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Repro. Med 4 > Breast Dz > Flashcards

Breast Dz Flashcards

1
Q

What are examples of benign breast dz? (FYI)

A 
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
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2
Q

Skin appendages for breasts/nipples arise from the _____

By week __ of fetal development, most have faded except on chest

A

mammary ridge “Milk Line”

9

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3
Q

Milk is created w/in the glands of the ____

A

alveoli

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4
Q

Many alveoli in a bundle form a ___.
Many____ in a bundle form a lobe.
____ connect the lobules and lobes to the nipple.

A

lobule
lobules
Ducts

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5
Q

What are the 3 tissues of the breast?

A

Fat
Glandular epithelium
Fibrous stroma and supporting structures

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6
Q

Where does arterial supply of the breast comes from?

A

Internal mammary artery (60%)

Lateral thoracic artery (30%)

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7
Q

What are the venous return pathways of the breast? (x3)

A

Axillary vein (primary)
Internal mammary vein
Intercostal veins

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8
Q

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

A

axillary
supraclavicular
CAN

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9
Q

___ are extra nipples or breast tissue along the milk line

A

Accessory or Supernumerary Nipples

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10
Q

Inverted nipples make ___ difficult, if a woman has a baby

A

breast feeding

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11
Q

A new finding with an inverted nipple is worrisome for _____

A

malignancy

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12
Q

____ is a benign solid tumor w/ a proliferative process in a single lobule

A

fibroadenoma

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13
Q

Malignant transformations of a fibroadenoma are (COMMON/RARE)

A

Rare

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14
Q

What are the various types of fibroadenomas?

A

Simple, solitary, small <1cm

Multiple, juvenile, large, giant >5 cm

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15
Q

Fibroadenomas are usually in pts who are __-___ y/o and are (PAINFUL/PAINLESS)

A

15-35 y/o

Painless lump

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16
Q

How would a fibroadenoma feel on breast exam?

A

rubbery
mobile
painless mass

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17
Q

What tools can you use to dx a fibroadenoma

A

US (circumscribed, solid mass)

FNAC/CNB

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18
Q

How do you tx a fibroadenoma?

A

Conservative: reassurance, clinical f/u

Surgical

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19
Q

When may you perform surgery on a pt with a fibroadenoma? (x3)

A

Large/increasing in size
Pt preference
Suspicious cytology

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20
Q

___ are rapidly growing, large, leaf-like projections

A

Phyllodes tumor

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21
Q

Phyllodes tumor are usually seen in pts __-__ y/o and are benign __-__% of the time

A

40-50 y/o

60-70% (can be borderline or malignant)

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22
Q

How do phyllodes tumors feel on a breast exam?

A

smooth
multinodular
well-defined firm mass that is mobile and painless

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23
Q

What tools can you use to dx a Phyllodes tumor?

A

US
Mammography
Cytology—core bx or excision bx

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24
Q

What is the tx for a Phyllodes tumor?

A

Wide local excision w/ follow-up (depending on pathology)

Simple mastectomy

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25
Q

___ are nonintegrated involution of breast tissue

A

breast cysts

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26
Q

Breast cysts are commonly seen in pts __-___ y/o and can be bilateral and multiple

A

30-50 y/o

`

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27
Q

Breast cysts are ____ influenced, so can be recurrent.

Are they painful or painless?

A

hormonally

can be either painful OR painless

28
Q

What tools can you use to dx breast cysts?

A

US

Aspiration—cytology if bloody

29
Q

How do breast cysts feel on a breast exam?

A

smooth
firm
discrete
often tender mass

30
Q

How can you tx breast cysts?

A

May require multiple aspirations

Excision if multiple recurrences

31
Q

___ is described as having pain and a lump in the breast w/ a hx of trauma (seatbelt, other blunt trauma, surgery)

A

Traumatic Fat Necrosis

32
Q

Traumatic Fat necrosis is caused by extensive ____ caused by tissue reaction

A

fibrosis

33
Q

What tool should you use to dx Traumatic Fat Necrosis, what would be seen?

A

Mammography: dense lesion, may have calcifications, mimic CA

34
Q

How do you tx Traumatic Fat Necrosis?

A

Excision or just follow

35
Q

Cyclic Mastalgia is common in ___% of women who report >5 days per month

A

30%

36
Q

Why is Cyclic Mastalgia cyclic?

A

Pain from hormonal cycling effects
Ovulation
Hormonal Rx

37
Q

Estrogen stimulates the ____ elements
Progesterone stimulates the ____
Prolactin stimulates ____ secretion

A

ductal
stroma
ductal

38
Q

Cyclic Mastalgia begins in the ____ phase, and dissipates with onset of _____

When do sx usually abate permanently?

