breast cyst Flashcards
definition of breast cyst
benign, fluid filled rounded lump,
aetiology of breast cyst
normally hormone dependent
reproductive history - abberation in normal development and higher cellular proliferation of breast epithelium may contribute to fibrocystic changes
RF for breast cyst
nulliparity
late menopause
oestrogen replacement therapy increases, however tamoxifen reduces prevalence
pathophysiology for breast cyst
association with reproductive and hormonal factors = cyclical nature of symptoms
dont correlate with increased risk of cancer - have to look at histology because different causes of fibrocystic disease = different risks
epidemiology of breast cyst
common >35yrs especially perimenopausal, can occur up to menopause
up to 50% women effected in lifetime
incidence increases with age
approx 7% women will present with palpable cyst in western world
Cysts account for around 15% of all discrete breast masses
They are uncommon after the menopause.
one-third of women will have a solitary cyst, one third will have between 2 and 5 cysts and one third will have more than 5.
About one-third of patients have cysts in both breasts.
sx of breast cysts
occasionally painful - premenstrual bilateral breast pain. Rarely pain can be unrelated to cycles - need to differentiate other causes of pain
may or may not be fluctuant
lump appears suddenly
diffuse symettrical lumpiness through both breasts
nipple discharge - bloody/watery, profuse and emanates from a single duct caused by ductal ectasia (part of the fibrocystic disease spectrum) and other things
signs of breast cysts
not fixed to surrounding tissue
smooth
mobile
not fixed to skin
ix of breast cyst
initial investigation: mammogram
- multiple smooth opacities consistent with cysts,
- characteristic halo
- smooth, round appearance,
- Often multiple and bilateral
US
- distinguish between solid and cystic lump
- cysts - transparent objects, well demarcated edges, posterior acoustic enhancement
FNA done if symptomatic or at first presentation for confirmation of diagnosis and reassurance - aspirate thrown away unless blood stained (then sent for cytology)
often incidental finding on screening
The proportion of cystic lumps which contain an intracystic carcinoma is relatively low and ultrasound is now of such high quality that it would be unusual to miss an intracystic carcinoma at ultrasound examination.
biopsy done if imaging inconclusive
