab first)
Puerperal - Fluclox

Question 27

What is Mondor’s syndrome?

Answer 27

Thrombophebitis in the breast

Question 28

What is galactorrhea?

Answer 28

Inappropriate and spontaneous milky secretion from the breasts unrelated to pregnancy

Question 29

What are the causes of galactorrhoea?

Answer 29

Idiopathic
- Prolactinoma (pituitary tumour)
- Drugs such as SSRIs, antiphsycotics
- Metabolic conditions such as hypothyroidism, liver disease, CKD

Question 30

What is the presentation of galatorrhoea?

Answer 30

• Spontanous milky discharge from nipples
• May also have menstrual irregularities if caused by a prolactinoma

Question 31

What are the investigations for galactorrhoea?

Answer 31

• Serum prolactin,
• TFTs
• Renal and liver tests
• MRI if prolactinoma is suspected