A

late luteal phase
menses

menopause

39
Q

What is the tx for Cyclic Mastalgia?

A

reassurance
dietary
good bra 24-7
Meds: NSAIDs, Danazol, Tamoxifen, bromocriptine, topical NSAIDS

40
Q

What are examples of non-cyclic mastalgia? (FYI)

A 
Cooper’s Ligament Stretching
Breast Masses: fibroadenomas, cysts
Breast Trauma
Mastitis: lactational and non-lactational
Superficial thrombophlebitis
Breast Cancer
41
Q

What are examples of extra-mammary mastalgia? (FYI)

A

angina
URI/cough
esophagitis, GERD
costochondritis, chest wall trauma, rib fractures
fibromyalgia, cervical radiculopathy, herpes zoster, pregnancy

42
Q

___ is the most frequent breast lesion and is a physiologic tissue pattern

A

Fibrocystic Breast Changes

43
Q

Fibrocystic Breast Changes is common in women __-__ y/o

A

30-50 y/o

44
Q

Cystic enlargement of ____ and ___ tissue of breasts in Fibrocystic Breast Changes.
Enlargement is due to ____, ____ tissue changes, ___ tissue.
Can be ______ responsive

A

glandular and connective

fluid retention
fibrous
scar

hormonally

45
Q

Do Fibrocystic Breast Changes alone increase the risk of breast CA?

What can put a woman at risk for CA?

A

No

Dense breast make visualization on mammography difficult

46
Q

What are S/S of Fibrocystic Breast Changes?

A
  • Asymptomatic mass
  • tenderness, worsens premenses when cysts enlarge
  • Can be multiple, bilateral, associated with nipple d/c
  • Hx of cyclic lumps/breast pain
47
Q

What does Fibrocystic Breast Changes look like on histology?

A
  • large confluences of glandular tissue

- filled w/ fluid (especially influenced by hormones)

48
Q

What is the tx for Fibrocystic Breast Changes ?

A

Symptomatic relief/same as mastalgia

If dominant mass, rule-out CA w/ mammogram, US, cytology

49
Q

What surface pathology can cause nipple discharge?

A

Eczema
psoriasis
chancre

50
Q

What is the ddx of the nipple discharge is bloody?

A

intraductal papilloma
duct ectasia
intraductal CA

51
Q

What is the ddx if the nipple discharge is serous?

A

fibrocystic changes

duct ectasia

52
Q

____ occurs w/ bloody nipple discharge, usually unilateral
May have associated mass

How do you tx this?

A

Ductal Papilloma (Intraductal Papilloma—IDP)

excision

53
Q

___ is often asymptomatic, can cause green/black discharge.
May have mass, inflammation of nipple and surrounding tissue

What is the tx?

A

Duct Ectasia (DE)

Symptomatic tx
Abx
Excise

54
Q

___ occurs w/ purulent nipple discharge

A

Subareolar abscess

55
Q

What can cause milk d/c in a non-lactating breast?

A
  • Chronic breast stimulation
  • Prolactin secreting pituitary adenoma
  • Hypothyroidism
  • Meds (dopamine antagonists)
56
Q

What can you use to dx nipple discharge?

A 
HCG
PRL
TSH
Assess possible Rx causes
(Cytology, ductogram
57
Q

How do you tx nipple discharge?

A

Treat underlying problem, adjust Rx

Excision of duct/mass or abscess

58
Q

___ is localized inflammation of the breast associated with fever, myalgias, breast pain and redness in a nursing woman

A

Mastitis

59
Q

Puerperal/Lactational mastitis occurs in __-__% of lactating mothers, first __-__ weeks postpartum

A

2-10%

2-4

60
Q

What are bacterial bacterial causes of mastitis?

A

Staph aureus
Staph epidermidis
Candida albicans
Strep, rarely gram neg rods

61
Q

What are S/S of mastitis?

A 
Breast engorgement
Nipple soreness
fissures
Erythema 
localized warmth
tenderness
Fever, chills
62
Q

How do you tx mastitis?

A 
Breast support
Fluids
Reduce local sx with ice,  NSAID
Assess nursing technique
Regular emptying of breast by pumping or nursing
Antibiotic
63
Q

What abx do you use to tx mastitis?

A

dicloxacillin or cephalosporin x 10-14 days

64
Q

If there is no response to abx in the tx of mastitis, we worry about___

A

abscess

65
Q

Breast abscesses are often caused by ___

A

MRSA

66
Q

How do you dx a breast abscess?

A

US
Needle aspiration
Surgical drainage

67
Q

What is the most common cause of nipple dicharge?

A

Intraductal papilloma

Repro. Med 4 (7 decks)

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