Benign Disorders of the Breast Flashcards
where is most of the breast pathologies located
upper outer quadrant
what nodes are most frequently involved with breast cancer metastases
axillary nodes (sentinel nodes)
what drives breast development during puberty
estrogen
what inhibits milk production
estrogen and progesterone
what drives lactation
prolactin
what is an infection of the breast
mastitis/breast cellulitis
what is the most common pathogen with mastitis
S. aureus
alternatively Strep and e.coli
what is the presentation of bastitis
typically unilateral
indurated, erythematous, edematous, tender area on breast
fever is common - myalgia, chills and malaise
pain including and beyond indurated area
if persistent mastitis what should be done for further workup (if post partum)
culture of midstream milk sample
when are biopsies completed with mastitis
palpable mass after infection resolves
repeated recurrence or treatment failure
what is the treatment options for mastitis
supportive measures: breastfeeding, bed rest, massage, supportive bra
pain control: Tylenol/anti-inflammatories
ABX
what is the first line antibiotic for the treatment of mastitis
dicloxacillin (Diclox) every 6 hrs for 7-14 days
what is the antibiotic for the treatment of mastitis if MRSA suspected of PCN allergy
clindamycin (cleocin) 4x/day for 5-14 days
what are risk factors for mastitis
first time nursing
difficulty nursing
blockage of milk duct
oversupply of milk
maternal stress or fatigue (excessive)
illness of mother or child
cracks or nipple sores
what are risk factors for breast absess
maternal age (>30)
primiparity (first time childbirth)
gestational age 41+ weeks
mastitis
what is a breast abscess
primarily extension/worsening of mastitis
what is the primary pathogen with breast abscess
s. aureus
20% are MRSA
what is the clinical presentation of breast abscess
similar to mastitis
PLUS palpable fluctuant mass
+/- spontaneous drainage
what is the diagnostic test of choice for breast abscess
aspiration (diagnostic and therapeutic)
when do we consider biopsy with breast abscess
mass remains after treatment
fails to improve after 48 hours of treatment
associated lymphadenopathy
MUST r/o inflammatory breast cancer
what is the treatment of choice for breast abscess
drainage (aspiration first) - I&D plus wound packing if fails
many will need ABX - bactrim, clinda, doxy
what is a galactocele
milk retention cyst
m/c lesion in lactating women
thickening of secretions-> obstruction of milk duct-> cystic collection of fluid
what is the clinical presentation of galactocele
palpable mass
soft, non-tender, mobile
NOT associated with systemic symptoms
what is the test of choice for galactocele
US imaging test of choice
what is the definitive diagnostic test for galactocele
needle aspiration (also therapeutic)
what is the treatment of Galactocele
may resolve on its own - warm compress
if not- aspiration
if develop symptoms of abscess - ABX
What are breast cysts
mostly related to hormones - overproduction of estrogen, suppression of progesterone
fibrosis of breast tissue - failure in formation of lobules/ducts
what is the clinical presentation of breast cysts
many discovered incidentally
may have cyclic breast tenderness or pain (cyclic mastalgia)
+/- palpable mass depending on size
should NOT have any pain, erythema, discharge, nipple or skin changes
what is the best initial test of breast cysts
US - differentiate between cystic and solid
consider mammography - looks for suspicious calcifications
what are the type of breast cysts
simple
complicated
complex
what are simple breast cysts
smooth, thin, regular walls
completely fluid filled
always benign
what are complicated breasts cysts
somewhere between simple and complex
some debris but not real solid components, no thick walls
what are complex breast cycsts
irregular or scalloped, thick walls
some solid components or debris
may be malignant
what is the definitive diagnostic test for breast cysts
FNA - Cytology +/- culture
diagnostic and can be therapeutic
what is the treatment of simple breast cysts
aspiration +/- excision if recurrent
no monitoring necessary
what is the treatment of complicated breast cysts
aspiration +/- cytology/culture
re-image (US vs. mammogram) and/or biopsy q6m x 2 years
what is the treatment of complex breast cysts
must do FNA or excisional biopsy
follow up q6m x 2 years
What are fibrotic changes
very common
proliferative and non-proliferative
what is non-proliferative fibrocystic changes
no epithelial hyperplasia in ducts
no increased risk for development of breast cancer
what is proliferative fibrocystic changes
some ducts have epithelial hyperplasia
if moderate to severe - 1.5-2.0x higher risk of developing breast CA
if proliferation is atypical - 4-5x higher risk
what is the clinical presentation of fibrocystic breast changes
many asymptomatic
cyclical breast mastalgia is often the presenting symptom - pain
pain exacerbated by menstruation, chocolate and caffeine
cyclical pain, fluctuation in size and multiplicity of lesions help to differentiate these lesion from carcinoma
how are fibocystic changes worked up
mammogram if >35, US and/or biopsy
what is the treatment for fibrocystic changes
reassurance
supportive bra to limit pain
role of caffeine/chocolate not supported by literature
tylenol/NSAIDs
what is the most common benign tumor of the breast
fibroadenoma
what population if fibroadenomas usually seen in
females younger than 30
commonly found in adolescence
what are fibroadenomas
benign tumors of CT - stromal and epithelial cells
- likely related to estrogen (worsen with pregnancy, shrink after menopause)
what is the clinical presentation of fibroadenomas
often discovered by accident
usualyl solitary but can be multiple
may occur bilaterally
typically in upper outer quadrant
round, discrete, mobile, painless mass
rubbery consistency
usually around 1-5cm in diameter
when can fibroadenomas increase in size
pregnancy and exogenous estrogen use
what is the best initial test for fibroadenomas
US
mammogram if >35
what is the treatment of fibroadenomas
Biopsy confirms benign fibroadenoma - no tx needed
when is excision and histology or cryablation for fibroadenomas necessary
uncertain diagnosis
rapid growth
size >2cm
patient request
What are intraductal papilloma
benign tumor of ductal epithelial cells
solitary or multiple papillomas
what are the risk factors for intraductal papilloma
contraceptive use
hormonal replacement therapy (HRT)
lifetime estrogen exposure
family hx
what age is most common for intraductal papilloma
between 35-55yo
what is the clinical presentation of intraductal papilloma
may be asymptomatic in younger patient - incidental US finding
spontaneous nipple discharge (clear or bloody)
occasionally palpable - primarily multipel papillomas
what is the diagnostic test of choice for a patient < 35 yo with concern of intraductal papilloma
ultrasound
what is the diagnostic test of choice for a patient > 35 yo with concern of intraductal papilloma
mammogram
what is the definitive diagnostic test for concern of intraductal papilloma
core needle biopsy to rule out malignancy
what is the treatment for intraductal papilloma
lumpectomy
surgical excision of entire mass
what are the screening recommendations for mammogram
over 40 every other year
