Breast Differentials Flashcards
What is gynaecomastia?
Development of breast tissue in males due to imbalance of oestrogen and androgen activity.
What is the relationship between gynaecomastia and breast cancer?
1% of gynaecomastis cases develop into breast cancer
What is the epidemiology of gynaecomastia?
Common condition - atleast 1/3 of men - usually entirely reversible.
Often confused with pseudogynaecomastia (breast growth due to adipose tissue in obestiy)
What are the common causes of physiological gynaecomastia?
Adolescene most common - delayed testosterone surge during puberty
Older population - decrease testosterone
What are the potential causes of pathological gynecomastia?
Changes in oestorgen:androgen activity
Lack of testosterone - renal disease, testicular atrophy, Klinefelter syndrome, androgen insensitivity
Increased oestrogen - liver disease, hyperthyroidism, obsetiy, adrenal tumours or testicular tumours.
Medication - digoxin, metronidazole, spironolcatone, chemo, gosereline, antipsychotics, anabolic steroids
Idiopathic
What are the clinical features of gynaecomastia?
Insidious
Rubbery or firm mass norm >2cm starting underneath the nipple and spread outwards
What investigations should be taken for gynaecomastia?
Screen for malignancy, triple assessment (weight loss, FIT test etc)
Liver and renal function (U&Es, LFTs)
Hormone profile - LH and testosterone
How does analysisng LH and testosterone level results suggest the cause of gynaecomastia is?
High LH and low testotserone - testicular failure
Low LH and low testosterone - increased oesotrogen
High LH and high testosterone - androgen resistance or gonadotrophin-secreting malignancy.
What are the different types of benign tumours that can be found in the breast?
Fibroadenoma - glandula and stromal tissue
Adenoma - epithelial tissue
Papilloma - norm derived from epidermis
Lipoma - adipose tissue
Phyllodes tumour - stromal tissue
What are the common features of fibroadenoma?
Most common benign growth
Women of reporductive age
Proliferation of stromal and epithelial tissue of duct lobules
Highly mobile, well-defined and rubbery
Multiple and bilateral (can be)
Very low malignant potential, some get smaller over years.
What are some common non-cancerous breast lumps?
Fibroadenoma
Fibrocystic changes
Breast cyst
Galactocele
Breast abscess
At what age are certain breast lumps the most common?
15-30 fibroadenoma (decline with age)
30-45 - fibrocystic changes
45-55 - breast cyst (peak at menopause)
55+ cancer most likely (post-menopause)
Absecc - may occur in 20s then rate declines
What is a fibroadenoma?
What are its key features?
Benign breast tumour made of fibrous tissue arising from breast lobules
Most common in young women 20-40years.
Is sensitive to oestrogen, so varies in size during menstraul cycle, grows during pregnancy and regress after menopause.
NOT associated with an increased risk of breast cancer
What are the clinical features of a fibroadenoma?
Well defined/circumscribed
Smooth, mobile mass
Non-tender
Usually solitary
Solid mass
What is the management for a fibroadenoma?
Observation
Excision considered if very large, uncertain diagnosis or psychological reasons.
What is meant by fibrocystic changes in the breast?
What are the most common features?
Increased tissue fibrosity and density with cystic changes results in “generalised lumpiness to the breast”
Normal variation
Related to increased hormonal sensitivity - fluctuate with the menstraul cycle
Common in menstruating age
Usually improves or resolves after menopause.
What are the symptoms of a fibrocystic change within the breast?
Lumpiness
Mastalgia (pain/tenderness)
Fluctuation of breast size
What is the management of fibrocystic changes in the breast?
Exclude cancer
Manage symptoms aka analgesia, supportive bra, heat compress
What is a breast cyst?
What are its common features?
Benign, single lump, fluid filled
Common in women aged 30-50yrs. (perimenopausal), less common post menopausal.
What are the features of a breast cyst on examination?
Smooth
Well-circumscribed/defined
Mobile
May be tender
How can you differentiate between a fibroadenoma and a breast cysts?
USS - determine if solid or fluid filled
What is the management for a breast cyst?
Monitor
Exclude cancer
If very large/painful consider aspiration
What is a galactocele?
Breast cyst filled with breast milk
Occurs when the lactiferous duct is blocked
Therefore occurs exclusively in lactating patients.
How does a galactocele typically present on examination?
Firm
Mobile
Usually painless
Often around the areolar area
What is the typical management of a galactocele?
Observe - usually resolve without any treatment
Can be aspirated
If becomes infected adminster antibiotics
What is a breast abscess?
What are its common features?
Contain collections of pus
Common in lactating women
Can be caused by trauma (e.g piercings) or a result of underlying breast disease e.g invasive cancer.
What are the features of a breast abscess on clinical examination?
Acute onset
Tender lump
Localised swelling
Warm
Erythema
Nipple discharge
+/- systemic features (fever)
