Benign Disorders of the Breast

Question 1

• usually incidental finding
• seen only on mammogram
• if biopsy is indicated, sterotactic biopsy

Answer 1

Breast calcifications

Question 2

• either palpable or seen on screening mammogram
• diagnostic mammography if over age 30
• targeted ultrasound in all women

biopsy- ultrasound guided most common
* cancer- refer to surgeon
* fibroadenoma (or other benign mass- monitor vs excision
* cyst- monitor vs aspiration if symptomatic
* abscess- treat with antibiotics; surgical referral if needed

Answer 2

Breast mass

Question 3

• spontaneous vs. elicited
• milky, serous, bloody, clear
• women over 30 evaluated by diagnostic and retro-areoular ultrasound
• most are of benign etiology
• 95% is related to benign etiologies such as papilloma or duct ectasia
• referral to surgeon for duct excision if it impacts
• persisent, spontaneous, single-duct most concerning

Answer 3

Nipple Discharge

Question 4

• diffuse or focal
• unilateral or bilateral
• cystic or noncystic
• Trial of NSAIDs and symptomatic care
• tamoxifen 10mg for 3 months if pain is severe and persistent
• often cause is not known- can have hormonal influence

Answer 4

breast pain

Question 5

• History of nipple discharge or abnormal imaging
• usually not palpable
• diagnosed by core biopsy
• surgical referral for consideration of excision

Answer 5

intraductal papilloma

Question 6

• palpable or incidental imaging finding
• often smooth and mobile on exam
• ultrasound gives definitive diagnosis
• benign
• aspirated only if symptomatic, surgery rare

Answer 6

Breast cysts

Question 7

• breast tenderness, pain and/or swelling
• breast feel lumpy or rope-like
• areas of hardness or thickening
• changing size of lumps with menstruation
• most common in women 20s to 50s

Answer 7

Fibrocystic Breast changes

Question 8

tx of fibrocystic breast changes?

Answer 8

• NSAIDs
• heat
• reduce caffeine
• supportive bra- avoid underwire bras
• tamoxifen 10mg for 3 months if severe

Question 9

• Palpable or incidental imaging finding
• smooth and mobile exam
• probable diagnosis by ultrasound supported by clincial findings
• close monitoring for stability over 2 years
• if any question, biopsy
• surgical excision only if increasing in size or bothersome

Answer 9

Fibroadenoma

Question 10

• breast becomes painful, swollen and red
• most common in the first three months of breastfeeding
• 2 to 10 percent prevalence
• risk factors: hx of mastitis, blocked duct, cracked nipples, use of nipple cream using a breast pump
• most caused by staph. aureus

Answer 10

Lactational mastitis

Question 11

• inflammatory condition of subareolar ducts
• primary affects young women but can occur in men as well
• the majority of patients with are smokers

Answer 11

nonlactational mastisis

(also known as periductal mastitis)

Question 12

• rare benign inflammatory breast disease of unkown etiology
• most often in parous young women
• may be inflammatory breast mass or multiple simultaneous areas of peripheral infection with abscess and/or overylying skin inflammation and ulceration
• self-limiting condition that resolves slowly (can take 12 mos)
• tx: antibiotics, steroids, may refer to inf. disease or rheum.
• surgery not indicated

Answer 12

granulomatous mastitis

Question 13

• mastitis can progress to this condition
• tender fluctuant area
• retro areolar are often associated with smoking
• use of ultrasound to diagnose
• aspiration if possible
• antibiotics
• counsel about smoking cessation

Answer 13

breast abscess

Question 14

• rapid onset and progression
• red to purple discoloration of skin
• skin thickening (peau d’ orange)
• induration
• in any women with mastitis
• skin punch biopsy

Answer 14

inflammatory breast cancer