Breast - Benign Breast Lesions and Causes of Nipple Discharge

Question 1

Benign lumps - Fibroadenoma: features and treatment

Answer 1

Features

• Develop from a whole lobule
• Mobile, firm breast lumps (12% of all breast masses)
• No increase in risk of malignancy

Treatment

• If >3cm surgical excision is usual
• May be confused with Phyllodes tumour (very fast growing cystosarcoma) which needs rapid excision

Question 2

Benign lumps - Breast cyst: features and treatment

Answer 2

Features

• 7% of all western ladies will present with a breast cyst
• Usually presents as smooth discrete lump (may be fluctuant)
• Small increased risk of breast cancer (especially if younger)

Treatment

• Cysts should be aspirated
• Blood stained or persistent refill of cyst should be biopsies or excised

Question 3

Benign lumps - Epithelial hyperplasia: features and treatment

Answer 3

Features

• Variable clinical presentation ranging form generalised lumpiness through to discrete lump
• Disorder consists of increased cellularity of terminal lobular unit
• Atypical features and family history of breast Ca confers greatly increased risk of malignancy

Treatment

• If no atypical features, then conversation treatment
• those with atypical features: close monitoring or surgical resection

Question 4

Benign lumps - Fat necrosis: features and treatment

Answer 4

Features

• Up to 40% have traumatic Ae
• Physical features usually mimic carcinoma
• Mass may initially increase in size

Treatment
-Imaging and core biopsy

Question 5

Benign lumps - Duct papilloma: features and treatment

Answer 5

Features

• Wart-like lump that usually originates from a single milk duct.
• Usually present with nipple discharge
• Large papilloma may present with mass
• No increase risk of malignancy

Treatment
-Microdochectomy: surgical removal of lactiferous duct

Question 6

Mastitis: presentation, criteria for treatment and treatment

Answer 6

• Affects 1/10 breastfeeding women: women present with erythematous, painful and swollen breast.
• Treat if systemically unwell, nipple fissure present or symptoms do not improve after 12-24h effective milk removal/culture indicates infection
• 1st line Tx is 10-14 days flucloxacillin and continue breastfeeding/expressing during Tx

Question 7

Causes of nipple discharge - Galactorrhea

Answer 7

• Commonest cause may be response to emotional events
• Drugs: histamine receptor antagonists
• Prolactinomas

Question 8

Causes of nipple discharge - Mammary duct ectasia: definition and type of discharge

Answer 8

Duct ectasia: dilatation and shortening of terminal breast ducts within 3cm of nipple.

• Common, incidence increases with ages
• PC: nipple retraction, most common in menopausal women
• Discharge: thick and white in colour

*Can occur in younger smoking women (Periductal mastitis) where there are features of inflammation, abscess or mammary duct fistula with green discharge -abscess may need drainage.

Question 9

Causes of nipple discharge - carcinoma: type of discharge

Answer 9

• Often blood stained

- May be able to palpable underlying mass or lymphadenopathy

Question 10

Causes of nipple discharge - intraductal papilloma

Answer 10

• Growth of papilloma in a single duct
• Commoner in younger patients
• May cause blood stained discharge
• Usually no palpable lump