Breast: Breast Lumps

Question 1

Name the 4 most common diagnoses for breast lumps.

Answer 1

1. Benign cystic change (fibrocystic change): benign collection of fibrous tissue +/- cysts
2. Fibroadenoma: benign breast tumour made up of stromal and epithelial tissue
3. Cyst: benign fluid-filled sac
4. Carcinoma

Question 2

What type of breast lumps are common in lactating women?

Answer 2

• abscess
• galactocoele: firm mass caused by obstruction of lactiferous duct which becomes distended with milk and epithelial cells
• mastitis: usually caused by skin commensals like S. aureus or S. epidermis

Question 3

What is the likely diagnosis if the lump appeared very fast? Slow?

Answer 3

Fast: abscess or cyst
Slow: fibroadenoma or carcinoma

Question 4

Trauma (e.g. injury, cyst aspiration) predisposes to what type of breast lump?

Answer 4

fat necrosis

Question 5

If the lump is painful, what diagnoses are more likely?

Answer 5

• benign cystic change
• acute mastitis
• abscesses
• cysts

Question 6

What is the likely diagnosis if a lady presents with discharge that is:

• bloody
• serous/serosanguinous
• green/brown/yellow
• milky?

Answer 6

• bloody: carcinoma
• serous: intraductal papilloma
• green/brown/yellow: periductal mastitis
• milky: galactocoele

Question 7

Lump feels:

• irregular surface
• indistinct contours
• mixed consistency
• immobile
• not fixed

Diagnosis?

Answer 7

benign cystic change

Question 8

Lump feels:

• smooth surface
• distinct contours
• firm-lax consistency
• immobile
• not fixed

Diagnosis?

Answer 8

solitary cyst

Question 9

Lump feels:

• irregular surface
• indistinct contours
• hard consistency
• immobile
• maybe fixed

Diagnosis?

Answer 9

carcinoma

Question 10

Lump feels:

• smooth surface
• distinct contours
• rubbery consistency
• mobile
• not fixed

Diagnosis?

Answer 10

fibroadenoma (breast mouse)

Question 11

A pt presents with a breast lump. How would you investigate?

Answer 11

Triple assessment:

1. clinical examination
2. radiological examination
   - USS if <35yrs (breast tissue too dense for mammography)
   - 2-view mammogram (+/- USS) if >35yrs
3. fine needle aspiration or core biopsy: FNA provides info on cell type/dysplasia whilst core biopsy also informs on local architecture

Question 12

How would you manage a pt with fibroadenoma?

Answer 12

1. Conservative: reassure Pt maj. of fibroadenomas resolve over several years and pose no increased risk of malignancy.
2. Excisional biopsy: if pt preference, lump increasing in size, lump causing discomfort.

Question 13

How should a pt with a breast abscess be treated?

Answer 13

• antibiotics

- surgical drainage or aspiration

Question 14

Suggest possible causes for gynaecomastia.

Answer 14

1. physiological/hormonal fluctuations
2. liver disease
3. drugs, e.g. cimetidine, spironolactone, phenothiazines, finasteride, anabolic steroids
4. primary testicular failure, e.g. anorchia, bilateral cryptorchidism
5. acquired testicular failure, e.g. mumps orchitis
6. secondary testicular failure, e.g. panhypopituitarism
7. endocrine tumours, E.g. testicle, adrenal, pituitard
8. non-endocrine tumours, e.g. bronchial carcinoma