Benign Neoplasms

Question 1

fibroadenoma is common in which age group?

lumps are often described as what?

Answer 1

<30 years

‘breast mouse’ - non-tender highly mobile lump

Question 2

is there an increase in risk of malignancy in fibroadenoma?

Answer 2

No

Question 3

Tx of fibroadenoma?

Answer 3

if >3cm = surgical excision

if very large = mastectomy

Question 4

difference between fibrocystic change + fibroadenoma in terms of the following:

1) age range
2) lump features?
3) pathology
4) pain?

Answer 4

1) fibrocystic = 30-50 (rare in extremes of age)
fibroadenoma = <30
2) fibrosis = irregular, cysts = hard, smooth, painful mobile lump
fibroadenoma = hard, smooth and highly mobile
3) fibrocystic = thickening of breast tissue +/- cysts
fibroadenoma = benign tumour

Fibroadenoma = painless lump  
fibrocystic = painful

Question 5

painless lump with eczematous changes?

Answer 5

Paget’s disease of the breast - intraductal carcinoma associated with a reddening and thickening (may resemble eczematous changes) of the nipple/areola

Question 6

What is duct ectasia?

most common at what age?

present?

Answer 6

dilatation of the large breast ducts

menopausal women

tender lump around areola with green discharge

Question 7

what is duct papilloma?

presents with?

age group?

Tx?

Answer 7

benign - epithelial proliferation in large mammory ducts

blood stained discharge + painless mass if large

young pts

microdochectomy (surgical excision of duct)

Question 8

breast abscess common in whom?

infection caused by what bacteria?

Tx?

Answer 8

Lactating women (lactational mastitis)

Staph aureus

Abx + US guided aspiration
Overlying skin necrosis is indication for surgical debridement

Question 9

Acute Bacterial Mastitis vs Periductal Mastitis

1) Pathology?
2) age range?
3) chronic painful lump w/ cellulitis w/ nipple discharge
4) acute painful lump during breastfeeding w/ no nipple discharge

Answer 9

1) acute bacterial: infective process (lactational or non-lactational)
periductal: inflammatory process
2) acute bacterial: 20-40
periductal: premenopausal women
3) periductal mastitis
4) acute bacterial mastitis

Question 10

Tx for acute bacterial mastitis?

if left untreated?

Answer 10

Flucloxacillin 10-14 days

Abscess (requiring incision + drainage)

Question 11

How many breastfeeding patients get mastitis?

who do you treat?

Answer 11

1 in 10

if systemically unwell,
if nipple fissure is present
if symptoms don’t improve after effective milk removal

Question 12

in fibroadenoma when should a core biopsy be performed?

Answer 12

when lump measuring more than 4cm

Question 13

how can you tell if a painless lump is fibroadenoma or carcinoma

Answer 13

fibroadenoma is mobile

Question 14

A 55-year-old women presents with nipple discharge. On examination she has a slit like retraction of the nipple in the centre of this area is a small amount of cheese like material.

what is it?

Answer 14

duct ectasia

Question 15

A 48-year-old lady presents with discomfort in the right breast. On examination she has a discrete soft fluctuant area in the upper outer quadrant of her right breast. A mammogram is performed and a ‘halo sign’ is seen by the radiologist.

what is it?

Answer 15

breast cyst - Lesions such as breast cysts compress the underlying fat and produce a radiolucent area (halo sign).

Question 16

when should cysts be aspirated?

Answer 16

when they are symptomatic

Question 17

A 35-year-old woman complains of ‘lumpy’ breasts. Her symptoms are worse in the premenstrual period.

what is it?

Answer 17

Fibroadenosis

Question 18

A 72-year-old woman complains of ‘eczema’ on her left nipple. On examination the areola is erythematous and thickened

what is it?

Answer 18

Paget’s disease of breast

Question 19

A 22 year old lady presents with lump in the right breast. She reports it has been present for around 4 months but she has grown increasingly concerned as it has not gone away. On examination there is a 2cm smooth lump in the right breast. It is mobile and not fixed to the skin. There are no nipple or skin changes. What is the most likely diagnosis?

Answer 19

Fibroadenoma

Fibroadenomas are the most common breast lumps in women aged 15-25. They are typically less than 3cm in size, are firm and mobile.

Question 20

A 38-year-old lady who smokes heavily presents with recurrent episodes of infection in the right breast. On examination, she has an indurated area at the lateral aspect of the nipple areolar complex. Imaging shows no mass lesions. What is the most likely diagnosis?

Answer 20

Periductal mastitis is common in smokers and may present with recurrent infections. Treatment is with co-amoxiclav.

Question 21

A 18-year-old female notices a non tender mobile breast lump. Clinically there is a smooth lump which is not tethered to the skin.

Answer 21

Fibroadenoma

Question 22

A 21-year-old female notices a bloody discharge from the nipple. She is otherwise well. On examination there are no discrete lesions to feel and mammography shows dense breast tissue but no mass lesion.

Answer 22

Intraductal papilloma