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Gen surg > Breast lump differentials > Flashcards

Breast lump differentials Flashcards

1
Q

What is the most common cause of breast masses

A

Fibroadenoma

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2
Q

Normal changes to the breasts during pregnancy and breast-feeding

A

Tenderness, discomfort or pain

Increase in size

Areolar and nipple changes(darkening of colour, enlargement of nipples, enlargement of the montgomery glands on the areola)

Leaking of colostrum or milk

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3
Q

Normal changes to the breasts during pregnancy and breast-feeding

A

Tenderness, discomfort or pain

Increase in size

Areolar and nipple changes(darkening of colour, enlargement of nipples, enlargement of the montgomery glands on the areola)

Leaking of colostrum or milk

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4
Q

What are fibroadenomas

A

Arise in breast lobules and are composed of fibrous and epithelial tissue

Hormones seem to be involved in aetiology, and HRT increases incidence

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5
Q

Fibroadenomas features

A

Firm, non-tender, highly mobile palpable lumps

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6
Q

What are complex and multiple fibroadenomas associated with

A

Increase in risk of breast cancer

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7
Q

First line imaging investigation for breast lump

A

Ultrasound before age 40

Mammogram above 40

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8
Q

What are phyllodes tumours

A

Rare growths of breast that can have benign or malignant characteristics which present as a rapidly growing, painless breast mass

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9
Q

Which factors are associated with an increased risk of local recurrence for phyllodes tumours

A

Increased cellularity
Atypia
Mitoses
Positive margins

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10
Q

What is a fibrocystic breast

A

Spectrum of patholoigcal changes to include epithelial hyperplasia, apocrine metaplasia, and cystic dilation and fibrosis

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11
Q

Which population are commonly affected by benign breast cysts

A

Premenopausal and perimenopausal women

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12
Q

Features of breast cysts

A

Characteristically mobile and have distinct borders on exam

Sometimes tender and can fluctuate with the menstrual cycle

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13
Q

What does breast fat necrosis occur secondary to

A

Injury of the breast

Source may be iatrogenic(e.g. breast biopsy, breast reduction or augmentation) or traumatic(seat belt injury)

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14
Q

How do breast fat necrosis lesions present

A

Hard, fixed masses and demonstrate acoustic shadowing on ultrasound - characteristics suspicious for malignancy that mandate biopsy

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15
Q

What are breast papillomas

A

Typically benign, but they can be associated with histological findings of atypia, papillary ductal carcinoma in situ(DCIS) or invasive papillary cancer

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16
Q

Presentation of breast papilloma

A

Blood nipple discharge

Detected as a mass within the breast

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17
Q

Who does breast abscesses typically occur in

A

Women who are breastfeeding

Thought to result from ruptured sub-areolar ducts that leak into the periductal space

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18
Q

Genes implicated in breast cancer

A

BRCA-1 and BRCA-2 mutations are more common in women with a family history of: breast cancer before age 50 years, bilateral breast cancer, breast and ovarian cancer in the same relative, male breast cancer

Ashkenazi jewish ancestry

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19
Q

What should a family history include with regards to eliciting risk of breast cancer

A 
any family members with cancer 
primary cancer site 
whether affected relative had multiple primary cancers 
age of diagnosis 
age at death and sex
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20
Q

Characteristic features of breast examination indicative of malignancy

A 
Irregular fixed masses 
Skin thickening(peau d'orange) 
Nipple changes 
Enlarged axillae and regional lymph nodes 
Variation in breast size 
Dimpling or retraction of skin 
Nipple inversion
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21
Q

What is nipple inversion or excoriation associated with

A

Paget’s disease of the breast

22
Q

When should a person with a breast lump be referred for an urgent assessment by a breast specialist

A

Women > 30 years with an unexplained breast lump should be referred for an urgent(within 2 weeks) assessment by a breast specialist

Unilateral nipple changes in patients aged above 50

23
Q

Why should aspirated cyst fluid not be sent for cytology

A

With the exception of bloody cystic fluid, malignant cells are generally not identified

