Breast Disease Flashcards
Describe normal breast tissue
Normal breast tissue contains modified sweat glands which are non-functional except during lactation. The Lobules = acini and interlobular stroma. Myoepithelial cells line both the acini and the ducts.
How does breast tissue change throughout a woman’s life
- Prepubertal breast – few lobules
- 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 and secretory changes
What happens when lactation ceases?
Cessation of lactation – atrophy of lobules but not to former levels. With increasing age terminal duct lobular units (TDLUs) decrease in number and size, interlobular stroma replaced by adipose tissue (mammograms easier to interpret).
Describe the common causes of breast pain
- May be cyclical and diffuse throughout the whole breast, in which case often physiological – menstrual cycle
- Non-cyclical and focal – ruptured cysts, injury, inflammation
- Occasionally presenting complaint in breast cancer
Describe the common causes of palpable masses
- May represent normal nodularity
- Most worrying if hard, craggy and fixed
- Causes include: Invasive carcinomas, fibroadenomas and cysts
- No woman should be allowed to have a lump in the breast without a firm diagnosis
What can cause nipple discharge
- Most concerning if spontaneous and unilateral
- Milky – endocrine disorders e.g. pituitary adenoma; side effect of medication e.g. contraceptives – often bilateral
- Bloody or serous – benign lesions e.g. papilloma, duct ectasia and occasionally malignant lesions
What worrying signs can be visible on mammograms?
Worrying findings include densities and calcifications
- Densities – invasive carcinomas, fibroadenomas, cysts
- Calcifications – ductal carcinoma in situ (DCIS), benign changes
Describe the most common breast diseases at different ages
Fibroadenomas – Can occur at any age during reproductive period – Often over 30s and is the most common finding with breast problems
Phyllodes tumours – most common in 6th decade – can be malignant.
Breast Cancer is rare before 25 unless familial condition. Most occur post 50.
What is polythelia
Milk line remnants – polythelia accessory axillary breast tissue anywhere along the milk lines
Describe acute mastitis
Acute mastitis – Almost always occurs during lactation, usually Staphylococcus aureus infection from nipple cracks and fissures causing erythematous painful breast, often pyrexical. May produce breast abscesses and can usually be treated by expressing milk and antibiotics.
What is fat necrosis
Fat necrosis – Presents as a mass, skin changes or mammographic abnormality. Often history of trauma or surgery and can mimic carcinoma clinically and mammographically.
What is fibrocystic breast disease/change?
This is a benign Epithelial Lesions referred to as fibrocystic change. It is the most common breast lesion presenting as a mass or mammographic abnormality. The mass often disappears after fine needle aspiration (FNA). Histologically there will be cyst formation, fibrosis and apocrine metaplasia. This can mimic carcinoma clinically and mammographically.
Describe fibroadenomas
Fibroadenomas present with a mass, usually mobile, or mammographic abnormality called a Breast mouse because it’s mobile and elusive. Can be multiple and bilateral and can grow very large and replace most of the breast. Macroscopically it is well circumscribed, rubbery, greyish/white. Histologically it is composed of a mixture of lots of stroma and squashed epithelial elements. Can mimic carcinoma clinically and mammographically. It is a localised hyperplasia rather than true neoplasm.
What are phyllodes tumours
Rare before 40 years old – Present as masses or as mammographic abnormalities. Benign, borderline and malignant types; most benign, less than 5% malignant. Can be very large and involve entire breast. Histologically it contains nodules of proliferating stroma covered by epithelium (phullon = leaf). Stroma more cellular and atypical than that in fibroadenomas – Need to be excised with wide margin or may recur. Malignant type behaves aggressively, recur locally and metastasise by blood.
What is gynaecomastia and what can cause it?
Enlargement of male breast. Unilateral or bilateral. Often seen at puberty and in the elderly. Caused by relative decrease in androgen effect or increase in oestrogen effect. Can mimic male breast cancer especially if unilateral but it causes no increased risk of cancer.
Klinefelter’s syndrome or any reason for oestrogen excess may occur such as due to cirrhosis of the liver (when oestrogen not metabolised effectively). Gonadotrophin excess such as due to a functioning testicular tumour, e.g, Leydig and Sertoli cell tumours, testicular germ cell tumours. Drug-related: spironolactone, chlorpromazine, digitalis, cimetidine, alcohol, marijuana, heroin, anabolic steroids.
