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Clin Med3: Womens Health > Benign Disorders of the Breast > Flashcards

Benign Disorders of the Breast Flashcards

1
Q

where is most of the breast pathologies located

A

upper outer quadrant

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2
Q

what nodes are most frequently involved with breast cancer metastases

A

axillary nodes (sentinel nodes)

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3
Q

what drives breast development during puberty

A

estrogen

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4
Q

what inhibits milk production

A

estrogen and progesterone

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5
Q

what drives lactation

A

prolactin

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6
Q

what is an infection of the breast

A

mastitis/breast cellulitis

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7
Q

what is the most common pathogen with mastitis

A

S. aureus
alternatively Strep and e.coli

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8
Q

what is the presentation of bastitis

A

typically unilateral
indurated, erythematous, edematous, tender area on breast
fever is common - myalgia, chills and malaise
pain including and beyond indurated area

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9
Q

if persistent mastitis what should be done for further workup (if post partum)

A

culture of midstream milk sample

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10
Q

when are biopsies completed with mastitis

A

palpable mass after infection resolves
repeated recurrence or treatment failure

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11
Q

what is the treatment options for mastitis

A

supportive measures: breastfeeding, bed rest, massage, supportive bra
pain control: Tylenol/anti-inflammatories
ABX

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12
Q

what is the first line antibiotic for the treatment of mastitis

A

dicloxacillin (Diclox) every 6 hrs for 7-14 days

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13
Q

what is the antibiotic for the treatment of mastitis if MRSA suspected of PCN allergy

A

clindamycin (cleocin) 4x/day for 5-14 days

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14
Q

what are risk factors for mastitis

A

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

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15
Q

what are risk factors for breast absess

A

maternal age (>30)
primiparity (first time childbirth)
gestational age 41+ weeks
mastitis

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16
Q

what is a breast abscess

A

primarily extension/worsening of mastitis

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17
Q

what is the primary pathogen with breast abscess

A

s. aureus
20% are MRSA

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18
Q

what is the clinical presentation of breast abscess

A

similar to mastitis
PLUS palpable fluctuant mass
+/- spontaneous drainage

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19
Q

what is the diagnostic test of choice for breast abscess

A

aspiration (diagnostic and therapeutic)

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20
Q

when do we consider biopsy with breast abscess

A

mass remains after treatment
fails to improve after 48 hours of treatment
associated lymphadenopathy
MUST r/o inflammatory breast cancer

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21
Q

what is the treatment of choice for breast abscess

A

drainage (aspiration first) - I&D plus wound packing if fails
many will need ABX - bactrim, clinda, doxy

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22
Q

what is a galactocele

A

milk retention cyst
m/c lesion in lactating women
thickening of secretions-> obstruction of milk duct-> cystic collection of fluid

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23
Q

what is the clinical presentation of galactocele

A

palpable mass
soft, non-tender, mobile
NOT associated with systemic symptoms

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24
Q

what is the test of choice for galactocele

A

US imaging test of choice

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25
Q

what is the definitive diagnostic test for galactocele

A

needle aspiration (also therapeutic)

26
Q

what is the treatment of Galactocele

A

may resolve on its own - warm compress
if not- aspiration
if develop symptoms of abscess - ABX

27
Q

What are breast cysts

A

mostly related to hormones - overproduction of estrogen, suppression of progesterone
fibrosis of breast tissue - failure in formation of lobules/ducts

28
Q

what is the clinical presentation of breast cysts

A

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

29
Q

what is the best initial test of breast cysts

A

US - differentiate between cystic and solid
consider mammography - looks for suspicious calcifications

30
Q

what are the type of breast cysts

A

simple
complicated
complex

31
Q

what are simple breast cysts

A

smooth, thin, regular walls
completely fluid filled
always benign

32
Q

what are complicated breasts cysts

A

somewhere between simple and complex
some debris but not real solid components, no thick walls

33
Q

what are complex breast cycsts

A

irregular or scalloped, thick walls
some solid components or debris
may be malignant

34
Q

what is the definitive diagnostic test for breast cysts

A

FNA - Cytology +/- culture
diagnostic and can be therapeutic

35
Q

what is the treatment of simple breast cysts

A

aspiration +/- excision if recurrent
no monitoring necessary

36
Q

what is the treatment of complicated breast cysts

A

aspiration +/- cytology/culture
re-image (US vs. mammogram) and/or biopsy q6m x 2 years

37
Q

what is the treatment of complex breast cysts

A

must do FNA or excisional biopsy
follow up q6m x 2 years

38
Q

What are fibrotic changes

A

very common
proliferative and non-proliferative

39
Q

what is non-proliferative fibrocystic changes

A

no epithelial hyperplasia in ducts
no increased risk for development of breast cancer

40
Q

what is proliferative fibrocystic changes

A

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

41
Q

what is the clinical presentation of fibrocystic breast changes

A

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

42
Q

how are fibocystic changes worked up

A

mammogram if >35, US and/or biopsy

43
Q

what is the treatment for fibrocystic changes

A

reassurance
supportive bra to limit pain
role of caffeine/chocolate not supported by literature
tylenol/NSAIDs

44
Q

what is the most common benign tumor of the breast

A

fibroadenoma

45
Q

what population if fibroadenomas usually seen in

A

females younger than 30
commonly found in adolescence

46
Q

what are fibroadenomas

A

benign tumors of CT - stromal and epithelial cells
- likely related to estrogen (worsen with pregnancy, shrink after menopause)

47
Q

what is the clinical presentation of fibroadenomas

A

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

48
Q

when can fibroadenomas increase in size

A

pregnancy and exogenous estrogen use

49
Q

what is the best initial test for fibroadenomas

A

US
mammogram if >35

50
Q

what is the treatment of fibroadenomas

A

Biopsy confirms benign fibroadenoma - no tx needed

51
Q

when is excision and histology or cryablation for fibroadenomas necessary

A

uncertain diagnosis
rapid growth
size >2cm
patient request

52
Q

What are intraductal papilloma

A

benign tumor of ductal epithelial cells
solitary or multiple papillomas

53
Q

what are the risk factors for intraductal papilloma

A

contraceptive use
hormonal replacement therapy (HRT)
lifetime estrogen exposure
family hx

54
Q

what age is most common for intraductal papilloma

A

between 35-55yo

55
Q

what is the clinical presentation of intraductal papilloma

A

may be asymptomatic in younger patient - incidental US finding
spontaneous nipple discharge (clear or bloody)
occasionally palpable - primarily multipel papillomas

56
Q

what is the diagnostic test of choice for a patient < 35 yo with concern of intraductal papilloma

A

ultrasound

57
Q

what is the diagnostic test of choice for a patient > 35 yo with concern of intraductal papilloma

A

mammogram

58
Q

what is the definitive diagnostic test for concern of intraductal papilloma

A

core needle biopsy to rule out malignancy

59
Q

what is the treatment for intraductal papilloma

A

lumpectomy
surgical excision of entire mass

60
Q

what are the screening recommendations for mammogram

A

over 40 every other year

Clin Med3: Womens Health (13 decks)

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