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breast Flashcards

1
Q

MASTITIS what is it?

A

inflammation of breast tissue - can be acute or chronic

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2
Q

MASTITIS common causative organism?

A

staph aureus

what other cause (not an organism)?

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3
Q

MASTITIS can be classified by lactation status…expand

A
  • lactational mastitis (common) - in first 3 m of breast feeding or weaning. associated w? what child is it most common w?
  • non lactational mastitis - associated w what other breast conditions? what risk factor damages the sub areolar duct & predisposes to bacterial infection?
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4
Q

MASTITIS clinical features?

A

tenderness, swelling, erythema

* check there’s no abscess!!

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5
Q

MASTITIS management?

A
  • lactational? continue breast feeding

- analgesia & abx

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6
Q

BREAST ABSCESS what is it?

A

collection of pus within the breast lined w granulation tissue - most commonly develops from what other breast condition?

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7
Q

BREAST ABSCESS presentation?

A

fluctuate tenderness & erythmatous mass. systemic sx? x2

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8
Q

BREAST ABSCESS how to confirm diagnosis?

A

uss

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9
Q

BREAST ABSCESS management?

A

empirical abx & uss guided needle therapeutic aspiration

what about an advanced abscess?

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10
Q

BREAST ABSCESS complication of drainage of a non lactational abscess?

A

mammary duct fistula (communication between skin & sub areolar breast duct)
can be fixed surgically (fistulectomy & abx) but can recur

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11
Q

BREAST CYST what is it?

A

epithelial lined fluid filled cavities which form when lobules become distended due to blockage
? prevalent in what age group

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12
Q

BREAST CYST clinical features?

A

singularly or multiple
can affect one or both breasts
OE: distinct smooth palpable masses - may be tender

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13
Q

BREAST CYST investigations ?

A

USS - what typical shape is seen?
when is a cyst aspirated?
exclude CA if the aspirate is free of blood or lump disappears!

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14
Q

BREAST CYST management?

A

self resolving

  • analgesia
  • cyclical pain? gamolenic acid or danazol
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15
Q

BREAST CYST comps?

A
  • 2% CA at presentation
  • cysts inc risk of developing breast CA in future
  • some may develop fibroadenosis - what is this?
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16
Q

MAMMARY DUCT ECTASIA what is it?

A

dilation and shortening of the major lactiferous ducts

? common in which age group

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17
Q

MAMMARY DUCT ECTASIA presentation?

A
  • coloured green/yellow nipple discharge
  • palpable mass
  • nipple retraction
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18
Q

MAMMARY DUCT ECTASIA investigations?

A

mammography - what does it show?

biopsy - what does it show?

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19
Q

MAMMARY DUCT ECTASIA management?

A

conservatively

unremitting nipple discharge - ?

20
Q

FAT NECROSIS what is it?

A

common condition caused by an acute inflammatory response in the breast leading to ischaemic necrosis of fat lobules

21
Q

FAT NECROSIS often referred to as trauma fat necrosis - why?

A

associated w trauma - blunt, prev surgery, prev radiology

22
Q

FAT NECROSIS clinical features?

A

usually asymptomatic or presenting as a lump
less commonly presents w fluid discharge, skin dimpling, pain & nipple inversion
when can you get a solid irregular lump?

23
Q

FAT NECROSIS investigations?

A
  • +ve trauma hx
  • hyperechoic mass on uss
  • more developed & fibrotic? appears irregular therefore ? what do u to exclude CA
24
Q

FAT NECROSIS management?

