breast- benign

Question 1

what is used to assess patient suspected of cancer?

Answer 1

Triple assessment:
-Clinical (history + exam)
-Imaging (mammogram or US)
-Cellular pathology (sample)

Question 2

what are the classifications of breast cytopathology?

Answer 2

C1- unsatisfactory
C2- benign
C3- atypia (probs benign)
C4- atypia (suspiscious of mailgnancy)
C5- malignant

Question 3

what type of biopsy is normally diagnostic?

Answer 3

-(14 gage needle) core biopsy
-vacuum assisted biopsy
-skin biopsy
-incisional biopsy of mass

Question 4

enlarged breasts - what?

Answer 4

gynaecomastia

Question 5

causes- gynaecomastia?

Answer 5

-exogenous/ endogenous hormones
-cannabis
-prescription drugs
-liver disease

Question 6

what are fibrocystic changes?

Answer 6

Breast changes that fluctuate with menstrual cycle

Very common

Question 7

whaen do fibrocystic breast changes tend to stopp?

Answer 7

after menopause
(usually are happening due to breasts naturally changing over period)

Question 8

presentation of fibrocystic changes?

Answer 8

-Smooth discrete lumps
-Sudden pain
-Cyclical pain
-Lumpiness, rope like feeling

Question 9

macroscopic findings of fibrocystic changes?

Answer 9

Cysts found
1mm - several cm
Blue domed with pale fluids

intervening fibrosis

Question 10

management of fibrocystic changes?

Answer 10

-exclude malignancy and reassure patient its normal

Question 11

what a hamartoma?

Answer 11

Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution

‘Myoid’ rider

benign!

Question 12

is fibroadenoma benign or malignant?

Answer 12

benign

Question 13

describe presentation of fibroadenoma?

Answer 13

‘breast mouse’

painless, film, discrete and mobile mass

solid on USS

Question 14

pathological features of fibroadenoma?

Answer 14

-circumscribed
-rubbery
-grey white
-biphasic tumour of epithelium and stroma

Question 15

management of fibroadenoma?

Answer 15

-diagnose
-reassure
-excise

Question 16

examples of benign slcerosing lesions?

Answer 16

-sclerosing adenosis
-radial scar/ complex sclerosing lesion

Question 17

describe sclerosing lesions

Answer 17

bening, disorderly proliferation of acini and stroma

-can cause a mass or calcification
-may mimic carcinoma

(acini are responsible for milk secretion in terminal ductual lobular unit TDLU)

Question 18

presentation of slcerosing adenosis?

Answer 18

usually 20-70

-pain, tenderness, thickening of breast
-may be asymptomatic

Question 19

features of radial scar?

Answer 19

-fibro elastotic core
-radiating fibrosis containing distorted doctules
-fibrocystic changes and epithelial proliferation

Question 20

management of radial scar?

Answer 20

Triple assessment:
-Clinical (history + exam)
-USS/ mammogram (can mimic carcinoma on radiogram)
-Biopsy (no atypia)

Excise or sample extensively by vacuum biopsy/ excision (will show no atypia)

Question 21

examples of inflammatory breast lesions?

Answer 21

-fat necrosis
-duct ectasia
-acute mastitis/ abscess

Question 22

what causes fat necrosis?

Answer 22

-local trauma e.g. seat belt injury or fall
-Warfarin therapy

Question 23

Management of fat necrosis?

Answer 23

confirm diagnosis and exclude malignancy

Question 24

what increases chances of duct ectasia?

Answer 24

smoking

Question 25

presentation of duct ectasia?

Answer 25

-pain
-bloody and/or purulent discharge
-fistulation
-nipple retraction and distortion
-acute episodic inflammatory changes

Question 26

pathologicala features of duct ectasia?

Answer 26

-periductal inflammation
-periductal fibrosis
-scarring and distortion

Question 27

what causes acute mastitis/ abscess?

Answer 27

either from:
Lactation (more common)
-staph aureus
-strep pyogenes

Non lactational (Duct Ectasia)
-smoking is big risk
-mixed organisms

Question 28

presentation of breast mastitis?

Answer 28

-tenderness
-swelling
-erythema
-fever

Answer 29

if caused by lactational cause (staph aureus + strep pyogenes):
-Continue breast feeding
-heat packs
-if an abscess drain
Antibiotics: flucloaxicillin and erythromycin if penicillin allergic

Question 30

describe presentation of phyllodes tumour?

Answer 30

-slow growing unilateral breast mass

Question 31

intraductal papilloma?

Answer 31

-nipple discharge +/- blood
-nodules and calcification

usually 35-60 years

Question 32

management of intraductal papilloma?

Answer 32

-depends on symptoms/ wishes/ associations
-vacuum excision

Question 33

age of getting mammogram and USS?

Answer 33

USS <40 (pre menopausal)

mammogram >40 (post menopausal)

Question 34

most common cause of brown/ green discharge?

Answer 34

duct ectasia