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.
