Breast 2 Flashcards
When does fibroadenosis affect females?
after puberty and before menopause (in anovulatory periods)
Where is progesterone released from?
The ovaries from corpus luteam when it ruptures
What’s the pathology of fibrocystic disease? (fibroadenosis)
- fibrosis
- adenosis
- cyst formation
- papillomatosis
- epitheliosis
- atypical epithelial hyperplasia
is fibroadenosis precancerous?
NO
except if there is
- marked papillomatosis
- atypical epithelial hyperplasia
What is gynecomastia?
enlargement of male breast due to increase in glandular element
increase in fat element in male breast is called?
Lipomastia
What are the physiological causes of gynecomastia?
- neonatal: high maternal estrogen
- pubertal: hormonal imbalance
- old age: low testicular function
what is the most common cause of gynecomastia?
idiopathic
What drugs could cause gynecomastia?
digitalis
aldactone
cimitidine
How to treat gynecomastia if it’s physiological or idiopathic?
wait for 6 months it may disappear
if the patient demands it, preform surgical interventiom
if a patient presents with a recent onset of gynecomastia, what is the first line of treatment?
search for the secondary cause and treat the underlying cause
a patient presents with unilateral bleeding from 1 duct, what is your diagnosis?
duct papilloma
What causes the retroareolar breast lump causing obstruction in a ductal papilloma?
the retention cyst
What is the treatment of a duct papilloma?
Microdochectomy
What is the most common cause of breast lump is young females?
fibroadenoma
the most common cause of breast PAIN in young females is?
fibroadenosis
how do we treat hard fibroadenoma?
enucleation because it has 2 complete capsules
how do we treat soft fibroadenoma?
excision with a safety margin because it has an incomplete capsule
What is the phyllodes tumor?
giant type of soft intra-canalicular fibroadenoma
cystosarcoma pylloides
What is the most common cause of lipid discharge from nipple?
duct ectasia
What are the 3 most common pathologies occurring in pregnant females?
- lactating adenoma
- galactocele
- breast infarction
How should secondary causes be ruled out in gynecomastia?
- hormonal assay
- pelvi-abdominal CT
- scrotal ultrasound
What is a genetic cause of gynecomastia?
Klinefeter syndrome
What are pathological hormonal causes of gynecomastia?
HIGH ESTROGEN
- LCF
- feminizing tumors
LOW TESTOSTERONE
- orchectomy
- testicular atrophy
A female presents to the clinic with mastalgia that is increase premenstrual & my breast movement. She has dull aching pain. On palpation nodularity is felt. What is your diagnosis for these signs & symptoms, and what should be seen on further investigation to confirm your diagnosis?
Fibroadenosis
smooth filling defect should be seen on ductography
How should fibroadenosis be treated?
- reassurance
- analgesia
- anti-prolactin: Parlodel
- androgenic steroid: Danazol
What are the surgical indications for fibroadenosis?
- doubtful diagnosis
- large recurrent cyst
What are the lines of treatment for gynecomastia?
If SECONDARY
- treat the cause (stop offending drug or remove tumor)
If IDIOPATHIC
- subcutaneous mastectomy
- liposuction
- endoscopic surgery
What is the gross picture of fibroadenosis?
in major milk duct
- pedunculated mass
- may ulcerate and bleed
- may cause ductal obstruction
What are the differences between peri-canaliculaar & intra-canalicular fibroadenoma?
PERI-CANALICULAR INTRA-CANALICULAR
- hard - soft
- in 20-30 y/o - in 30-50 y/o
- small - large
- smooth - lobulated
- firm to hard - soft
- whorly - cystic degeneration
- 2 capsules - incomplete
- more fibrous - more glandular
- never turns malignant - may turn into a sarcoma
What are the signs & symptoms seen to diagnose fibroadenoma?
- painless breast mass
- freely mobile (BREAST MOUSE)
- no axillary LN enlargement
What is the clinical description of Phyllodes tumor?
- huge soft mass in the breast
- can cause pressure necrosis of the skin leading to ulceration (PROBE TEST for diagnosis)
- soft fibroadenoma
- may show malignant transformation & metastasis
How should Phyllodes tumor be treated?
Wide local excision up to simple mastectomy
