Breast Disease Flashcards
Describe the structure of the breast. (7)
Mammary glands produce and eject milk through lactiferous ducts due to the contraction of the surrounding myoepithelial cells.
Cooper’s suspensory ligaments support the mammary glands.
The breast is suspended off pec major, and is filled with adipose tissue.
Describe the hormone cycle prompted when a baby suckles. (7)
Input to hypothalamus when baby suckles.
Turns off prolactin inhibiting hormone production from the anterior pituitary to prompt prolactin production.
Turns on the posterior Pituitary to release oxytocin to prompt the release of milk through myoepithelial cell contraction.
Define thelarche. (3)
Breast enlargement, often initially unilateral, is the first sign of puberty in girls. It is a physiological cause of breast lumps.
Describe two disorders of development relating to breasts. (4)
Milk line remnants (called polythelia if there is a third nipple)
Accessory breast tissue (often axillary).
Describe fibrocystic change as a cause for breast lumps.
Presentation (2)
Symptoms (3)
Treatment (4)
Most common benign breast disorder, normally presenting 20-50y.
Symptoms are greatest (pain and nodularity) about a week before menstruation and resolve with period beginning - cyclical mastalgia.
Often disappears following fine needle aspiration, but can also be treated by watchful waiting, well-fitting bras and analgesia.
Describe breast cysts as a cause for breast lumps.
Presentation (3)
Treatments (1)
Common between 35 and 50, they are recurrent and cannot be distinguished from a solid tumour on examination.
Treated by fine needle aspiration
Describe fibroadenomas as a cause for breast lumps.
Pathophysiology (2)
Presentation (6)
Benign areas of localised hyperplasia made up of strongly and epithelial cells.
Common between 20 and 24, they are well circumscribed, highly mobile, non-tender, firm and can replace most of the breast tissue, especially on HRT.
Describe nipple discharge as a symptom. (2)
Highly concerning in a not-breastfeeding woman, especially if unilateral.
Give two differentials for milky nipple discharge. (2)
Endocrine eg prolactinoma, Pituitary tumour.
Side effects eg of OCP.
Give three differentials for serous or bloody nipple discharge. (3)
Intraductal papilloma
Duct ectasia
Malignancy
Describe duct ectasia. (2)
Dilation and acute inflammation of milk ducts, leading to a bloody discharge.
Describe mastitis.
Pathophysiology (4)
Presentation (4)
Treatment (2)
Generalised cellulitis of the breast that occurs during lactation from a staph aureus infection from nipple cracks.
Presents with an erythematous, painful breast, pyrexia and abscesses.
Treat by expressing milk and abx.
Describe breast abscesses.
Presentation (3)
Associations (2)
Treatment (4)
Presents with pyrexia, point tenderness and erythema.
Commonly associated with lactation, but can be not associated. Strong association with smoking.
Can be caused by staph (needs surgical drainage) or strep (diffuse but superficial so abx only).
Describe fat necrosis as a cause for breast lumps.
History (2)
Presentation (3)
History of trauma or surgery.
Presents with skin changes, masses or mammographic abnormalities.
Describe Phyllodes tumours.
Presentation (2)
Types (2)
Treatment (3)
Presents after 40 with a mass or mammographic abnormalities.
95% benign, 5% malignant.
Needs a wide resection so it doesn’t recur - the malignant ones recur often and metastasise through the blood.
