Breast Disease

Question 1

What are the main presenting features of breast disease

Answer 1

Swelling

Tenderness

Nodularity and palpable breast lumps

Mastalgia

Nipple discharge

Breast inflammation

Question 2

Name some causes of breast nodularity

Answer 2

Normal nodularity

Invasive carcinoma

Fibroademona

Cysts

Question 3

What are the three types of breast diseaes when seen histologically

Answer 3

Non-proliferative disorders

Proliferative disorders without atypia

Atypical hyperplasia

Question 4

What is a fibroadenoma, what is it formed of and where does it arise

Answer 4

Fibroadenomas - benign lumps in the breast

Most common cause of sore, lumpy breasts, usually affecting women <30

Arise in breast lobules and are formed of fibrous and epithelial tissue

Bilateral changes rarely pathological but asymmetrical changes should be reviewed

Question 5

Describe the aetiology of fibroadenomas

Answer 5

Fibroadenomas have hormonal aetiology as HRT increases the risk and the symptoms are greatest about 1wk before menstruation and then decrease once it starts

Symptoms are synchronised with menstrual cycle

Question 6

What is cyclical mastalgia

Answer 6

Cyclical mastaglia is tenderness and nodularity in premenstrual phase which resolves once menstruation starts

Question 7

Describe the features of breast cysts, i.e. when they are common, treatment, presentation

Answer 7

Breast cysts are most common between 35-50yrs

Found as discrete lumps and may be recurrent

Cannot be distinguished on clinical examination

Treated with aspiration

Question 8

Name some causes of nipple discharge

Answer 8

Endocrine disorders (pituitary adenoma) - milky

Medication side effect - milky

Galatorrhoea - milky

Benign lesions - bloody or serous

Malignant lesions - bloody or serous

Question 9

What is an intraductal papilloma

Answer 9

Intraductal papilloma - benign growth in a single milk duct cuaisng spontaneous discharge from one nipple only

Inflammation caused by the growth results in discharge

Question 10

What is mammary duct ectasia

Answer 10

Mammary duct ectasia - breast duct gets blocked causing inflammation

Have dilatation of major ducts which are filled with creamy secretion and there is periductal inflammation

Treatment is surgical excision of the duct

Question 11

How does mammary duct ectasia present

Answer 11

Asymptomatic

Nipple discharge

Retracted nipple

Acute inflammation

Recurrent chronic inflammation with abscess formation

Question 12

What is mastitis

Answer 12

Mastitis - generalised cellulitis of the breast

Treated with antibiotics

Question 13

What are the common bacteria causing mastitis

Answer 13

Staph aureus

Strep spp

Gram -ve bacilli, e.g. E. coli

Question 14

Describe what fat necrosis is

Answer 14

Fat necrosis is where there is trauma or surgery to the breast resulting in an inflammation and necrosis of the breast fat

Presents as a mass, skin changes or mammograhic abnormalities

Question 15

What is fibrocystic change of the breast

Answer 15

Fibrocystic change of the breast is a common breast lesion that presents as a mass or mammographic abnormality

It is treated with fine needle aspiration

Question 16

Describe the physiological changes that occur to the breast tissue over time

Answer 16

Prepubertal - few lobules

Menarche - increased lobules, increased volume of interlobular stroma

Menstrual cycle - after ovulation, cell proliferation and stromal oedema occurs. Menstruation decreases size of lobules

Pregnancy - increased size and number of lobules. Decreased stroma. Secretory changes

Question 17

Name some conditions that cause mammographic abnormalities

Answer 17

Densities - invasive carcinomas, fibroadenomas, cysts

Calcifications - ductal carcinoma in situ, benign changes

Question 18

What is a phyllodes tumour

Answer 18

Phyllodes tumours - occur in 6th decade. Rare before 40. Present as masses or mammographic abnormalities

Either benign, borderline or malignant

Can be large and involve entire breast

Histologically have nodules of proliferating stroma covered by epithelium. Stroma more cellular and atypical than fibroadenomas