breast- benign Flashcards
what is used to assess patient suspected of cancer?
Triple assessment:
-Clinical (history + exam)
-Imaging (mammogram or US)
-Cellular pathology (sample)
what are the classifications of breast cytopathology?
C1- unsatisfactory
C2- benign
C3- atypia (probs benign)
C4- atypia (suspiscious of mailgnancy)
C5- malignant
what type of biopsy is normally diagnostic?
-(14 gage needle) core biopsy
-vacuum assisted biopsy
-skin biopsy
-incisional biopsy of mass
enlarged breasts - what?
gynaecomastia
causes- gynaecomastia?
-exogenous/ endogenous hormones
-cannabis
-prescription drugs
-liver disease
what are fibrocystic changes?
Breast changes that fluctuate with menstrual cycle
Very common
whaen do fibrocystic breast changes tend to stopp?
after menopause
(usually are happening due to breasts naturally changing over period)
presentation of fibrocystic changes?
-Smooth discrete lumps
-Sudden pain
-Cyclical pain
-Lumpiness, rope like feeling
macroscopic findings of fibrocystic changes?
Cysts found
1mm - several cm
Blue domed with pale fluids
intervening fibrosis
management of fibrocystic changes?
-exclude malignancy and reassure patient its normal
what a hamartoma?
Circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution
‘Myoid’ rider
benign!
is fibroadenoma benign or malignant?
benign
describe presentation of fibroadenoma?
‘breast mouse’
painless, film, discrete and mobile mass
solid on USS
pathological features of fibroadenoma?
-circumscribed
-rubbery
-grey white
-biphasic tumour of epithelium and stroma
management of fibroadenoma?
-diagnose
-reassure
-excise
examples of benign slcerosing lesions?
-sclerosing adenosis
-radial scar/ complex sclerosing lesion
describe sclerosing lesions
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)
presentation of slcerosing adenosis?
usually 20-70
-pain, tenderness, thickening of breast
-may be asymptomatic
features of radial scar?
-fibro elastotic core
-radiating fibrosis containing distorted doctules
-fibrocystic changes and epithelial proliferation
management of radial scar?
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)
examples of inflammatory breast lesions?
-fat necrosis
-duct ectasia
-acute mastitis/ abscess
what causes fat necrosis?
-local trauma e.g. seat belt injury or fall
-Warfarin therapy
Management of fat necrosis?
confirm diagnosis and exclude malignancy
what increases chances of duct ectasia?
smoking
presentation of duct ectasia?
-pain
-bloody and/or purulent discharge
-fistulation
-nipple retraction and distortion
-acute episodic inflammatory changes
pathologicala features of duct ectasia?
-periductal inflammation
-periductal fibrosis
-scarring and distortion
what causes acute mastitis/ abscess?
either from:
Lactation (more common)
-staph aureus
-strep pyogenes
Non lactational (Duct Ectasia)
-smoking is big risk
-mixed organisms
presentation of breast mastitis?
-tenderness
-swelling
-erythema
-fever
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
describe presentation of phyllodes tumour?
-slow growing unilateral breast mass
intraductal papilloma?
-nipple discharge +/- blood
-nodules and calcification
usually 35-60 years
management of intraductal papilloma?
-depends on symptoms/ wishes/ associations
-vacuum excision
age of getting mammogram and USS?
USS <40 (pre menopausal)
mammogram >40 (post menopausal)
most common cause of brown/ green discharge?
duct ectasia
