Breast Flashcards

1
Q
Fibroadenoma
Ep
Ax
Sxs
Mx [2]
Prog
A

Ep: 20-30y/o
Ax: aberration in normal development
Sy/Si: painless, firm highly mobile lump
Mx:
- conservative if <40y/o or biopsy proven dx
- excision if >40y/o, >3cm or increasing size or pt choice
Pro: usually remain unchanged but 1/3 resolve spontaneously

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2
Q

Fibroadenoma

Ix: describe triple assessment and what you may find

A

Mammogram: well circumscribed oval mass
USS: well circumscribed round or ovoid mass
FNAC then biopsy

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3
Q
Breast cysts
Ep
Ax [2]
Sxs [2]
Mx
A

Ep: perimenopausal women
Ax: unknown but can be part of fibrocystic breast disease with cyclical mastalgia
Sy/Si: fluctuant or solid lump; may be tender or multiple
Mx: aspiration

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4
Q

Breast cysts

Ix: describe triple assessment and what you may find

A
  • USS: anechoic signal, smooth walls, well circumscribed, underlying fat compression leads to halo sign
  • FNAC: do cytology if fluid on aspiration bloody (should be straw coloured)
  • Biopsy: if residual lump after aspiration
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5
Q

Phyllodes Tumour
Ax
Benign/malignant
Sxs [2]

A

Ax: fibro epithelial neoplasm; usually benign but can recur post-excision; some malignant but haematogenous metastasis uncommon
Sy/Si: firm lump, size may increase rapidly

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6
Q

Phyllodes Tumour
Ix: describe triple assessment and what you may find
Mx

A

Ix
• Mammogram: non-specific large oval or lobulated w/ smooth margins, may have radiolucent halo
• USS: non-specific, mimics fibro adenoma
• FNAC then biopsy
Mx: wide local excision or mastectomy in large tumours

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7
Q
Duct Papilloma
Ep
Ax
Classification [2]
Sxs [2]
Cx
A

Ep: common, usually perimenopausal but can occur in younger women
Ax:
- benign neoplasm of sub areolar ducts
Categorised as central or peripheral
Sy/Si:
- single or multiple lumps
- with nipple single duct discharge (usually clear but may be bloody)
Cx: risk of later malignancy greater if peripheral

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8
Q

Duct Papilloma
Ix [4]
Mx

A
Ix:
•	Mammogram: normal 
•	USS: well defined solid nodule or intra-ductal mass 
•	Galactography: filling defect 
•	FNAC then biopsy

Mx: no mx or surgical excision of duct (microdochectomy)

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9
Q
Fat necrosis
Ax [2]
Px
Sxs
What is one important thing in diagnosing fat necrosis
A

Ax:

  • trauma e.g. seatbelt, implant removal
  • prior reconstruction

Px:
- fat cell disruption causes inflammation and fibrosis

Sy/Si:

  • firm painful lump, associated haematoma
  • CANNOT clinically differentiate from carcinoma*
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10
Q

Fat necrosis
Ix [3]
Mx

A
  1. Mammogram: irregular spiculated mass area
  2. USS: hyper-echoic mass with well-defined margins +/- mural nodules
  3. FNAC then biopsy

Mx: conservative mx once dx proved by biopsy

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11
Q
Duct Ectasia
Ep
Ax [2]
RF
Sxs [2]
A

Ep: post-menopausal
Ax:
- normal chronic inflammatory fibrotic changes
- where ducts widen and shorten during breast involution in later life
RF: smoking
Sy/Si:
- lump
- nipple discharge (usually THICK AND GREEN; may be bloody)
- SYMMETRICAL slit-like nipple retraction

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12
Q

What is Mondor’s disease

A

Thrombophlebitis of a breast vein

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13
Q

Duct Ectasia
Ix [3]
Mx [2]

A

• Mammogram: dilated linear branching densities in sub areolar lesion with rod like calcifications
• USS: dilated fluid filled sub areolar ducts with moving debris
• FNAC then biopsy
Mx:
- conservative once dx proved by biopsy
- can do microdochectomy in young or total duct excision in old for excessive discharge

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14
Q
Lipoma
Ax
Sx
Ix [3]
Mx
A

Ax: benign neoplasm of adipose tissue
Sy/Si: lump
Ix: triple assessment
• Mammogram: fat composed lesion in subcutaneous plane with no calcification
• USS: rounded iso-echoic lesion
• FNAC then biopsy
Mx: conservative once dx proved by biopsy (surgical excision may be needed to confirm dx)

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15
Q
Sclerosing adenosis
Prog
Ax
Px [3]
Sxs [2]
Ix [2]
Mx
A
Prog: no increased malignancy risk
Ax: disorder of involution
Px: 
- distortion of distal lobular unit 
- without hyperplasia (hyperplasia in complex lesions) 
- radial scars
Sy/Si: 
- breast lump or breast pain 
Ix: 
•	Mammogram: can mimic carcinoma
•	FNAC then biopsy ***must be biopsied***
Mx: can be excised
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16
Q
Epithelial hyperplasia
Ax
Sx
Ix
Mx
A

Ax: increased cellularity of terminal lobular unit
Sy/Si: varies from lumpy breast to discrete lump
Ix: triple assessment
Mx: conservative unless atypical features or +ve FHx

17
Q
Galactocele
Ep
Ax
Sxs
Ix
Mx
A

Ep: women who have recently stopped breastfeeding
Ax: build-up of milk due to lactiferous duct occlusion
Sy/Si: smooth cystic lesion with no local or systemic signs of infection
Ix: not rqd
Mx: not rqd