24
Q

What may mastitis be associated with

A

Lactation

25
Q

Management of mastitis associated with lactation

A

Warm compresses and analgesia such as ibuprofen/paracetamol

Encourage to continue breast feeding

Penicillianse-resistant antibiotic such as flucloxacillin

Incision and drainage in the event of an abscess

Swabs should be sent for culture

26
Q

What are spontaneous peripheral abscesses in non-lactating women associated with

A

Diabetes and immune compromise

Smoking and nipple rings can predispose to non-lactational mastitis

27
Q

Features of cyclical mastalgia

A

Tenderness and nodularity of the breasts in the premenstrual phase

Rapidly resolves as menstruation starts

28
Q

Management of fibrocysts

A 
Analgesia 
Good well-fitting bra
Avoid caffeine 
Applying heat to the area 
Hormonal treatments(tamoxifen) under specialist guidance
29
Q

Management of intraductal papilloma

A

Triple assessment with examination, imaging and biopsy in a specialist breast clinic

30
Q

What is duct ectasia

A

Dilatation and shortening of the terminal breast ducts within 3 cm of the nipple

31
Q

How does duct ectasia present

A

Nipple retraction and occasionally creamy nipple discharge

32
Q

Management of duct ectasia

A

Patients with troublesome discharge may be treated by microdochectomy(if young) or total duct excision(if older)

33
Q

In which population are fibroadenomas more common in

A

Younger women aged between 20 to 40 years

34
Q

When do fibrocystic breast changes tend to occur

A

It is common in women of menstruating age. Symptoms often occur prior to menstruating (within 10 days) and resolve once menstruation begins. Symptoms usually improve or resolve after menopause.

35
Q

Features of breast cysts

A

Smooth
Well-circumscribed
Mobile
Possibly fluctuant

36
Q

Management of breast cysts

A

Breasts cysts require further assessment to exclude cancer, with imaging and potentially aspiration or excision.

Aspiration can resolve symptoms in patients with pain.

Having a breast cyst may slightly increase the risk of breast cancer.

37
Q

What is tamoxifen

A

Selective oEstrogen Receptor Modulator (SERM) which acts as an oestrogen receptor antagonist and partial agonist. It is used in the management of oestrogen receptor positive breast cancer

38
Q

Adverse effects of tamoxifen

A

menstrual disturbance: vaginal bleeding, amenorrhoea
hot flushes - 3% of patients stop taking tamoxifen due to climacteric side-effects
venous thromboembolism
endometrial cancer

39
Q

What causes gynaecomastia

A

hormonal imbalance between oestrogen and androgens (e.g., testosterone), with higher oestrogen and lower androgen levels

Also raised prolactin

Idiopathic

Physiological(adolescents)

40
Q

Which conditions can increase oestrogen levels in males to cause gynaecomastia

A

Obesity (aromatase is an enzyme found in adipose tissue that converts androgens to oestrogen)
Liver cirrhosis and liver failure
Hyperthyroidism

41
Q

Tumours associated with gynaecomastia

A

Testicular cancer (oestrogen secretion from a Leydig cell tumour)

Human chorionic gonadotrophin (hCG) secreting tumour, notably small cell lung cancer

42
Q

Medications which can cause gynaecomastia

A 
Anabolic steroids 
Antipsychotics 
Digoxin 
Spironolactone 
marijuana 
opioids
43
Q

Which conditions reduce testosterone to cause gynaecomastia

A

Testosterone deficiency in older age

Hypothalamus or pituitary conditions that reduce LH and FSH levels (e.g., tumours, radiotherapy or surgery)

Klinefelter syndrome (XXY )

Orchitis (inflammation of the testicles, e.g., infection with mumps)
Testicular damage

44
Q

Mx of gynaecomastia

A

Resolves with time in adolescents

Stop causative drug

Tamoxifen

Surgery

45
Q

Most common type of breast cancer

A

DCIS

46
Q

Mx of DCIS

A

Complete wide excision

Widespread or multifocal DCIS requires complete mastectomy

47
Q

Surgical options for breast cancer

A

Breast conserving - wide local excision

Mastectomy

Axillary surgery - Sentinel node biopsy, axillary node clearance

48
Q

Complications of axillary node clearance

A

paraesthesia, seroma formation, and lymphedema in the upper limb

49
Q

Risk factors for breast cancer

A 
Female 
Age 
BRCA1 and 2
Family history 
Exposure to unopposed oestrogen 
early menarche
50
Q

How can paget’s disease be differentiated from eczema

A

Paget’s always affects the nipple and only involves the areola as a secondary event

Eczema nearly always involves the areola and spares the nipple

51
Q

Mx of Paget’s disease of breast

A

Surgical

Radiotherapy if malignancy associated

52
Q

Criteria for primary breast cancer prognosis

A

Nottingham prognostic index

Gen surg (24 decks)

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