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Year 3 Surgery > Breast Conditions > Flashcards

Breast Conditions Flashcards

1
Q

What is a Fibroadenoma?

A 
Most common benign breast lesion
Affects women of reproductive age
Proliferation of stromal/epithelial tissue
Highly mobile
Well defined
Rubbery
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2
Q

What is an Adenoma?

A

Benign gladular tumour
Nodular
Mimics malignancy

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3
Q

What is a Papilloma?

A

40s-50s
Usually Sub-areolar
Bloody/clear nipple discharge
Requires biopsy

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4
Q

What is a Lipoma?

A

Soft/Mobile adipose tumour

Otherwise asymptomatic

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5
Q

What is a Phyllodes tumour?

A

Rare fibroepithelial tumour

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6
Q

As a rule, how do benign breast lumps present?

A

Mobile
Smooth Border
Multiple lumps are common

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7
Q

What does the triple assessment entail?

A

History and Examination
Imaging
Histology

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8
Q

What is Gynaecomastia?

A

A condition in which males develop breast tissue due to an imbalanced ratio of oestrogen and androgen activity

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9
Q

What are the common causes of Gynaecomastia?

A

Pathological

Physiological

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10
Q

How does Physiological Gynaecomastia present?

A

Adolescence, due to a delayed testosterone surge during puberty
Can also present in older patients due to declining testosterone levels

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11
Q

What are some Pathological causes of Gynaecomastia?

A

Lack of testosterone
Increased Oestrogen
Medication
Idiopathic

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12
Q

What are the clinical features of Gynaecomastia?

A

Insidious onset

Rubbery/Firm mass that starts under the nipple

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13
Q

What additional exam should you consider if you suspect the patient has Gynaecomastia?

A

Testicular exam

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14
Q

What is Pseudogynaecomastia?

A

Fat deposits in the breast that give the appearance of Gynaecomastia

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15
Q

What is Mastitis?

A

Inflammation of breast tissue, which can be acute or chronic

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16
Q

What are the common subtypes of Mastitis?

A

Lactational

Non-Lactational

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17
Q

What are the clinical features of Mastitis?

A

Tenderness
Swelling
Induration
Erythema over the area of infection

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18
Q

What is the management for Mastitis?

A

Empirical antibiotic therapy

Analgesia

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19
Q

What are Breast Cysts?

A

Epithelial-lined fluid-filled cavities which form when lobules become distended due to blockage

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20
Q

What are the clinical features of Breast Cysts?

A

Singular/Multiple Lumps
Distinct smooth masses
Tenderness

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21
Q

What is Mammary Duct Ectasia?

A

Dilation and shortening of the major lactiferous ducts

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22
Q

What are the clinical features of Mammary Duct Ectasia?

A

Coloured Green/Yellow Nipple Discharge
Palpable Mass
Nipple Retraction

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23
Q

What is Fat Necrosis?

A

Acute inflammatory response in the breast leading to ischaemic necrosis of fat lobules

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24
Q

What are some causes of Fat Necrosis?

A

Blunt trauma

Surgical/Radiological Intervention

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25
Q

What are the clinical features of Fat Necrosis?

A 
Asymptomatic
Lump
Fluid Discharge
Skin Dimpling
Pain
Nipple Inversion
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26
Q

What are Breast Carcinomas in Situ?

A

Malignancies contained within the basement membrane tissue

27
Q

What are the common types of Breast Carcinoma in Situ?

A

Ductal Carcinoma in Situ (DCIS)

Lobular Carcinoma in Situ (LCIS)

28
Q

What is DCIS?

A

Malignancy of breast tissue that is contained within the basement membrane

29
Q

What is the treatment for DCIS?

A

Excision of the affected area

30
Q

What is LCIS?

A

Malignancy of the secretory lobules of the breast

31
Q

What are the classifications of Invasive breast cancer?

A

Invasive Ductal Carcinoma
Invasive Lobular Carcinoma
Other Subtypes

32
Q

What are Risk Factors for Invasive Breast Cancer?

A 
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
33
Q

What are clinical features of invasive breast cancer?

