breast diseases Flashcards
If a smooth breast lump is associated with pre-menstrual tenderness what is the likely cause?
breast cyst
how long after breast surgery can lymphoedema present in the arm
months to years
what is a breast papilloma?
a benign wart like growth within the mammary duct
usually one solitary lesions in the larger ducts near the nipple but can be multiple lesions
How do papillomas present?
-small lump next to the nipple (less than 10mm)
-can be painful but usually not
-can cause clear or blood nipple discharge
who is most commonly associated with having intraductal papillomas?
perimenopausal women age 40-50
Explain the pathophysiology of papillomas
there is epithelial proliferation within the duct- forms small growths made from fibrovascular cores lined with epithelial cells
How are papillomas diagnosed?
may be picked up on mammogram or USS showing a dilated duct with a stalk
Ductography may be used- dye is injected to where discharge comes from and then x ray taken
breast biopsy
How are papillomas treated? (4)
may not need treatment
surgical removal of the papilloma
Microdochectomy - removal of the effected duct
some women may have hadfield procedure where all major ducts of the breast are removed
which papillomas are at more of a risk of becoming cancerous?
those with bloody discharge, those with multiple papillomas
what is pagets disease of the breast?
intraepithelial malignancy characterised by eczematoid change of the skin
almost always associated with underlying intraductal breast cancer
how does pagets disease present?
chronic eczemtous change
- itching, burning and pain
- erythema
- scale formation
- ulceration
- erosions
- nipple discharge and bleeding
may have an underlying lump
investigations for pagets disease
mammography or USS
biopsy of the skin and discharge cytology
What is mammary duct ecstasia?
a benign condition where there is dilation of the large ducts in the breast
who is most commonly affected by mammary duct ecstasia
perimenopausal women
higher in smokers
how does mammary duct ectasia present?
nipple discharge
tenderness
nipple retraction
a lump in the breast that when compressed can lead to discharge
how is mammary duct ectia diagnoses
triple assessment - imaging with mammography or USS
ductography- dye injected
nipple discharge cytology
ductoscopy - tiny needle endoscpe
How does mammary duct ectasia present on mammography
microcalcifications
management of mammary duct ectasia
reassurance its not breast cancer
conservative- supportive bra, warm compress, analgesia
surgical options- microdochectomy
if infection - antibiotics
What is breast abscess?
a collection of pus within an area of the breast usually caused by breast infection.
Can be lactational or non-lactational
What are some risk factors for breast abscesses
smoking
damage to the nipple
what is the most common bacteria associated with breast abscesses?
staph. aureus
How do breast abscesses present?
- red hot swollen breast
- swollen fluctuant tender breast
- If active infection may be hardened mass
- generalised illness- fever, fatigue
How are breast abscesses diagnosed?
USS
management of a breast abscess
1st line is surgical intervention- need needle aspiration and drainage
plus antibiotics
How is mastitis treated?
1- continue breast feeding and analgesia
2- antibiotics: oral flucloxacillin for 10-14 days
RF for mastitis
poor breast feeding technique
nipple damage
maternal stress
previous history of mastitis
