Breast

Question 1

Breast Abscess:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 1

Definition - local accumulation of pus within the breast due to infection
Epidemiology - 3-11% women with mastitis, 10-33% off women lactating get mastitis
Pathogenesis - non lactating: caused by infection - staph aureus, associated with: diabetes, trauma, RA, corticosteroids, granulomatous lobular mastitis
Presentation - fever, malaise, muscle aching, swollen tender lump, redness, heat and swelling in overlaying skin
Investigations - breast examination, ultrasound, culture from abscess
Differentials - lactating associated breast conditions, non-lactating associated breast conditions, conditions causing nipple pain
Risk Factors - mastitis, breast abscess
Treatment - surgical intervention: ultrasound guided needle aspiration + IV or oral antibiotic: dicloxacillin, cephlaxin, doxycycline

Question 2

Breast Fibrocystic Disease:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 2

Definition - benign condition where breasts are lumpy
Epidemiology - 30-60% women
Pathogenesis - response to oestrogen/progesterone,
Presentation - diffuse symmetrical lumpiness, breast aching, tenderness related to periodic swelling, itching
Investigations - breast examination, ultrasound, mammography, potential breast biopsy
Differentials - breast malignancy
Risk Factors - 30-50, hormone therapy
Treatment - mastalgia: pain killers, 1st line: tamoxifen hormonal therapy 2nd line: bromocriptine 3rd line: danazol

Question 3

Ductal Papilloma:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 3

Definition - wart like lump developed in milk ducts
Epidemiology - 2-3% incidence, women>40
Pathogenesis - atypical hyperplasia
Presentation - bloody discharge, 20-40, small lump on exam, tenderness
Investigations - breast examination, mammogram, ultrasound, ductogram, biopsy
Differentials - malignancy
Risk Factors - women nearing menopause, younger women for peripheral papilloma
Treatment - excision: potentially whole duct

Question 4

Breast Carcinoma:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 4

Definition - malignancy originating in breast - ductal/lobular
Epidemiology - most common female malignancy
Pathogenesis - genetic causes - BRCA1/2, HER 2
Presentation - hard, irregular, nodular, painless, non-mobile lump, lymphadenopathy, nipple retraction, peaud’orange, retraction of skin, scaling of nipple, discharge from nipple
Investigations - breast examination, ultrasound, mammogram, biopsy, HER 2 Receptor testing
Differentials - fibrocystic changes, fibroadenoma, mastitis
Risk Factors - age, smoking, alcohol, genetics, HRT, radiation exposure
Treatment - Surgery: lumpectomy or mastectomy
Node negative: surgery + chemo + radiotherapy
Node Positive: surgery + chemo + toxin based chemo + radio
Hormone therapy