A 
Symptomatic
Asymptomatic via Screening
Breast Lumps
Asymmetry
Swelling
Abnormal nipple discharge
Nipple retraction
Skin Changes
Mastalgia
34
Q

What is Pagets disease of the Nipple?

A

Rare condition presenting as roughening, reddening and ulceration of the nipple

35
Q

Histologically, what is Pagets Disease of the Nipple?

A

Involvement of the epidermis by malignant ductal carcinoma cells

36
Q

What are clinical features of Pagets disease of the nipple?

A 
Itching/Redness in the nipple/areola
Flaking/Thickened skin around the nipple
Painful and Sensitive
Flattened nipple 
\+/- Yellow/Bloody discharge
37
Q

What must be excluded with any presenting breast lump?

A

Breast Carcinoma

38
Q

How can breast lumps present?

A

Discrete Lumps
Generalised Swelling
Swellings behind the breast

39
Q

How can causes of discrete breast lumps be sub-classified?

A

Benign

Malignant

40
Q

What are some malignant causes of discrete breast lumps?

A

Carcinoma

Phyllodes Tumour

41
Q

What are some benign causes of discrete breast lumps?

A 
Fibroadenoma
Cyst
Duct ectasia
Sebaceous cyst
Galactocoele
Fat Necrosis
Lipoma
TB abscess
42
Q

What are some causes of generalised breast swelling?

A

Pregnancy
Lactation
Puberty
Mastitis

43
Q

What are some causes of swellings behind the breast?

A

Retromammary abscess
Tietze’s disease
Rib deformities
Chondroma of the costal cartilage

44
Q

What are some risk factors for breast carcinoma in the patient history?

A 
FHx
Nulliparous state
Early Menarche
Late menopause
Hx of Cystic Hyperplasia
45
Q

How can a breast carcinoma present?

A

Breast lump
Skin Dimpling
Nipple Retraction
Axillary swelling

46
Q

Where does breast carcinoma commonly metastasise to?

A

Brain
Bone
Liver
Lung

47
Q

What are some signs of metastatic breast cancer?

A

Jaundice - Liver involvement
Bone pain - Bone involvement
Confusion - Brain involvement
Breathlessness - Lung involvement

48
Q

What are some common causes of breast lumps in the pregnant/lactating woman?

A

Mastitis
Abscess
Galactocoele

49
Q

What is the most common cause of fat necrosis?

A

Breast Trauma

50
Q

How does Duct ectasia commonly present?

A

Aged >50
Retroareolar pain
Nipple retraction
Thick, creamy discharge

51
Q

How does a Fibroadenoma usually present?

A

Aged 15-25

Non-tender mobile swelling

52
Q

What may be found upon examination of a breast carcinoma?

A 
Hard irregular swelling fixed to skin/fixed deeper
Skin dimpling
Nipple retraction
Pagets disease of the nipple
Axillary Lymphadenopathy
Supraclavicular Lymphadenopathy
Hepatomegaly
Pathological fractures
53
Q

What may be found upon examination of a Phyllodes tumour?

A

Mobile mass, may become very large

54
Q

What may be found upon examination of a Fibroadenoma?

A

Smooth, rounded, mobile mass

55
Q

What is a Fibroadenoma also known as?

A

Breast mouse - very mobile

56
Q

What may be found upon examination of a breast cyst?

A

Smooth, mobile, possibly tender swelling

Generalised breast lumpiness

57
Q

What may be found upon examination of a Galactocoele?

A

Smooth, mobile swelling in the lactating breast

58
Q

What may be found upon examination of Fat Necrosis?

A

Hard irregular swelling, possibly with overlying bruising

59
Q

What may be found upon examination of a lipoma?

A

Soft, lobulated swelling

60
Q

What may be found upon examination of Duct Ectasia?

A

Tender retro-areolar area
Erythema
Nipple retraction
Thick, creamy discharge

61
Q

What may be found upon examination of a Sebaceous cyst?

A

Mobile swelling, fixed to skin

62
Q

What may be found upon examination of mastitis?

A

Enlarged, tender, hot breast

63
Q

What are some appropriate common investigations for a breast lump?

A

FBC
LFTs
Serum Ca
CXR

64
Q

What are some specific tests that can be used to diagnose a breast lump?

A 
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

Year 3 Surgery (10 decks)

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