Breast lumps Flashcards
Describe 3 main features of breast pain that you need to consider
- Truly from the breast or referred pain from another
structure - Associated with breast swelling / nodularity
- Worse before /relieved by menstruation
List 2 exacerbating factors of breast pain
Perimenopause, exogenous hormone intake
List 4 potential causes of breast pain
bra - ? correct fitting
weight
exercise – may exacerbate
intercurrent life events –stressors
What are the non medical treatment options for breast pain?
- Reassurance
- Evening primrose oil
- soya milk
- Reduce fat intake
What are the medical treatments for breast pain? State the mode of action for eat drug
Tamoxifen - antiestrogens. It blocks the activity of estrogen (a female hormone) in the breast.
Danazol - Androgen Receptor Agonist - synthetic steroid
Zoladex (Goserelin) - leutinizing hormone releasing hormone (LHRH) agonist. LHRH agonists work by telling the pituitary gland located in the brain to stop producing leutinizing hormone, resulting in reduced oestrogen production from ovaries (oestradiol production in women)
Bromocriptine - dopamine receptor agonists. Lowers the serum prolactin concentration. Best used for cyclical breast pain
List the tests under the triple assessment for a breast lump
- Mammography
- Ultrasound
- Cytology / Histology
What are the causes of a benign breast lump?
- Aberrations of normal breast development, cyclical changes
and involution - Fibroadenoma
- Cystes
What is a fibroademona?
Breast lump made from Made of stromal tissue and proliferatory epithelium
-
Which region of the breast does a fibroadenoma come from?
Arise from lobular unit
What does a fibroadenoma feel like on palpation?
Extremely mobile, discrete, rubbery mass
Which type of tumour can be confused for a fibroadenoma? What type of tumour is it and how is it treated?
Phyllodes tumour
fibroepithelial tumour, needs wide local excision
Name the 2 classifications of breasts cysts and the age (period of life) they are most likely to present
Macrocyst or microcyst
Age of presentation usually around
perimenopause
How is a Fibroadenoma
assessed and treated in those over 40?
In the over 40’s must differentiate from cancer
Management depend on age, size, triple assessment
How is a breast cyst treated?
Investigate using triple assessment
Management –
Re-assure
Aspirate, occasionally operate
What is the cause of Sclerotic/Fibrotic breast lesions?
- Involution of breast may lead to fibrosis
- Usually occurs in premenopausal women and is hormone mediated
List causes of breast lumps which are not associated with Aberrations of normal breast development and involution (ANDI)
Beast infections:
Lactational
Non-lactional
Lipomas
Fat necrosis
Montgomery’s gland
Mondor’s disease
Gynaecomastia in men
What is Montgomery’s gland?
all periareolar glands
around nipple which may develop a cyst
Montgomery’stubercles are sebaceous (oil)glandsthat appear as small bumps around the dark area of the nipple. Their primary function is lubricating and keeping germs away from the breasts. Enlargement of the glad usually occurs in pregnancy.
What is Mondor’s disease ?
thrombophlebitis of
superficial veins of the breast
List the different types of Sclerotic/Fibrotic breast lesions. How do they present? How are they treated?
Sclerosing adenosis - palpable mass with pain
Associated with involution causing fibrosis
Presents with
Stromal sclerosis/fibrosis, -
-Epethilal proliferation within the lobules (proliferative adenosis)
- on imaging it presents as - microcalcification and with histology presensts as - myoepithelial proliferation
When there is sclerosis with no clinical sign of a lump - then it is called a radial scar or complex sclerosis Lesion
Present as a radial scar (<1cm)
complex sclerosing lesion (>1cm)
These are asymptomatic.
Hard to differentiate from malignancy on imaging. Should do a biopsy
Treatment is excision as they are associated with cancer
What are the 2 main causes of fat necrosis?
Trauma
Breast surgery
What does fat necrosis look like on a mammogram?
Multinucleated giant cells with calcification
