Breast Conditions Flashcards
What is a Fibroadenoma?
Most common benign breast lesion Affects women of reproductive age Proliferation of stromal/epithelial tissue Highly mobile Well defined Rubbery
What is an Adenoma?
Benign gladular tumour
Nodular
Mimics malignancy
What is a Papilloma?
40s-50s
Usually Sub-areolar
Bloody/clear nipple discharge
Requires biopsy
What is a Lipoma?
Soft/Mobile adipose tumour
Otherwise asymptomatic
What is a Phyllodes tumour?
Rare fibroepithelial tumour
As a rule, how do benign breast lumps present?
Mobile
Smooth Border
Multiple lumps are common
What does the triple assessment entail?
History and Examination
Imaging
Histology
What is Gynaecomastia?
A condition in which males develop breast tissue due to an imbalanced ratio of oestrogen and androgen activity
What are the common causes of Gynaecomastia?
Pathological
Physiological
How does Physiological Gynaecomastia present?
Adolescence, due to a delayed testosterone surge during puberty
Can also present in older patients due to declining testosterone levels
What are some Pathological causes of Gynaecomastia?
Lack of testosterone
Increased Oestrogen
Medication
Idiopathic
What are the clinical features of Gynaecomastia?
Insidious onset
Rubbery/Firm mass that starts under the nipple
What additional exam should you consider if you suspect the patient has Gynaecomastia?
Testicular exam
What is Pseudogynaecomastia?
Fat deposits in the breast that give the appearance of Gynaecomastia
What is Mastitis?
Inflammation of breast tissue, which can be acute or chronic
What are the common subtypes of Mastitis?
Lactational
Non-Lactational
What are the clinical features of Mastitis?
Tenderness
Swelling
Induration
Erythema over the area of infection
What is the management for Mastitis?
Empirical antibiotic therapy
Analgesia
What are Breast Cysts?
Epithelial-lined fluid-filled cavities which form when lobules become distended due to blockage
What are the clinical features of Breast Cysts?
Singular/Multiple Lumps
Distinct smooth masses
Tenderness
What is Mammary Duct Ectasia?
Dilation and shortening of the major lactiferous ducts
What are the clinical features of Mammary Duct Ectasia?
Coloured Green/Yellow Nipple Discharge
Palpable Mass
Nipple Retraction
What is Fat Necrosis?
Acute inflammatory response in the breast leading to ischaemic necrosis of fat lobules
What are some causes of Fat Necrosis?
Blunt trauma
Surgical/Radiological Intervention
What are the clinical features of Fat Necrosis?
Asymptomatic Lump Fluid Discharge Skin Dimpling Pain Nipple Inversion
What are Breast Carcinomas in Situ?
Malignancies contained within the basement membrane tissue
What are the common types of Breast Carcinoma in Situ?
Ductal Carcinoma in Situ (DCIS)
Lobular Carcinoma in Situ (LCIS)
What is DCIS?
Malignancy of breast tissue that is contained within the basement membrane
What is the treatment for DCIS?
Excision of the affected area
What is LCIS?
Malignancy of the secretory lobules of the breast
What are the classifications of Invasive breast cancer?
Invasive Ductal Carcinoma
Invasive Lobular Carcinoma
Other Subtypes
What are Risk Factors for Invasive Breast Cancer?
Female sex Age BRCA1/2 mutations Family Hx in first degree relative Previous Benign disease Obesity Alcohol Early Menarche Late Menopause Nulliparous Women Oral Contraception HRT
What are clinical features of invasive breast cancer?
Symptomatic Asymptomatic via Screening Breast Lumps Asymmetry Swelling Abnormal nipple discharge Nipple retraction Skin Changes Mastalgia
What is Pagets disease of the Nipple?
Rare condition presenting as roughening, reddening and ulceration of the nipple
Histologically, what is Pagets Disease of the Nipple?
Involvement of the epidermis by malignant ductal carcinoma cells
What are clinical features of Pagets disease of the nipple?
Itching/Redness in the nipple/areola Flaking/Thickened skin around the nipple Painful and Sensitive Flattened nipple \+/- Yellow/Bloody discharge
What must be excluded with any presenting breast lump?
Breast Carcinoma
How can breast lumps present?
Discrete Lumps
Generalised Swelling
Swellings behind the breast
How can causes of discrete breast lumps be sub-classified?
Benign
Malignant
What are some malignant causes of discrete breast lumps?
Carcinoma
Phyllodes Tumour
What are some benign causes of discrete breast lumps?
Fibroadenoma Cyst Duct ectasia Sebaceous cyst Galactocoele Fat Necrosis Lipoma TB abscess
What are some causes of generalised breast swelling?
Pregnancy
Lactation
Puberty
Mastitis
What are some causes of swellings behind the breast?
Retromammary abscess
Tietze’s disease
Rib deformities
Chondroma of the costal cartilage
What are some risk factors for breast carcinoma in the patient history?
FHx Nulliparous state Early Menarche Late menopause Hx of Cystic Hyperplasia
How can a breast carcinoma present?
Breast lump
Skin Dimpling
Nipple Retraction
Axillary swelling
Where does breast carcinoma commonly metastasise to?
Brain
Bone
Liver
Lung
What are some signs of metastatic breast cancer?
Jaundice - Liver involvement
Bone pain - Bone involvement
Confusion - Brain involvement
Breathlessness - Lung involvement
What are some common causes of breast lumps in the pregnant/lactating woman?
Mastitis
Abscess
Galactocoele
What is the most common cause of fat necrosis?
Breast Trauma
How does Duct ectasia commonly present?
Aged >50
Retroareolar pain
Nipple retraction
Thick, creamy discharge
How does a Fibroadenoma usually present?
Aged 15-25
Non-tender mobile swelling
What may be found upon examination of a breast carcinoma?
Hard irregular swelling fixed to skin/fixed deeper Skin dimpling Nipple retraction Pagets disease of the nipple Axillary Lymphadenopathy Supraclavicular Lymphadenopathy Hepatomegaly Pathological fractures
What may be found upon examination of a Phyllodes tumour?
Mobile mass, may become very large
What may be found upon examination of a Fibroadenoma?
Smooth, rounded, mobile mass
What is a Fibroadenoma also known as?
Breast mouse - very mobile
What may be found upon examination of a breast cyst?
Smooth, mobile, possibly tender swelling
Generalised breast lumpiness
What may be found upon examination of a Galactocoele?
Smooth, mobile swelling in the lactating breast
What may be found upon examination of Fat Necrosis?
Hard irregular swelling, possibly with overlying bruising
What may be found upon examination of a lipoma?
Soft, lobulated swelling
What may be found upon examination of Duct Ectasia?
Tender retro-areolar area
Erythema
Nipple retraction
Thick, creamy discharge
What may be found upon examination of a Sebaceous cyst?
Mobile swelling, fixed to skin
What may be found upon examination of mastitis?
Enlarged, tender, hot breast
What are some appropriate common investigations for a breast lump?
FBC
LFTs
Serum Ca
CXR
What are some specific tests that can be used to diagnose a breast lump?
Fine Needle Aspirate and Cytology Mammography Open Excision and Biopsy USS - Better than mammo in young women CT Chest/Abdo and Head Genetic Testing - BRCA1 and BRCA2