18
Q
Mastalgia: CYCLICAL
Ep [2]
Ax
Symptoms [3]
Signs [2]
A

Ep:
- pre-menopausal women, NOT associated with carcinoma
- mastalgia affects 70% of women in their lifetime
Ax: response to hormonal changes in menstrual cycle
Sy:
- pain mid-cycle to menstruation
- breast heaviness
- lumpiness
Si:
- breast tenderness of lateral half
check for signs of breast cancer (10-15%)

19
Q

Cyclical breast pain conservative mx [4]

A
  • reassurance
  • better fitting day bra and soft support bra at night
  • oral PARACETAMOL and IBUPROFEN
  • continue these for 6m before secondary referral*
20
Q

Cyclical breast pain Specialist mx [5]

A
  • DANAZOL (anti-gonadotrophin; needs non-hormonal contraception as androgenic effects on fetus)
  • TAMOXIFEN, GOSERELIN injections (inhibits gonadotrophin release; SE: vaginal dryness, flushes)
  • BROMOCRIPTINE (SE: nausea, dizziness, postural hypotension, constipation)
  • GESTRINONE (inhibits pituitary gonadotrophin)
  • TOREMIFENE (SERM)
21
Q
Non cyclical breast pain
Ep [2]
Ax
Symptoms
Ix
Mx [4]
A

Ep: post-menopausal women, NOT associated with carcinoma
Ax: unknown (but can be referred pain from chest wall)
Sy: continuous or intermittent breast pain
Ix: CXR to excl. chest wall pain (chest wall arthritis, lung disease)
Mx: reassurance, better fitting day bra and soft support bra at night, oral PARACETAMOL and IBUPROFEN

22
Q

Appearance of breast implant rupture US [3]

A
  • Extracapsular rupture causes breast shape distortion
  • and snowstorm appearance in breast
  • and axilla die to silicone leakage
23
Q

Nipple discharge: breastmilk [3]

A
  • Physiological: breastfeeding
  • Galactorrhoea: emotional events, histamine receptor antagonists
  • Hyperprolactinaemia: pituitary adenoma
24
Q

Nipple discharge:

  • Green
  • Carcinoma
  • Intraductal papilloma
A
  • Duct ectasia: green
  • Carcinoma: blood stained with underlying mass or axilla lump
  • Intraductal papilloma: younger patients with blood stained discharge and no palpable lump
25
Q

Paget’s disease of the nipple [2]

Dx

A
  • Eczematoid change of nipple (involves nipple primarily only laterally then spread to areolar)
  • Associated with an underlying breast malignancy
    Dx: punch biopsy, mammography, breast US
26
Q

Mastitis
Ep [2]
Ax
Px [2]

A

Ep: post-partum or non-lactating women
Ax: usually staph aureus but can be mixed (anaerobic and recurrent most likely in smokers)
Px:
• Lactational: milk stasis or over production plus bacteria entering through traumatised nipple
• Non-lactational: duct ectasia causes squamous metaplasia of lactiferous ducts causing blockage and inflammation making more prone to infection

27
Q

Mastitis

RF [9]

A
  • > 30y/o
  • poor breastfeeding technique, milk stasis
  • lactation
  • previous or prolonged mastitis, prior breast abscess
  • shaving or plucking areolar hair
  • anatomical breast defect
  • mammoplasty or scar, nipple piercing, foreign body e.g. breast implants
  • skin infection, immunosuppression
28
Q

Mastitis
Symptoms [5]
Signs [3]

A

Sy: pain, tenderness, redness, flu-like symptoms, decreased milk outflow
Si: pyrexia, erythema, tenderness, fluctuance (abscess)

29
Q

Mastitis
Ix: describe what a triple assessment, 3 other investigations
Complications [4]

A

• USS: hyperechoic lesion (abscess), may be well circumscribed, macrolobulated or irregular
• FNAC: drainage of purulent fluid indicates breast abscess (send for cytology and microbiology)
• MC&S: milk, aspirate, discharge or biopsy tissue
• Skin punch biopsy: if floridly inflamed (suspect inflammatory breast cancer)
• Bloods: cultures and FBC
• Pregnancy test: if not post-partum or knowingly pregnant
Complications:
- breastfeeding cessation, sepsis, scarring, fistula

30
Q

Mastitis mx [5]

Mx of breast abscess or mammary duct fistula

A

SEPSIS 6 if signs of systemic infection
PCM, Ibuprofen
• Lactational: effective milk removal (breastfeeding or pumping); if symptoms persist beyond 12h or systemic signs, give empirical abx
• Non-lactational: FLUCLOXACILLIN 250-500mg x4/day (or CO-AMOVICLAV if smoker)
• Breast abscess or mammary duct fistula: aspiration or incision and drainage with LA under USS guidance

31
Q

Gynaecomastia
Ep [3]
Ax [6]

A
Ep: males, puberty and old age 
Ax:
•	Drugs: spironolactone, digoxin, cimetidine, cannabis
•	Cirrhosis
•	Renal failure 
•	Testicular tumours 
•	Pseudo-gynaecomastia: obesity
32
Q

Drugs that cause gynecomastia [4]

A

spironolactone, digoxin, cimetidine, cannabis

33
Q

Gynaecomastia
RF [4]
Symptoms
Signs

A
RF: 
- anabolic steroids
- prostate cancer
- gender identity disorder
- drugs
Sy: soft lump that may be painful, symptoms of underlying cause 
Si; unilateral or bilateral soft lump
34
Q

Gynaecomastia Mx [4]

A

Remove underlying cause
SERM eg Tamoxifen
Androgen therapy
Surgery: breast reduction

35
Q

Androgen therapy
MOA [2]
SE [3]

A
DANAXOL inhibits pituitary gonadotrophins; combines androgenic activity with anti-oestrogenic and anti-progesterogenic activity 
SE: 
- impaired glucose tolerance
- reduced spermatogenesis
- facial oedema