Breast cysts

Question 1

When a patient has suspected breast pathophysiology they will attend a specialist breast clinic. The basis of all breast investigations can be remembered using CRP. What does this relate to?

1 - clinical examination, relative history, path medical history
2 - clinical examination, radiology, pathology
3 - clinical examination, radiology, path medical history
4 - clinical examination, relative history, pathology

Answer 1

2 - clinical examination, radiology, pathology

• referred to as the triple assessment if lump is present

Question 2

When a patient has suspected breast pathophysiology they will attend a specialist breast clinic. During the clinical examination and history we ask about pain, and if it is cyclic or non cyclic. What does this mean?

1 - cyclic refers to pain that comes and goes in continuous pattern
2 - patient that cycles in line with circadian rhythm
3 - pain that is present during menstruation cycle

Answer 2

3 - pain that is present during menstruation cycle

• so non-cyclic pain is anything not involving menstruation

Question 3

If we locate a mass on the breasts, we must describe all of the following, EXCEPT?

1 - location
2 - size
3 - contour
4 - texture
5 - duration its been there

Answer 3

5 - duration its been there

Question 4

What % of women will experience breast pain at some point?

1 - 0.7%
2 - 7%
3 - 37%
4 - 70%

Answer 4

4 - 70%

Question 5

Breast pain can be categorised into various types. Which of the following is most common?

1 - cyclical
2 - non-cyclical
3 - extra-mammary
4 - intra-mammary

Answer 5

3 - extra-mammary

• essentially not breast related
• outside of breast tissue

Question 6

What % of breast lumps in women between 20-50 y/o are benign?

1 - 0.9%
2 - 9%
3 - 49%
4 - >90%

Answer 6

4 - >90%

• patients always think malignancy
• if lump is present we do triple therapy (CRP)

Question 7

There are a myriad of different benign breast lumps. A fibroadenoma is a firm and mobile mass common in young women. What is a fibroadenoma?

1 - glandular and stromal tissue (fat)
2 - fluid filled sac lined by epithelial cells
3 - collection of pus lined by any types of cells
4 - fibrotic tissue around fluid filled sacs

Answer 7

1 - glandular and stromal tissue (fat)
- adenoma relates to glandular tissue

• same tissue as normal breast tissue, but contains more fibrous tissue

Question 8

There are a myriad of different benign breast lumps. A fibrocystic change is a mildly tender nodular breast, common in premenopausal women. What is a fibrocystic change?

1 - glandular and stromal tissue (fat)
2 - fluid filled sac lined by epithelial cells
3 - collection of pus lined by any types of cells
4 - fibrotic tissue around fluid filled sacs

Answer 8

4 - fibrotic tissue around fluid filled sacs

Question 9

There are a myriad of different benign breast lumps. A breast abscess is a painful and tender lump that can occur with skin changes. What is a breast abscess?

1 - glandular and stromal tissue (fat)
2 - fluid filled sac lined by epithelial cells
3 - collection of pus lined by any types of cells
4 - fibrotic tissue around fluid filled sacs

Answer 9

3 - collection of pus lined by any types of cells

Question 10

There are a myriad of different benign breast lumps. A galactocele is common in breastfeeding women.
What is a galactocele?

1 - glandular and stromal tissue (fat)
2 - fluid filled sac lined by epithelial cells
3 - a collection of breast milk
4 - fibrotic tissue around fluid filled sacs

Answer 10

3 - a collection of breast milk

Question 11

There are a myriad of different benign breast lumps. Fat necrosis is common following trauma. What is fat necrosis?

1 - glandular and stromal tissue (fat)
2 - necrosis of fat tissue due to trauma
3 - a collection of breast milk
4 - fibrotic tissue around fluid filled sacs

Answer 11

2 - necrosis of fat tissue due to trauma

Question 12

There are a myriad of different benign breast lumps. Which is the most common in a woman >40y/o?

1 - Fibroadenoma
2 - Breast cyst
3 - Fibrocystic changes
4 - Galactocele
5 - Fat necrosis
6 - Breast abscess

Answer 12

2 - Breast cyst

• generally drained if patient requests this

Question 13

There are a myriad of different benign breast lumps. Which is the most common in a woman <40y/o?

1 - Fibroadenoma
2 - Breast cyst
3 - Fibrocystic changes
4 - Galactocele
5 - Fat necrosis
6 - Breast abscess

Answer 13

1 - Fibroadenoma

Question 14

What is a cyst?

1 - pus filled collection lined by any type of cell
2 - fluid filled area lined by granulation tissue
3 - fluid filled area lined by epithelial cells

Answer 14

3 - fluid filled area lined by epithelial cells

• generated from terminal duct lobular unit

Question 15

When we find a lump in the breast tissue, it could be a cyst of the terminal duct of the the lobular unit. If we want to confirm a cyst and rule out cancer, what imaging modality would be appropriate?

1 - mammogram
2 - ultrasonography
3 - CT
4 - MRI

Answer 15

2 - ultrasonography

• can biopsy if still in doubt

Question 16

What is the peak age cystic ducts occur in women?

1 - 15-30 y/o
2 - 25-40 y/o
3 - 35-50 y/o
4 - >55 y/o

Answer 16

3 - 35-50 y/o

• most common in premenopausal women

Question 17

Which of the following is most likely to cause a breast cyst?

1 - trauma
2 - breast feeding
3 - smoking
4 - HRT

Answer 17

4 - HRT

• 66% on HRT will develop cyst
• BUT 69% resolve within 5 years

Question 18

Breast cysts have a myriad of characteristics including:

• can be painful and painless
• form as a solitary mass or a small cluster of microcysts
• can cause severe pain

What imaging modality can be used to identify if the mass if fluid filled or solid?

1 - ultrasound
2 - X-ray
3 - CT
4 - mammogram

Answer 18

1 - ultrasound

Question 19

How are the majority of cysts treated generally?

1 - conservative watch and wait
2 - core needle biopsy
3 - surgical excision

Answer 19

1 - conservative watch and wait

• can be aspirated where required
• monitored to make sure they do not become malignant