Breast Disorders Flashcards
What are the normal changes in the breast during the mid 20s?
Lobules and stroma in breast respond to hormonal stimuli in an exaggerated fashion
Development of single and multiple palpable fibroadenomas
What are the normal changes in the breast during the mid 30s-40s?
Enhanced normal lobular tissue – “adenosis” The degree of palpable nodularity increases
What are the normal changes in the breast during menopause?
Glandular tissue undergoes further hypertrophy in assoc. with increased stromal tissue
Higher prevalence of cyst formation in late menopause.
Describe the three types of breast pain:
Cyclic:
Occurs during late menstrual cycle, may accompany PMS
Resolves at onset of menses
Noncyclic:
Pain unrelated to menstrual cycle
Focal tenderness helpful – suggests tender cyst or tender area of modularity
Nonbreast Pain Pain arises from chest wall mistakenly attributed to breast Localized or diffuse chest wall pain Radicular pain from cervical arthritis Costochondritis
What is the first line treatment for breast pain/chest wall pain?
NSAIDS
What should be considered pathologic for nipple discharge:
Considered pathologic if discharge is spontaneous, arises from single duct, persistent, contains gross blood
What is the most important factor in malignancy?
Age is important factor in malignancy
what are some causes of nipple discharge:
-Benign intraductal papilloma Medications: -Tricyclic antidepressants -Cimetidine (Tagamet) -Verapamil -Metoclopramide Endocrine: -Prolactin level
How are benign diseases separated?
Subdivided into proliferative and nonproliferative lesions
Are proliferative/non-proliferative cancerous?
-Nonproliferative had no increased risk of breast cancer in studies
-Proliferative lesions have risk of malignancy
Risk depended upon specific proliferative lesion
Ranged from minimal to almost 6 fold increase
What should you look for on physical exam of the breast?
Symmetry on inspection
Skin or nipple retraction, nipple inversion
Discoloration or edema (peau d’orange)
Nipple discharge
Palpation – masses, nodules
Do NOT forget to check axillary and supraclavicular areas for nodes
What should always be down before imaging and biopsy?
BREAST EXAM
If someone has a palpable breast mass and they are premenopausal what should you do? what about post-menopausal?
Premenopausal:
OK to follow over one menstrual cycle and re-evaluate
Postmenopausal:
Start work-up upon discovering mass
What constitutes a suspicious mass?
Suspicious mass Hard Nontender Irregular High-risk patient
Does a negative mammogram mean there is no cancer?
Not necessarily. 10-15% of mammograms miss breast cancer
What is fibrocystic change?
Benign changes – microcystic formation leads to nodularity
Breasts feel “lumpy” and possibly tender on exam
Breast tenderness usually cyclical
BILATERAL
What contributes to fibrocystic breast disease?
HRT in postmenopausal women Most common in menstruating women High caffeine intake (controversial) Genetic disposition Larger breasts Dietary fat intake (being studied)
What is mastoplasia?
Mastoplasia – “ropy” thickening of tissue common in 25-55 yo
What are the symptoms associated with breast cysts?
Mass is tender and may fluctuate in size with menstrual cycle
On physical exam
Smooth and mobile
What will U/S show with breast cysts?
Anechoic (fluid filled) Round or oval Well-circumscribed Posterior enhancement If ALL above are present, almost 100% benign simple cyst Can drain cyst if symptomatic
***some can appear “complex” and these need a workup
What is Mastitis? What are the two types?
inflammation of the ducts
lactational and non-lactational
Describe lactational mastitis:
Lactational:
Reflux of bacteria into breast during breast-feeding
Patient will notice extreme tenderness
On exam erythema, warmth, tender to touch and possibly induration
Need to treat with antibiotics – usually for gram-positive cocci
Woman can continue to nurse and continue to pump milk
May be painful, but will help prevent engorgement
Be sure to follow-up with patient
What is non-lactational?
Secondary to milk ducts become congested with secretions and debris – “duct ectasia”
Periductal inflammation
On exam, may have green nipple discharge or retraction, significant tenderness, erythema and warmth
Broad spectrum antibiotic to cover gram-positive cocci and skin anaerobes
What are some proliferative disorders of the breast?
Proliferative Lesions:
Fibroadenoma Microglandular adenosis Sclerosing adenosis Papilloma Atypical ductal hyperplasia Atypical lobular hyperplasia
