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Surgery block (Y3) > Breast (2) (Benign conditions) > Flashcards

Breast (2) (Benign conditions) Flashcards

1
Q

Benign breast conditions

A
  • Inflammatory disease
    • Mastitis
    • Breast cysts
    • Mammary duct ectasia
    • Fat necrosis
  • Benign tumours
  • Gynaecomastia
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2
Q

mastitis

A

Inflammation of breast tissue (can be acute or chronic). Classed by lactation status

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3
Q

lactational mastitis (most common)

A
  • 1/3 of breastfeeding women- during first 3 months
  • Associated with cracked nipples and milk stasis
  • More common with first child
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4
Q

non-lactational mastitis

A
  • In women with other conditions e.g. duct ectasia, as a peri-ductal mastitis
  • Tobacco smoking is an important RF
    • Causes damaged to sub-areolar duct walls – predisposing to bacterial infection
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5
Q

causes of mastitis

A
  • Infection e.g. S.Aureus
  • Granulomatous
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6
Q

presentation of mastitis

A
  • Tenderness
  • Swelling/ induration
  • Erythema
  • Ensure there is no abscess formation
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7
Q

management of mastitis

A
  • Systemic antibiotic therapy
  • Simple analgesics

For lactational mastitis

  • Continued milk drainage or feeding
  • If persistent or multiple areas of infection
    • Give Cabergoline (dopamine agonist) to cause cessation of breastfeeding
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8
Q

if persistent mastitis (lactational) what is the management

A
  • Give Cabergoline (dopamine agonist) to cause cessation of breastfeeding
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9
Q

complication of mastitis

A

breast abscess

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10
Q

breast abscess

A
  • Collection of pus within breast lined granulation tissue- most commonly developing from acute mastitis
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11
Q

presentation of breast abscess

A

Tender fluctuant and erythematous masses, with a punctum potentially present

  • Systemic features inc fever and lethargy
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12
Q

investigations for breast abscess

A

US

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13
Q

management of breast abscess

A
  • If caught early
    • Prompt empirical antibiotics
    • US-guided needle therapeutic aspiration
    • If advanced
      • Incision and drainage under local
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14
Q

complication of breast abscess

A

formation of mammary duct fistula

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15
Q

breast cysts

A

Cysts are epithelial lined fluid-filled cavities, which form when lobules become distended due to blockage. Common cause of breast masses.

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16
Q

RF for breast cyst

A
  • perimenopausal
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17
Q

presentation of breast cyst

A
  • Singular or multiple lumps affecting one or both breasts
  • Cysts:
    • Smooth
    • Distinct (non tethered)
    • May be tender
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18
Q

investigations for breast cyst

A
  • Mammography- halo shaped
  • US offers definitive diagnosis
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19
Q

management of breast cysts

A
  • Most require no further management and self resolve
  • Persisting , symptomatic or undeterminable cystic masses may be aspirated à cancer may eb excluded if the fluid is free of blood or the lump disappears (otherwise send for cytology)
  • Cyclical pain treated with high dose gamolenic acid (GLA) or danazol
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20
Q

complications of breast cysts

A
  • 2% of patients with cysts have carcinoma at presentation
    • Patient with cysts also have 2-3 times greater risk of developing breast cancer in the future
  • Fibro adenosis (fibrocystic changes) caused by multiple small cysts and fibrotic area
    • Tender and cause asymmetry
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21
Q

mammary duct ectasia

A

Duct ectasia is the dilation and shortening of the major lactiferous ducts.

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22
Q

RF for mammary duct ectasia

A

menopause

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23
Q

presentation of mammary duct ectasia

A
  • Coloured green/yellow nipple discharge
    • Any blood-stained discharge requires triple assessment
  • Palpable mass
  • Nipple retraction
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24
Q

nvestigations for mammary duct ectasia

A
  • Mammography
    • Dilated calcified ducts without any other features of malignancy
  • If biopsied: multiple plasma cells on histology- plasma cell mastitis
25
Q

management of mammary duct ectasia

A
  • Managed conservatively
  • Unless need to exclude malignancy
  • Unremitting nipple discharge can be treated with duct excision
26
Q

fat necrosis

A

Fat necrosis is a common condition caused by an acute inflammatory response in the breast, leading to ischaemic necrosis of fat lobules.

27
Q

causes of fat necrosis

A
  • Trauma (blunt)
  • Previous surgical or radiological intervention
28
Q

presentation of fat necrosis

A
  • Asymptomatic or presents as a lump
  • Less commonly
    • Fluid discharge
    • Skin dimpling
    • Pain
    • Nipple inversion
  • Solid irregular lump (if acute inflammatory response persist- chronic fibrotic change)
29
Q

investigation of fat necrosis

A
  • Fat necrosis may be suggested by a positive traumatic history and/ or hyperechoic (fat content) mass on US
  • More developed fibrotic lesions will mimic carcinoma on mammogram- as calcified irregular speculated masses and the solid irregular lump may feel suspicious on palpation
    • Core biopsy- to rule out malignancy
30
Q

management of fat necrosis

A
  • Fat necrosis is self -limiting
  • Analgesic management and reassurance
31
Q

benign tumours

A

Differential diagnosis

  • Send to Triple Assessment to distinguish between breast lumps
    • Cysts
    • Abscesses
    • Malignant lesions
  • If lump cannot be diagnosed as benign → lump excised and send to histology
32
Q

what does triple assessment involve

A
  • Examination
  • Imaging
  • Histology
33
Q

breast screening programme for women aged

A

50-70 yrs

34
Q

how often do women have mammogram after turning 50

A

every 3 years

35
Q

aim of breast screening

A
  • Aim is to detect small impalpable cancers and pre-invasive cancer (incidence of DCIS has increased from 5% of breast cancers to 25% in screened populations)
  • Look for asymmetric densities, parenchymal deformities, calcifications
  • Assess abnormalities using further imaging, core biopsy and FNAC
36
Q

name some benign tumours

A

papilloma

adenoma

lipoma

fibroadenoma

phyllodes tumour

37
Q

papilloma

A

Intraductal papilloma’s are a benign breast lesion -wart-like tumors that grow within the milk ducts of the breast.

