Benign Conditions of the Breast Flashcards
What is the most common congenital breast abnormality?
Ectopic breast tissue. Most often found on the milk line between axilla and groin. The tissue can be lactational
Breast hypoplasia is seen in what conditions?
Poland’s syndrome.
Turner’s syndrome,
Congenital adrenal hyperplasia
Name some different benign breast conditions
Fibroadenoma
Breast cysts
Mastitis
Intraductal papilloma
Radial scar
Fat necrosis
Fibrocystic breast disease
Mammary duct ectasia
Describe features of a fibroadenoma
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.
What is fibrocystic breast changes?
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.
Describe features of breast cysts
Benign fluid filled lumps which are smooth, well-circumscribed, mobile and fluctant. Occur most often between ages 30-50.
Explain fat necrosis
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.
What is the management of fat necrosis?
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
What are lipomas?
Benign tumours of fat tissue. On examination lipomas are soft, painless, mobile.
What is a galactocele?
- 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.
what are Phyllodes tumours?
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.
What is the presentation of intraductal papillomas?
- Often asymptomatic but can present with nipple discharge (clear or bloodstained), tenderness and a palpable lump
What is the diagnosis of intraductal papilloma?
- Clinical assessment,
- Imaging
- Histology
- Ductography which involves injecting contrast into the duct and performing a mammogram.
What is the management of intraductal papilloma?
Surgical excision. Tissue is then examined for atypical hyperplasia or cancer.
What is mammary duct ectasia?
Dilation of large ducts in the breast that occurs with age. Typically presents with nipple retraction and creamy nipple discharge.
What is the presentation of mammary duct ectasia?
It is dilation of milk ducts >2m
Nipple discharge, tenderness, nipple retraction and breast lump
What are the investigations for mammary duct ectasia?
- Clinical assessment
- Imaging (microcalcifications can be seen on mammogram) only if you suspect malignancy
- Histology
- Others: Ductography, nipple discharge cytology and ductoscopy
What is the most common bacterial cause of mastitis?
S.aureus
What is the presentation of mastitis?
Breast pain and tenderness
Erythema
Local warmth and inflammation
Nipple discharge
Fever
What is the management of mastitis?
Conservative - Continue breastfeeding (it won’t harm baby), heat packs, warm showers, simple analgesia
Medical - Flucloxacillin (fluconazole if candidia).
Surgical - Drainage of breast abscess
Describe features of candida of the nipple
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
What it the treatment for candida of the nipple?
Topical miconazole for nipple after every feed
Oral miconazole or nystatin for baby
What is sclerosing adenosis?
- Spectrum including radial scars and complex sclerosing lesions.
- Presents as a breast lump +/- pain.
- Can mimic carcinoma on mammogram so must be biopsied.
What is diabetic fibrous mastopathy?
Stromal fibrosis which presents as a hard mass. It is associated with type 1 diabetes
Describe features of periductal mastitis
Non-pregnancy, chronic inflammation, mastitis that occurs in women who smoke. Complications include nipple inversion, abscess formation, mammary duct fistula
What is the treatment of puerperal and non puerperal mastitis
Non-puerperal - Metronidazole and flucloxacilin or co-amox (however get swab first)
Puerperal - Fluclox
What is Mondor’s syndrome?
Thrombophebitis in the breast
What is galactorrhea?
Inappropriate and spontaneous milky secretion from the breasts unrelated to pregnancy
What are the causes of galactorrhoea?
Idiopathic
- Prolactinoma (pituitary tumour)
- Drugs such as SSRIs, antiphsycotics
- Metabolic conditions such as hypothyroidism, liver disease, CKD
What is the presentation of galatorrhoea?
- Spontanous milky discharge from nipples
- May also have menstrual irregularities if caused by a prolactinoma
What are the investigations for galactorrhoea?
- Serum prolactin,
- TFTs
- Renal and liver tests
- MRI if prolactinoma is suspected
