booby conditions Flashcards
mastalgia
rarely assoc with malignancy unless palpable breast lump
cyclic
- diffus, most intense during premenstrual phase
- usually bilateral, can be uni
- heaviness, aching
non-cyclic
- localised, persistent, less responsive to treatment
- ensure pain from breast, not chest wall
- causes - meds (contraception), infection, pregnancy
nipple discharge
physiologic - clear, yellow, watery
pathologic - bloody, from a singular duct
commonest cause - intraductal papilloma (benign)
rarely a sign of malignancy unless palpable
Ix - mammography, ultrasonography, surgical excision of dischargin ducts
breast cysts
palpable common in late reproductive yrs
smooth discrete lump (may be fluctuant)
small increased risk of BC (esp in younger)
often tender esp before menstruation
Mx = aspirate
- blood stained or persistently refil -> biopsy/excise
galactocele
palpable milk filled cyst
assoc with pregnancy or lactation
FNA can diagnose + drain
lipoma
thin smooth border on mammography
can be palpable + reveals only adipose cells by biopsy
causes of gynaecomastia
imbalance of oestrogen + androgen (testosterone)
- higher oestrogen, lower androg
- oest stimulates breast development, androg inhibits
- increase oes - puberty, obesity (aromatase in adipose converts androgens to oestrogen), Leydig cell testicular cancer, hyperthyroidism, liver disease
- decrease testosterone - old age, hypothalamus, klinefelter syndrome, orchitis (mumps), testicular damage
prolactin also stimulates glandular breast tissue + breast milk development
- raised prolactin -> gynaecomatia
- dopamine agonists (antipsychtics) block dopamine allowing prolactin to rise
–> gynaecomastia + galactorrhea
drugs
- steroids, antipsychotics
- digoxin, spirnolactone
- GnRH agonists (gosereline)
- opiates, cannabis, alcohol
management of gynaecomastia
depends on cause
problematic cases (psycological distress)
- tamoxifen - selective oestrogen receptor modulator that reduces the effect of oestrogen on breast tissue
- surgery
clinical features suggesting breast cancer
hard, irregular, painless or fixed in place
may be tether to skin or chest wall
nipple retraction
skin dim[ling or oedema
who gets a 2wk referral
unexplained breast lump in patients >=30
unilateral nipple changes in patients >=50 - discharge, retraction or other changes
fibrocystic change
women of menstruating age (majority 40-50)
- symptoms often improve post menopause
- V common
assoc with early menarche + late menopause
generalised lumpiness of breast, cyclical fluctuation
connective tissue (stroma), ducts + lobules respond to female hormone making fibrous + cystic
presentation of fibrocystic change
smooth discrete lumps
mastalgia - cyclical
generalised lumpiness
fluctuation in breast size
symptoms start premenstrual, resolve during
cysts
- blue domed with pale fluid
- thin walled with fibrotic wall
- lined by apocrine epithelium
management of fibrocystic pain
exclude malignancy (aspirate), reassure
manage cyclical breaast pain -
- wearing supportive bra
- NSAIDs
- apply heat to area
harmartoma
circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution
fibroadenoma
benign tumours of stromal/epithelial breast duct tissue - no increase in malignancy risk
common, palpable mass
usually solitary
commoner in african women
20-40yrs - peak 30s
usually found on screening
fibroadenoma presentation
“breast mouse” - move around with breast tissue
painless, firm discrete small mobile mass
smooth round, well circumscribed, rubbery
grey/white colour
responds to female hormones - decrease after menopause
biphasic tumour/lesion - epithelium, stroma
30% shrink over 2yr period
fibroadenoma investigation
US - solid
diagnosis = US core biopsy
not assoc with increase BC risk, complex ones with fam history of BC may indicate higher risk
fibroadenoma mangement
diagnose, reassure
if >3cm surgical excision is usual
can decrease in size pproching menopause
sclerosing lesions
sclerosing adenosis, radial scar/complex sclerosing lesion
benign, disorderly, proliferation of acini + stroma
can cause a mass or calcification, may MIMIC carcinoma
no increase BC risk
sclerosing adenosis
benign, no increase BC risk
pain, tenderness
lumpiness/thickening
age 20-70
radial scar
wide age range, common
incidental finding on screening
mimic carcinoma radiologically - shows epithelial proliferation
in situ or invasive carcinoma may occur with these lesion
radial scar presentation + treatment
fibro-elastic scar
radiating fibrosis containing distorted ductules
fibrocystic change
epithelial proliferation
Mx = excise or sample extensively by vacuum biopsy/excision (no atypia)
examples of inflammatory lessions
fat necrosis
duct ectasia
acute mastitis/abscess
fat necrosis
benign lump formed by localised degeneration + scarring of fat tissue in the breast
- may be assoc with oil cyst (eggshell)
physical feature mimic carcinoma - no increase risk tho
mass may increase in size initially
**commonly triggered by localised traume, radiotherapy or surgery
- inflammatory reaction resulting in fibrosis + necrosis of fat tissue
causes
- 40% due to local traume - seat belt injury, falls
- warfarin therapy
pathophysio + presentation of fat necrosis
damage + disruption of adipocytes
infiltration by acute inflammatory
“foamy” macrophages/histocytes
subsequent fibrosis + scarring
calcification, ghost adipocytes - “oil cyst”
presentation
- painless, firm, irregular lump
- fixed to local structures
- may be skin dimpling or nipple inversion
