Breast Disorders Flashcards
List some differential diagnoses of a breast mass
Fibrocystic changes of the breast
Fibroadenoma
Carcinoma
Intra-ductal papilloma
Little benign growths that cause bloody nipple discharge
Fat necrosis
Duct ectasia
abscess
cyst
What is the most common organism in mastitis?
S. aureus
Mastitis in a non-lactating female need to rule out what?
inflammatory carcinoma
Most common reason for fever after the immediate puerperium in nursing mothers
Mastitis
More common within three months of delivery and in first time mothers
Mastitis
What is the treatment for mastitis?
Ibuprofen
Cold compress
Frequent nursing
Dicloxaxillin or Cephalexin if indicated
What are some risk factors for breast abscess development?
obese
smoking
black
blocked milk duct
nipple piercings
Female appearing male breast
Enlargement of the male breast, often asymmetric or unilateral
Gynecomastia
Gynecomastia must be distinguished from what?
tumors or mastitis
Which type of gynecomastia is characterized by tenderness, while the other type of gynecomastia is typically non-tender?
Glandular gynecomastia
Fatty gynecomastia
What genetic disorder is it common to see gynecomastia?
Klinefelter Syndrome
Lactation that occurs in the absence of nursing
Galactorrhea
Evaluation of galactorrhea should be done if present in nulliparous female, or if associated with what symptoms?
headache
amenorrhea
visual changes
systemic symptoms
What are some causes for galactorrhea?
Medications
CNS lesions (i.e. pituitary microadenomas (measure prolactin))
Medical conditions
What is the test of choice for galactorrhea?
MRI
Indications for an MRI in galactorrhea?
Prolactin >200mg/dL in the non-pregnant
Patients with headaches, vision changes
Persistent increase in prolactin
In fibrocystic breast disease, size and tenderness fluctuates with what two factors?
menstruation cycle and caffeine
Most common etiology of breast “lump” – benign solid mass
Common benign neoplasm in young women
Fibrous and glandular tissue
Fibroadenoma
Firm, round, non-tender, mobile
“rubbery”
Usually solitary and unilateral
Palpable and visible on ultrasound
Fibroadenoma
On physical exam of a fibroadenoma, what are the 5 Rs?
R – round
R – rubbery
R – recluse (unilateral)
R – roaming (mobile)
R – really doesn’t hurt (non-tender)
Second most common malignancy in women
breast cancer
Second most common cause of cancer death in women
breast cancer
What is the most common type of breast cancer?
infiltrating ductal carcinoma (80%)
What is the most lethal type of breast cancer?
inflammatory
What is the largest risk factor for breast cancer?
age
List some risk factors for breast cancer
Age
BRCA1 and 2 mutations
Family history in a first-degree relative
Early age of menstrual onset (<12 years old)
Delaying childbearing or nulliparity (First pregnancy after 30)
Radiation exposure
Overweight after menopause
2-4 alcoholic drinks per week
Hormone therapy
Not breast feeding
White
History of atypical hyperplasia
Tobacco use
What are common sites of metastases for breast cancer?
Lymph notes (most common)
Lung/pleura
Liver
Bone
Brain
What is the most common site for breast cancer metastases?
Lymph notes (most common)
How do you get a definitive diagnosis of solid breast tumor?
Excisional breast biopsy
What type of breast cancer is described below?
Pre-maligment lesion
Arises from ductal hyperplasia
Asymptomatic
Usually not palpable
Contained within the mammillary ducts
Ductal Carcinoma In-Situ
What type of breast lesion is described below?
Contained within breast lobules
Usually bilateral
Not palpable and doesn’t show up on a mammogram
Diagnosis is usually incidental on biopsy
Lobular Carcinoma In-Situ
What type of breast cancer is described below?
Most common breast malignancy
Worse and most invasive
Typically post-menopausal women
Firm, fibrous, rock-hard mass with sharp margins
Likes to metastasize
Infiltrating Ductal Carcinoma
What type of breast cancer is described below?
Second most common breast malignancy
Usually bilateral
Arises from lobular epithelium
Infiltrating Lobular Carcinoma
What is the most common breast malignancy?
Infiltrating Ductal Carcinoma
What type of breast cancer is described below?
Infiltrating intra-ductal carcinoma in the nipple and ducts of nipple
Often associated with DCIS
Eczematous changes of the nipple
Crusting, scaly lesion
Paget’s Disease of the Nipple
What type of breast cancer is described below?
Extremely aggressive malignancy
Poorly differentiated tumor with dermal lymphatic invasion
Edema, erythema, peau d’orange, warm skin overlying the breast
May present like mastitis in a non-lactating woman
Most malignant form of breast cancer
Tends to occur in younger women
Characterized by rapid enlargement of breast without underlying mass
Inflammatory Breast Carcinoma
Most malignant form of breast cancer
Inflammatory Breast Carcinoma
