Breast Dz Flashcards
What are examples of benign breast dz? (FYI)
Congenital d/o Fibroadenoma/Phylloides Tumor Cysts Traumatic fat necrosis Mastalgia—cyclic, non-cyclic, extramammary Fibrocystic breast changes Intraductal papilloma, Duct ectasia, Nipple discharge Mastitis and Abscess
Skin appendages for breasts/nipples arise from the _____
By week __ of fetal development, most have faded except on chest
mammary ridge “Milk Line”
9
Milk is created w/in the glands of the ____
alveoli
Many alveoli in a bundle form a ___.
Many____ in a bundle form a lobe.
____ connect the lobules and lobes to the nipple.
lobule
lobules
Ducts
What are the 3 tissues of the breast?
Fat
Glandular epithelium
Fibrous stroma and supporting structures
Where does arterial supply of the breast comes from?
Internal mammary artery (60%)
Lateral thoracic artery (30%)
What are the venous return pathways of the breast? (x3)
Axillary vein (primary)
Internal mammary vein
Intercostal veins
75% of the lymphatic drainage of the breast goes to the ____ nodes.
The remainder goes to the ____ nodes, or the internal mammary nodes– where it (CAN/CANNOT) cross over to the other side
axillary
supraclavicular
CAN
___ are extra nipples or breast tissue along the milk line
Accessory or Supernumerary Nipples
Inverted nipples make ___ difficult, if a woman has a baby
breast feeding
A new finding with an inverted nipple is worrisome for _____
malignancy
____ is a benign solid tumor w/ a proliferative process in a single lobule
fibroadenoma
Malignant transformations of a fibroadenoma are (COMMON/RARE)
Rare
What are the various types of fibroadenomas?
Simple, solitary, small <1cm
Multiple, juvenile, large, giant >5 cm
Fibroadenomas are usually in pts who are __-___ y/o and are (PAINFUL/PAINLESS)
15-35 y/o
Painless lump
How would a fibroadenoma feel on breast exam?
rubbery
mobile
painless mass
What tools can you use to dx a fibroadenoma
US (circumscribed, solid mass)
FNAC/CNB
How do you tx a fibroadenoma?
Conservative: reassurance, clinical f/u
Surgical
When may you perform surgery on a pt with a fibroadenoma? (x3)
Large/increasing in size
Pt preference
Suspicious cytology
___ are rapidly growing, large, leaf-like projections
Phyllodes tumor
Phyllodes tumor are usually seen in pts __-__ y/o and are benign __-__% of the time
40-50 y/o
60-70% (can be borderline or malignant)
How do phyllodes tumors feel on a breast exam?
smooth
multinodular
well-defined firm mass that is mobile and painless
What tools can you use to dx a Phyllodes tumor?
US
Mammography
Cytology—core bx or excision bx
What is the tx for a Phyllodes tumor?
Wide local excision w/ follow-up (depending on pathology)
Simple mastectomy
___ are nonintegrated involution of breast tissue
breast cysts
Breast cysts are commonly seen in pts __-___ y/o and can be bilateral and multiple
30-50 y/o
`
Breast cysts are ____ influenced, so can be recurrent.
Are they painful or painless?
hormonally
can be either painful OR painless
What tools can you use to dx breast cysts?
US
Aspiration—cytology if bloody
How do breast cysts feel on a breast exam?
smooth
firm
discrete
often tender mass
How can you tx breast cysts?
May require multiple aspirations
Excision if multiple recurrences
___ is described as having pain and a lump in the breast w/ a hx of trauma (seatbelt, other blunt trauma, surgery)
Traumatic Fat Necrosis
Traumatic Fat necrosis is caused by extensive ____ caused by tissue reaction
fibrosis
What tool should you use to dx Traumatic Fat Necrosis, what would be seen?
Mammography: dense lesion, may have calcifications, mimic CA
How do you tx Traumatic Fat Necrosis?
Excision or just follow
Cyclic Mastalgia is common in ___% of women who report >5 days per month
30%
Why is Cyclic Mastalgia cyclic?
