Breast - Benign Disease

Question 1

Failure of development of the breast at puberty is uncommon- this is usually related to what condition?

Answer 1

Turner’s syndrome

Question 2

When is a fibroadenoma most likely to be diagnosed?

Answer 2

In the early reproductive years, most commonly the 3rd decade

Question 3

What are the 3 potential outcomes of a fibroadenoma?

Answer 3

1/3rd regress, 1/3rd stay the same, 1/3rd get bigger

Question 4

When should a fibroadenoma be excised?

Answer 4

If it is growing or changing, or if it is > 3cm

Question 5

Fibrocystic change can affect women of any reproductive age, but is most common when?

Answer 5

Aged 40-50

Question 6

What are the main symptoms of fibrocystic change?

Answer 6

A discrete lump or lumpy breasts, and cyclical pain

Question 7

What benign breast lesion is this describing: a circumscribed lesion composed of cell types normal to the breast but present in an abnormal proportion or distribution?

Answer 7

Hamartoma

Question 8

Why may sclerosing lesions of the breast mimic carcinoma?

Answer 8

Because the mass can feel irregular and they are histologically similar

Question 9

Which sclerosing lesions of the breast are not malignant per se but may show epithelial proliferation, and in situ or invasive carcinomas may occur within them?

Answer 9

Radial scar and complex sclerosing lesion

Question 10

What is the difference between a radial scar and a complex sclerosing lesion?

Answer 10

Radial scar = 1-9mm, complex sclerosing lesion = > 9mm

Question 11

What treatment is required for sclerosing lesions of the breast?

Answer 11

Excision

Question 12

What is usually the cause of fat necrosis of the breast? What medication may be implicated?

Answer 12

Local trauma / warfarin

Question 13

How does fat necrosis usually present?

Answer 13

A hard, painless lump

Question 14

What is the biggest risk factor for developing duct ectasia?

Answer 14

Smoking

Question 15

When does duct ectasia typically occur?

Answer 15

Around the menopause

Question 16

Breast pain, bloody and/or purulent nipple discharge and nipple retraction/distortion are features of what benign breast condition?

Answer 16

Duct ectasia

Question 17

Which benign breast condition may be described as feeling like a ‘bag of worms’?

Answer 17

Duct ectasia

Question 18

What are the two main aetiologies behind acute mastitis and breast abscess?

Answer 18

Lactation and duct ectasia

Question 19

Lactational mastitis or breast abscess is most likely to be caused by which organism?

Answer 19

Staph Aureus

Question 20

How should breast mastitis be treated? What additional treatment is required for a breast abscess?

Answer 20

Antibiotics (usually flucloxacillin) / aspiration or incision and drainage is also required for an abscess

Question 21

What is the advice given regarding breastfeeding to women with lactational mastitis or breast abscess?

Answer 21

Continue breastfeeding

Question 22

If a case of mastitis is unresponsive to antibiotic therapy, and is spread all over the breast, what other diagnosis must be considered?

Answer 22

Inflammatory breast cancer

Question 23

What are some measures which may improve cyclical mastalgia?

Answer 23

A firm, well-fitting bra, exercise, evening primrose oil

Question 24

What may be a useful treatment for non-cyclical mastalgia?

Answer 24

Topical NSAIDs

Question 25

What is the most likely diagnosis for the development of a firm, vertical, cord-like structure after breast trauma?

Answer 25

Mondor’s disease (phlebitis of superficial veins)

Question 26

How is Mondor’s disease managed?

Answer 26

It will usually resolve spontaneously in 8-12 weeks

Question 27

What may differentiate a Phyllodes tumour from a fibroadenoma?

Answer 27

Occurs in older women and is often larger

Question 28

How should a Phyllodes tumour be treated?

Answer 28

Excision with 1cm margins

Question 29

Why should those who have had a Phyllodes tumour be closely followed up?

Answer 29

They are prone to local recurrence

Question 30

How do intraductal papillomas usually present?

Answer 30

Nipple discharge which may or may not be bloody

Question 31

How should breast papillomas be treated?

Answer 31

Excision with 1cm margins