Breast Flashcards
What is the TDLU?
Terminal duct lobular unit
Basic functional secretory unit of the breast
What are some of the physiological changes to the breast and what mediates them?
Pregnancy: oestrogen and progesterone proliferate secretory tissue and glands enlarge to prepare for lactation
Menopause: lack of oestrogen causes secteory cell sand elastic fibres in breast to degenerate
What is physiological nipple discharge?
Clear, yellow, watery
this is common in women of reproductive age and not a worrying sign
Management of bloody nipple discharge.
Blood is pathological.
History and examination, imaging and resection of discharging breast.
Bloody discharge is rarely cancer unless associated mass.
Breast lump after trauma.
Diagnosis?
Cause?
Management?
Fat necrosis
Foamy macrophage inflammation causes fibrosis
Fibrosis can cause mass and mimic cancer. Imaging and biopsy may be required if uncertainty.
What is duct ectasia?
How does it present?
How do you treat it?
Lacteriferous duct thickening causing build up of thick fluid which can block the duct.
Lump, thick nipple discharge, nipple inversion infection and tenderness in a smoker.
Exclude malignancy, treat infections, surgically remove pathological duct.
Localised inflammation in lactating woman.
Diagnosis?
Management?
Mastitis
Antibiotics (monitor response and change antibiotic if needed) + continue pumping breast until infection clears
Bulging mass in area of mastitis.
Diagnosis?
Management?
Breast abscess
US (shows fluid filled centre), aspirate and microscopy/surgical drainage if not clearing
Small mobile breast lump.
Diagnosis?
Management?
Fibroadenoma (most common benign neoplasm)
Reassure
What can cause gynaecomastia?
Oestrogen
Liver disease
Cannabis
Drugs (spironolactone)
What is fibrocytsic change?
Cyst formation and intervening fibrosis as breasts age
What is a hamartoma and how might it present?
Rare benign growth of all breast tissue in abnormal distribution
Like fibroadenoma
How might a breast cyst present and how is it managed?
Lump often in late reproductive years.
US shows fluid filled centre.
Aspirate, do cytology if blood and palpate afterwards to exclude intracystic carcinoma
What are sclerosing lesions and how do they present?
Disorderly but benign proliferation (two types: sclerosing adenosis and radial scar/complex sclerosing lesion)
Asymptomatic commonly and show incidentally on mammogram. They can calcify and look malignant, definitive diagnosis if with vacuum biopsy.
What is a Phyllodes tumour and how might it be managed?
Rare and potentially malignant (‘sarcomatous malignant’) oval breast mass
If malignant (divided pathologically into benign, intermediate and sarcomatous malignant), excise tumor with wide margins and follow up.
Where can papillomas form in breast tissue and how might they present?
Intraduct: sub-areolar duct, nipple discharge
Intracystic: within cyst, bloody aspirate
What cells do breast carcinoma arise in?
Epithelium of the TDLU
What are the two broad types of breast carcinoma and what is the commonest?
Ductal (commonest)
Lobular
Risk factors for breast cancer.
Old Early menarche No children/breastfeeding Oestrogen supplementation Family history (BRCA1/2) Previous breast disease Obesity Alcohol
How does breast cancer present?
Lump
Bloody discharge
Nipple inversion
Orange peel skin
Name 4 precursor lesions for invasive breast carcinoma from least concerning to most concerning.
Columnar cell change
Usual type hyperplasia
Atypical hyperplasia
Carcinoma in situ
What does carcinoma in situ mean pathologically and clinically?
Malignant cells contained within the basement membrane.
Increased cancer risk so excise with adjuvant radiotherapy and monitor
What is Paget’s disease of the nipple?
Ductal carcinoma in situ (DCIS) presenting with eczema of the nipple
Common sites for metastasis.
Axillary/supraclavicular/parasternal lymph nodes Bone Brain Lung Liver Genital tract
What hormone receptors are often found on tumours and what is the significance of this?
Oestrogen receptor - tumour responsive to anti-oestrogen therapy
Progesterone receptor - all progesterone posisive tumours are also oestrogej receptor positive
HER 2 receptor - responsive to trastumazab
What is the best treatment for breast cancer?
What may be given before and after this treatment?
Breast conserving sugery
Before:
tamoxifen and chemotherapy
After: tamoxifen radiotherapy letrozole (aromatase inhibitor) trastumazab (with chemo and a taxane)
What is tamoxifen, letrozole and trastumazab?
Tamoxifen: oestrogen blocker
Letrozole: aromatase inhibitor
Trastumazab: antibody against HER2
