Breast Conditions

Question 1

Describe the condition of mastitis:

Answer 1

Acute inflammation of the breast, usually caused by staph or strep entering cracked nipple tissue

(Infection proliferates in stagnant breast milk and can cause abscess)

SSX:

• hard, painful & inflamed breasts
• axillary lymphadenopathy

Treatment:

• antibiotics
• if abscess: incision & drainage

Question 2

Describe the condition of traumatic fat necrosis

Answer 2

Necrosis and granulation of adipose tissue caused by traumatic rupture of adipocyte cells

Presentation:

• can calcify & mimic presentation of a breast tumour
• can cause nipple retraction or skin fixation due to fibrous tethering

Incidence:
- more common in large, fatty breasts

Treatment:
- screening to rule out tumour

Question 3

What are the different types of mammary dysplasia?

Answer 3

1. Cyst formation
   - dilation of ducts secondary to obstruction
2. Epitheliosis
   - hyperplasia of ductal epithelium
   - increased risk of breast cancer
3. Adenosis
   - enlargement of lobules
   - associated with menstruation & pregnancy
4. Fibrosis
   - accumulation of fibrous tissue can result in a hard painless lump
   - associated with ageing

Question 4

Describe the condition of mammary dysplasia:

Answer 4

• lumps in breast

4 types:

• cyst formation
• epitheliosis (hyperplasia of ductal epithelium)
• adenosis (enlargement of lobules)
• fibrosis (accumulation of fibrous tissue)

Incidence:

• common between puberty and menopause
• linked to menstrual cycle

SSX:

• breast tenderness
• palpable lump (adenosis or fibrosis)
• painless swelling or local hardening (epitheliosis)

Question 5

What are the differentials for a hard, painless lump?

Answer 5

Carcinoma (malignancy)
Fatty necrosis
Fibrosis (mammary dysplasia)

Question 6

What are the differentials for a tender mass?

Answer 6

Mastitis
Adenosis (mammary dysplasia)
Cyst formation (mammary dysplasia - ruptured cyst)

Question 7

What are the differentials for breast swelling?

Answer 7

Adenosis (mammary dysplasia) - can be painful or painless

Epitheliosis (mammary dysplasia) - painless

Question 8

What are the 3 different types of breast carcinoma and their definitions?

Answer 8

Non-invasive (tumours have not crossed basement membrane of epithelium) - can be ductal carcinoma in situa or lobular carcinoma in situ

Invasive
(tumours have crossed basement membrane) - invasive ductal carcinoma or invasive lobular carcinoma

Metastatic spread
(carcinogenic cells have spread through the lymphatic or circulatory systems)

Question 9

What is the difference between breast neoplasia and breast carcinoma?

Answer 9

Neoplasia = new cell growth (can be benign or carcinogenic)

Carcinoma = cancer cells in breast (non-invasive, invasive or metastatic)

Question 10

What is the most common breast carcinoma?

Answer 10

Invasive ductal carcinoma (80% of all breast cancers)

Question 11

What are the symptoms of breast carcinoma?

Answer 11

Often asymptomatic and not palpable

SSX:

• hard firm lump with irregular margins
• axillary node enlargement (hard and fixed)
• nipple retraction / puckering
• nipple discharge
• skin colour change
• systemic SSX including weight loss, malaise, fever, loss of appetite

Question 12

What are the treatment options for breast carcinoma?

Answer 12

Surgery:

• lumpectomy
• masectomy

Treatment:

• chemotherapy
• radiotherapy

Hormonal:

• LHRH blockers
• oestrogen receptor antagonists
• aromatase inhibitors
• monoclonal antibody therapy

Question 13

What are the risk factors for breast carcinoma?

Answer 13

age
previous or family Hx
genetics
mammary dysplasia (especially epitheliosis)
lifestyle & hormonal factors

Question 14

Which type of mammary dysplasia is associated with a higher risk of breast cancer?

Answer 14

Epitheliosis

Question 15

What are the 3 types of breast neoplasia?

Answer 15

Benign tumours

• fibroadenoma
• papilloma

Primary malignant

• carcinoma
• sarcoma

Secondary malignant
- cancer that has spread to the breast tissue from elsewhere

Question 16

What is the difference between a sarcoma and a carcinoma?

Answer 16

Carcinoma = cancerous cells grown from epithelial tissue (90%)

Sarcoma = cancerous cells grown from non-epithelial tissue (usually connective) (10%)

Question 17

What are the 2 types of benign breast tumours, and the 5 types of malignant breast tumours?

Answer 17

Benign:

• fibroadenoma
• papilloma

Malignant:

• DCIS (ductal carcinoma in situ)
• LCIS (lobular carcinoma in situ)
• invasive ductal carcinoma
• invasive lobular carcinoma
• secondary malignant

Question 18

What is the difference between a fibroadenoma and a papilloma?

Answer 18

Both benign tumours (breast neoplasia)

Fibroadenoma = epithelial tissue supported by connective tissue matrix

Papilloma = tumour in the duct formed by gland and fibrous tissue

Question 19

what is the difference between a fibrosis and a fibroadenoma?

Answer 19

Fibrosis = type of mammary dysplasia where accumulated fibrous tissue causes a hard, painless lump
- hard to palpate

Fibroadenoma = a type of benign tumour composed of epithelial tissue & connective tissue stroma
- elastic & non-fixed to palpate

Question 20

What are the basic actions of the 4 medications used to treat breast cancer?

Answer 20

1. LHRH blockers
   - block luteinising hormone releasing hormone
2. Oestrogen receptor antagonists
   - block uptake of oestrogen
3. Aromatase inhibitors
   - block the release of oestrogen
4. Monoclonal antibody therapy
   - used for HER2 (human epidermal growth factor) cancer
   - antibodies target HER2 receptors