Breast Disease Flashcards
What are the lobules made up of in the breast?
Acini and intralobular stroma
What changes happen during menarche?
Increase in number of lobules and increased volume of interlobular structure
What changes happen to the breast throughout the menstrual cycle?
Follicular phase - lobules are inactive
After ovulation - cell proliferation and stromal oedema
Menstruation - decrease in the size of lobules
What is menarche?
First menstrual cycle/onset of puberty
How do the breasts change in pregnancy?
Increase in size and number of lobules
Decrease in stroma
Secretory changes
What changes happen to the breast after cessation of lactation?
Atrophy of lobules but not to former levels
How do breasts change with increasing age?
Terminal duct lobular units decrease in number and size
Interlobular stroma replaced by adipose tissue
What makes mammograms easier to interpret in older women?
The interlobular stroma is replaced by adipose tissue, makes lesions more clear
Clinical presentation of breast conditions?
Pain Palpable mass Nipple discharge Skin changes Lumpiness Mammographic abnormalities
What is physiological breast pain like?
Cyclical and diffuse
What is pathological breast pain like?
Possible causes?
Non-cyclical and focal
Ruptured cyst, injury, inflammation, breast cancer
What characteristics of a palpable mass make it worrying?
Hard
Craggy
Fixed
Causes of a palpable mass in the breast?
Invasive carcinoma
Fibroadenoma
Cyst
What makes nipple discharge more concerning?
Spontaneous and unilateral
What can cause milky discharge?
Endocrine disorders
-pituitary adenoma
Side effect of medication
-eg OCP
What can cause bloody or serous discharge?
Benign lesions eg
- papilloma
- duct ectasia
- occasionally malignant lesions
What is duct ectasia?
When the lactiferous duct becomes blocked or clogged
Between what ages are mammograms offered to women and how regularly?
47-73
Every 3 years
What may be some worrying findings on a mammogram and what could the signify?
Densities - invasive carcinoma, fibroadenoma, cyst
Calcifications - ductal carcinoma in situ, benign changes
What is the most common type of benign tumour of the breast?
Fibroadenoma
When do fibroadenomas normally occur?
At any age during reproductive period, often under 30
When are phyllodes tumours most common?
In 6th decade
What are some disorders of development of the breasts?
Milk line remnants - polythelia
Accessory axillary breast tissue
When does acute mastitis usually occur?
During lactation
What usually occurs in acute mastitis?
Staphylococcus aureus infection from nipple cracks and fissures
Signs and symptoms of acute mastitis?
Erythematous, painful breast
Pyrexia
Can get breast abscesses
How does fat necrosis of the breast normally present?
A mass, skin changes or mammographic abnormality
What is often in the history when there is fat necrosis?
Trauma or surgery
What can fat necrosis of the breast mimic?
Carcinoma - clinically and mammographically
How can a fibrocystic change present?
Mass or mammographic abnormality
Mass often disappears after fine needle aspiration if a cyst
How does a fibrocystic change present histologically?
Cyst formation
Fibrosis
Apocrine metaplasia
What can a fibrocystic change mimic?
Carcinoma - clinically and mammographically
Give some examples of stromal tumours
Fibroadenoma Phyllodes tumour Lipoma Leiomyoma Hamartoma
How do fibroadenomas present?
Mass, usually mobile - ‘breast mouse’ - mobile and elusive
May be multiple and bilateral
Can grow very large and replace most of breast tissue
Mammographic abnormality
What is a fibroadenoma?
Localised hyperplasia (rather than a true neoplasm)
What does a fibroadenoma look like macroscopically?
Well circumscribed
Rubbery
Greyish/white
What does a fibroadenoma look like histologically?
Mixture of stromal and epithelial elements
How do phyllodes tumours present?
Rare before 40
Masses or mammographic abnormality
Can be very large and involve the entire breast
What are the classifications of phyllodes tumours?
Benign
Borderline
Malignant (
Histological features of a phyllodes tumour?
Stroma more cellular and atypical than in fibroadenomas
Nodules of proliferating stroma covered by epithelium (phullon = leaf)
How do malignant phyllodes tumours behave?
Agressively
Recur locally
Metastasize by blood stream
What is gynaecomastia?
Enlargement of male breasts - bilateral or unilateral
When is gynaecomastia normally seen?
Puberty
In the elderly
What causes gynaecomastia?
Relative decrease in androgen effect or increase in oestrogen effect
Why does gynaecomastia happen in neonates?
Secondary to circulating maternal and placental oestrogens and progesterone
Why does gynaecomastia affect more than half of boys at puberty?
Oestrogen production happens peaks earlier than that of testosterone
Other causes of gynaecomastia?
Klinefelter’s syndrome
Oestrogen excess - cirrhosis of liver (oestrogen not metabolised effectively)
Gonadotrophin excess - functioning testicular tumour eg Leydig/Sertoli cell tumour, testicular germ cell tumours
Drug-related
What drugs can cause gynaecomastia?
Spironolactone Cimetidine Alcohol Marijuana Heroin Anabolic steroids (Chlorpromazine Digitalis)
