Breast Disease Flashcards
Describe normal breast tissue in general.
Modified sweat glands
Non-functional except during lactation
Lobules = acini and intralobular stroma
Describe the physiological breast changes that a women goes through.
Prepubertal breast - few lobules (before puberty male and female breasts are identical)
Menarche - increase in number of lobules, increased volume of interlobular stroma
Menstrual cycle - follicular phase lobules quiescent, after ovulation cell proliferation and stromal oedema, with menstruation see decrease in size of lobules
Pregnancy - increase in size and number of lobules, decrease in stroma, secretory changes
Cessation of lactation - atrophy of lobules but not to former levels
Increasing age - terminal duct lobular units (TDLUs) decrease in number and size, interlobular stroma replaced by adipose tissue (mammograms easier to interpret)
What are the general clinical presentation of breast conditions?
Pain Palpable mass Nipple discharge Skin changes Lumpiness
Mammographic abnormalities
What sort of pain presentation will someone with a breast disease present with?
May be cyclical and diffuse, in which case often physiological
Non-cyclical and focal - ruptured cysts, injury, inflammation
Occasionally presenting complaint in breast cancer
Tell me about palpable masses found in breasts.
May represent normal nodularity Most worrying if hard, craggy and fixed Causes include: - Invasive carcinomas - Fibroadenomas - Cysts No woman should be allowed to have a lump in the breast without a firm diagnosis
Tell me about nipple discharge.
Most concerning if spontaneous and unilateral
Milky - endocrine disorders e.g. pituitary adenoma; side effect of medication e.g. OCP
Bloody or serous - benign lesions e.g. papilloma, duct ectasia; occasionally malignant lesions
Tell me about mammographic abnormalities.
Found during mammographic screening
Easier to detect lesions in breasts of older women
Women between 47-73 years invited every 3 years
Worrying findings include densities and calcifications
- Densities - invasive carcinomas, fibroadenomas, cysts
- Calcifications - ductal carcinoma in situ (DCIS), benign
changes
Tell me about the incidence of breast conditions in general.
Breast symptoms and signs are common
Most breast symptoms and signs will be benign
Fibroadenoma most common benign tumour
Breast cancer most common non-skin malignancy in women
Mammographic screening increases detection of small invasive tumours and in situ carcinomas
Give the incidence of fibroadenomas.
Can occur at any age during reproductive period
Often
Give the incidence of breast cancer.
Rare before 25 years (except for some familial cases) Incidence rises with age 77% occurs in women >50 years Average age at diagnosis is 64 years In UK: - 45,500 new female cases and 300 new male cases a year - 12,500 deaths per year
What are general types of pathological conditions of the breast?
Disorders of development Inflammatory conditions Benign epithelial lesions Stromal tumours Gynaecomastia Breast carcinoma
Give an example of a disorder of development.
Milk line remnants - polythelia (third nipple), accessory axillary breast tissue (and potential breast tissue malignancies associated)
Name some inflammatory conditions of the breast.
Acute mastitis
Fat necrosis
Describe acute mastitis.
Almost always occurs during lactation
Usually Staphylococcus aureus infection from nipple cracks and fissures
Erythematous painful breast, often pyrexia
May produce breast abscesses
Usually treated by expressing milk and antibiotics
Describe fat necrosis.
Present as a mass, skin changes or mammographic abnormality (can be misinterpreted as cancer)
Often history of trauma or surgery
Can mimic carcinoma clinically and mammographically