Pain from hormonal cycling effects
Ovulation
Hormonal Rx
Estrogen stimulates the ____ elements
Progesterone stimulates the ____
Prolactin stimulates ____ secretion
ductal
stroma
ductal
Cyclic Mastalgia begins in the ____ phase, and dissipates with onset of _____
When do sx usually abate permanently?
late luteal phase
menses
menopause
What is the tx for Cyclic Mastalgia?
reassurance
dietary
good bra 24-7
Meds: NSAIDs, Danazol, Tamoxifen, bromocriptine, topical NSAIDS
What are examples of non-cyclic mastalgia? (FYI)
Cooper’s Ligament Stretching Breast Masses: fibroadenomas, cysts Breast Trauma Mastitis: lactational and non-lactational Superficial thrombophlebitis Breast Cancer
What are examples of extra-mammary mastalgia? (FYI)
angina
URI/cough
esophagitis, GERD
costochondritis, chest wall trauma, rib fractures
fibromyalgia, cervical radiculopathy, herpes zoster, pregnancy
___ is the most frequent breast lesion and is a physiologic tissue pattern
Fibrocystic Breast Changes
Fibrocystic Breast Changes is common in women __-__ y/o
30-50 y/o
Cystic enlargement of ____ and ___ tissue of breasts in Fibrocystic Breast Changes.
Enlargement is due to ____, ____ tissue changes, ___ tissue.
Can be ______ responsive
glandular and connective
fluid retention
fibrous
scar
hormonally
Do Fibrocystic Breast Changes alone increase the risk of breast CA?
What can put a woman at risk for CA?
No
Dense breast make visualization on mammography difficult
What are S/S of Fibrocystic Breast Changes?
- Asymptomatic mass
- tenderness, worsens premenses when cysts enlarge
- Can be multiple, bilateral, associated with nipple d/c
- Hx of cyclic lumps/breast pain
What does Fibrocystic Breast Changes look like on histology?
- large confluences of glandular tissue
- filled w/ fluid (especially influenced by hormones)
What is the tx for Fibrocystic Breast Changes ?
Symptomatic relief/same as mastalgia
If dominant mass, rule-out CA w/ mammogram, US, cytology
What surface pathology can cause nipple discharge?
Eczema
psoriasis
chancre
What is the ddx of the nipple discharge is bloody?
intraductal papilloma
duct ectasia
intraductal CA
What is the ddx if the nipple discharge is serous?
fibrocystic changes
duct ectasia
____ occurs w/ bloody nipple discharge, usually unilateral
May have associated mass
How do you tx this?
Ductal Papilloma (Intraductal Papilloma—IDP)
excision
___ is often asymptomatic, can cause green/black discharge.
May have mass, inflammation of nipple and surrounding tissue
What is the tx?
Duct Ectasia (DE)
Symptomatic tx
Abx
Excise
___ occurs w/ purulent nipple discharge
Subareolar abscess
What can cause milk d/c in a non-lactating breast?
- Chronic breast stimulation
- Prolactin secreting pituitary adenoma
- Hypothyroidism
- Meds (dopamine antagonists)
What can you use to dx nipple discharge?
HCG PRL TSH Assess possible Rx causes (Cytology, ductogram
How do you tx nipple discharge?
Treat underlying problem, adjust Rx
Excision of duct/mass or abscess
___ is localized inflammation of the breast associated with fever, myalgias, breast pain and redness in a nursing woman
Mastitis
Puerperal/Lactational mastitis occurs in __-__% of lactating mothers, first __-__ weeks postpartum
2-10%
2-4
What are bacterial bacterial causes of mastitis?
Staph aureus
Staph epidermidis
Candida albicans
Strep, rarely gram neg rods
What are S/S of mastitis?
Breast engorgement Nipple soreness fissures Erythema localized warmth tenderness Fever, chills
How do you tx mastitis?
Breast support Fluids Reduce local sx with ice, NSAID Assess nursing technique Regular emptying of breast by pumping or nursing Antibiotic
What abx do you use to tx mastitis?
dicloxacillin or cephalosporin x 10-14 days
If there is no response to abx in the tx of mastitis, we worry about___
abscess
Breast abscesses are often caused by ___
MRSA
How do you dx a breast abscess?
US
Needle aspiration
Surgical drainage
What is the most common cause of nipple dicharge?
Intraductal papilloma