38
Q

papilloma RF

A

40-50 yrs

39
Q

papilloma presentation

A
  • Subareolar lesion (less than 1cm away from nipple)
  • Bloody or clear nipple discharge
40
Q

investigation for papilloma

A
  • Appear similar to ductal carcinomas on imaging therefore require biopsy
41
Q

management of papilloma

A

Risk of breast cancer is only increased with multi-ductal papilloma and most are treated with microdochectomy.

42
Q

adenoma

A

A ductal adenoma is a benign glandular tumour

RF

  • Older women

Presentation

  • Nodular
  • Easily mimic malignancy

Management

  • Triple assessment
43
Q

fibroadenoma

A

Most common benign growth. Proliferations of stromal and epithelial tissue of the duct lobules.

  • Very low malignant potential and can be left in situ
44
Q

fibroadenoma rf

A
  • Women of a reproductive age
45
Q

fibroadenoma presentation

A
  • Highly mobile (breast mouse)
  • Well defined
  • Rubbery
  • <5cn
  • Can be multiple or bilateral
46
Q

management of fibroadenoma

A
  • Excision if >3cm in diameter or patient preference
47
Q

Lipoma

A

Benign adipose tumour

Presentation

  • Soft and mobile normally otherwise asymptomatic.

Management

They have low malignant potential and are usually only removed if they are significantly enlarging or causing symptomatic compressive or aesthetic issues.

48
Q

phyllodes tumour

A

Rare fibroepithelial tumour. Comprise both epithelial and stromal tissue. Grow rapidly.

RF

  • Older age group

Investigations

  • Hard to distinguish from fibroadenoma, however 1/3 have malignant potential

Management

  • Should be widely excised or mastectomy if lesion is large
49
Q

Gynaecomastia

A

A condition by which males develop breast tissue due to an imbalanced ratio of oestrogen and androgen activity.

  • It is usually a benign disease but breast cancer can develop in about 1% of cases.
  • It is a common condition with at least a third of men experiencing gynaecomastia in their lifetime and is usually an entirely reversible condition.
50
Q

pathophysiology of gynaecomastia: physiological

A
  • Adolescence
    • Due to delayed testosterone surge relative to oestrogen at puberty
    • Older population
      • Secondary to decreasing testosterone levels
51
Q

pathophysiology of gynaecomastia: pathological

A
  • due to changes in oestrogen: androgen activity ratio. Variety of mechanisms
  • Lack of testosterone
    • Causes include Klinefelter’s syndrome, androgen insensitivity, testicular atrophy, or renal disease
  • Increased oestrogen levels
    • Causes include liver disease, hyperthyroidism, obesity, adrenal tumours, or certain testicular tumours (e.g. Leydig’s cell tumours)
  • Medication*
    • Common causative agents include digoxin, metronidazole, spironolactone, chemotherapy, goserelin, antipsychotics, or anabolic steroids
  • Idiopathic
52
Q

presentation of gynaecomastia

A
  • Insidious onset
  • Rubbery or firm mass (typically <2cm) that starts from underneath the nipple and spreads outwards over the breast region
53
Q

DD for gynaecosmastia

A
  • Pseudo gynaecomastia (associated with being overweight)
54
Q

investigations of gynaecomastia

A
  • Test are only necessary if cause is unknowns
  • If malignancy suspected- triple assessment
  • Cause of unknown
    • Liver and renal function
    • Hormone profile
55
Q

management of gynaecomastia

A

Depends on the causative factors and the phase of gynaecomastia

  • Reversible underlying cause, then treatment or reversal of this should also allow for the resolution of the gynaecomastia as well.
  • In most cases, reassurance may be enough for the patient
  • Tamoxifen can also be used in cases to help alleviate symptoms, especially tenderness. In patients with later stages of fibrosis, surgery may be the only option if medical treatments have failed.
56
Q

hormone profile for gynaecomastia

A
  • LH high and testosterone low = testicular failure
  • LH low and testosterone low = increased oestrogen
  • LH high and testosterone high = androgen resistance or gonadotrophin-secreting malignancy
57
Q

pagets disease of the nipple

A

A rare condition presents as a roughening, reddening, and slight ulceration of the nipple. The vast majority of Paget’s (97%) will also have an underlying neoplasm (ductal), either in situ or invasive disease, and it is associated with 1-4% of all cases of breast cancer.

  • Involvement of epidermis by malignant ductal carcinoma cells
  • Hypothesised that malignant cells migrate from the ducts to the nipple surface or the cells of the nipple themselves become malignant
58
Q

presentation of pagets disease of nipple

A
  • Itching or redness in the nipple
  • Flaking and thickened skin around the nipple
  • Painful and sensitive
  • Flattened nipple
  • With or without yellowish or bloody discharge
59
Q

investigations for pagets

A
  • Biopsy
  • Complete breast and axilla exam due to association with malignancy

Surgery block (Y3) (38 decks)

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