Breast lumps

Question 1

Describe 3 main features of breast pain that you need to consider

Answer 1

• Truly from the breast or referred pain from another
  structure
• Associated with breast swelling / nodularity
• Worse before /relieved by menstruation

Question 2

List 2 exacerbating factors of breast pain

Answer 2

Perimenopause, exogenous hormone intake

Question 3

List 4 potential causes of breast pain

Answer 3

bra - ? correct fitting

weight

exercise – may exacerbate

intercurrent life events –stressors

Question 4

What are the non medical treatment options for breast pain?

Answer 4

• Reassurance
• Evening primrose oil
• soya milk
• Reduce fat intake

Question 5

What are the medical treatments for breast pain? State the mode of action for eat drug

Answer 5

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

Question 6

List the tests under the triple assessment for a breast lump

Answer 6

• Mammography
• Ultrasound
• Cytology / Histology

Question 7

What are the causes of a benign breast lump?

Answer 7

• Aberrations of normal breast development, cyclical changes
  and involution
• Fibroadenoma
• Cystes

Question 8

What is a fibroademona?

Answer 8

Breast lump made from Made of stromal tissue and proliferatory epithelium

-

Question 9

Which region of the breast does a fibroadenoma come from?

Answer 9

Arise from lobular unit

Question 10

What does a fibroadenoma feel like on palpation?

Answer 10

Extremely mobile, discrete, rubbery mass

Question 11

Which type of tumour can be confused for a fibroadenoma? What type of tumour is it and how is it treated?

Answer 11

Phyllodes tumour

fibroepithelial tumour, needs wide local excision

Question 12

Name the 2 classifications of breasts cysts and the age (period of life) they are most likely to present

Answer 12

Macrocyst or microcyst

Age of presentation usually around
perimenopause

Question 13

How is a Fibroadenoma

assessed and treated in those over 40?

Answer 13

In the over 40’s must differentiate from cancer

Management depend on age, size, triple assessment

Question 14

How is a breast cyst treated?

Answer 14

Investigate using triple assessment

Management –
Re-assure
Aspirate, occasionally operate

Question 15

What is the cause of Sclerotic/Fibrotic breast lesions?

Answer 15

• Involution of breast may lead to fibrosis

- Usually occurs in premenopausal women and is hormone mediated

Question 16

List causes of breast lumps which are not associated with Aberrations of normal breast development
and involution (ANDI)

Answer 16

Beast infections:
Lactational
Non-lactional

Lipomas

Fat necrosis

Montgomery’s gland

Mondor’s disease

Gynaecomastia in men

Question 17

What is Montgomery’s gland?

Answer 17

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.

Question 18

What is Mondor’s disease ?

Answer 18

thrombophlebitis of

superficial veins of the breast

Question 19

List the different types of Sclerotic/Fibrotic breast lesions. How do they present? How are they treated?

Answer 19

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

Question 20

What are the 2 main causes of fat necrosis?

Answer 20

Trauma

Breast surgery

Question 21

What does fat necrosis look like on a mammogram?

Answer 21

Multinucleated giant cells with calcification