A

self limiting
analgesia
reassurance

25
BENIGN TUMOURS types?
fibroadenoma, adenoma, papilloma, lipoma, phyllodes tumour
26
BENIGN TUMOURS fibroadenoma more info
- most common - young women - proliferations of stromal & epithelial tissue of the duct lobules - OE: highly mobile (aka ?), well defined & rubbery, <5cm. can be multiple & bilateral - low malignant potential - when are they excised?
27
BENIGN TUMOURS ductal adenoma more info
- benign glandular tumour - older female - nodular - easily mimic CA therefore triple assessment
28
BENIGN TUMOURS papilloma more info
- 40-50 yrs - sub areolar region (less than ? cm away from the nipple) - present: bloody/clear nipple discharge. larger papillomas can present as mass - on imaging the appear similar to ductal carcinomas - so need biopsy - some might excised to ensure no atypical cells/neoplasia present - multi ductal papilloma inc risk of ca… treated w ?
29
BENIGN TUMOURS lipoma more info
- soft & mobile - adipose tumour - asymptomatic - low malignant potential - when are they removed?
30
BENIGN TUMOURS phyllodes tumours more info
- rare fibroepithelial tumours - large & fast growing - older age group - epithelial & stromal tissue - hard to differentiate clinically & microscopically from fibroadenomas - 1/3 have malignant potential so wide excision
31
GYNAECOMASTIA what is it?
- development of male breast tissue due to an imbalanced ration of oestrogen & androgen activity - common - reversible
32
GYNAECOMASTIA types?
- physiological | - pathological eg x4?
33
GYNAECOMASTIA physiological type more info
- occurs in adolescence - due to delayed testosterone surge relative to oestrogen @ puberty - ***less commonly occurs in older population 2° to what?
34
GYNAECOMASTIA pathological type more info
results from changes in the oestrogen:androgen activity - lack of testosterone - klinefelters, AIS, testicular atrophy, renal disease - inc oestrogen levels - liver disease, hyperthyroidism, obesity, adrenal tumours or leydig cell tumours - medication - spirinolactone, digoxin, metronidazole, chemo - idiopathic
35
GYNAECOMASTIA clinical features
- insidious onset - ask about associated sx & comorbidities - assess for underlying causes - OE: presents as a ruberry/firm mass (>2cm)that starts under the nipple & spreads outwards over the breast region * * what examination is essential in young pts?
36
GYNAECOMASTIA differentials?
- pseudogynaecomastia - adipose tissue in breast region associated w being overweight - how do you test for this?
37
GYNAECOMASTIA investigations?
``` - only done is cause unknown initially: - U&Es - for renal function - LFTs - for liver function normal? then LH... - ↑LH↓testosterone=testicular failure - ↓LH↓testosterone=increased oestrogen - ↑LH↑testosterone=androgen resistance or gonadotrophin secreting malignancy ```
38
GYNAECOMASTIA management?
- fix underlying factor - tamoxifen for tenderness - fibrosis ? surgery
39
DCIS what is it?
malignancy of the ductal tissue of the breast that is contained within the basement membrane - premalignant condition but can become invasive - appears as microcalcifications on mammogram - wide excision to treat
40
TRIPLE ASSESSMENT
- clinical assessment = hx & examination (clockwork) of breast & lymph nodes - imaging assessment = mammography (older less dense tissue) +/- USS (younger denser tissue) - pathological assessment = core biopsy (full histology - differentiates between in situ & invasive CA), FNAC (only cytology)
41
MASTALGIA what is it?
breast pain
42
MASTALGIA classification?
- cyclical - associated w menstrual cycle. common. affects both breasts, starts a few days before beginning of menstruation & subsides at the end. due to hormonal changes so common in what women? x2 - non cyclical - unrelated to menstrual cycle. caused by meds eg? x3 - extra mammary - eg chest wall or shoulder pain
43
MASTALGIA clinical features?
specific hx to indicate a pathological cause : lump, skin changes, fevers, discharge, association w menstrual cycle ** ask about drug hx, breast feeding, preganancy, pmh, fhx
44
MASTALGIA investigations?
- isolated pain w no relevant features on hx or oe ? not an indication for imaging * * preg test if repro age!
45
MASTALGIA mgmt?
- reassurance & pain control via better br/soft support bra during night, po ibuprofen, po paracetamol or topical NSAIDs - unsuccessful? referral - 2nd line? danazol (anti gonadotropin agent) unpleasant SEs? x3

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