breast diseases

Question 1

If a smooth breast lump is associated with pre-menstrual tenderness what is the likely cause?

Answer 1

breast cyst

Question 2

how long after breast surgery can lymphoedema present in the arm

Answer 2

months to years

Question 3

what is a breast papilloma?

Answer 3

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

Question 4

How do papillomas present?

Answer 4

-small lump next to the nipple (less than 10mm)
-can be painful but usually not
-can cause clear or blood nipple discharge

Question 5

who is most commonly associated with having intraductal papillomas?

Answer 5

perimenopausal women age 40-50

Question 6

Explain the pathophysiology of papillomas

Answer 6

there is epithelial proliferation within the duct- forms small growths made from fibrovascular cores lined with epithelial cells

Question 7

How are papillomas diagnosed?

Answer 7

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

Question 8

How are papillomas treated? (4)

Answer 8

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

Question 9

which papillomas are at more of a risk of becoming cancerous?

Answer 9

those with bloody discharge, those with multiple papillomas

Question 10

what is pagets disease of the breast?

Answer 10

intraepithelial malignancy characterised by eczematoid change of the skin
almost always associated with underlying intraductal breast cancer

Question 11

how does pagets disease present?

Answer 11

chronic eczemtous change
- itching, burning and pain
- erythema
- scale formation
- ulceration
- erosions
- nipple discharge and bleeding

may have an underlying lump

Question 12

investigations for pagets disease

Answer 12

mammography or USS
biopsy of the skin and discharge cytology

Question 13

What is mammary duct ecstasia?

Answer 13

a benign condition where there is dilation of the large ducts in the breast

Question 14

who is most commonly affected by mammary duct ecstasia

Answer 14

perimenopausal women
higher in smokers

Question 15

how does mammary duct ectasia present?

Answer 15

nipple discharge
tenderness
nipple retraction
a lump in the breast that when compressed can lead to discharge

Question 16

how is mammary duct ectia diagnoses

Answer 16

triple assessment - imaging with mammography or USS
ductography- dye injected
nipple discharge cytology
ductoscopy - tiny needle endoscpe

Question 17

How does mammary duct ectasia present on mammography

Answer 17

microcalcifications

Question 18

management of mammary duct ectasia

Answer 18

reassurance its not breast cancer

conservative- supportive bra, warm compress, analgesia

surgical options- microdochectomy

if infection - antibiotics

Question 19

What is breast abscess?

Answer 19

a collection of pus within an area of the breast usually caused by breast infection.
Can be lactational or non-lactational

Question 20

What are some risk factors for breast abscesses

Answer 20

smoking
damage to the nipple

Question 21

what is the most common bacteria associated with breast abscesses?

Answer 21

staph. aureus

Question 22

How do breast abscesses present?

Answer 22

• red hot swollen breast
• swollen fluctuant tender breast
• If active infection may be hardened mass
• generalised illness- fever, fatigue

Question 23

How are breast abscesses diagnosed?

Answer 23

USS

Question 24

management of a breast abscess

Answer 24

1st line is surgical intervention- need needle aspiration and drainage
plus antibiotics

Question 25

How is mastitis treated?

Answer 25

1- continue breast feeding and analgesia
2- antibiotics: oral flucloxacillin for 10-14 days

Question 26

RF for mastitis

Answer 26

poor breast feeding technique
nipple damage
maternal stress
previous history of mastitis