Breast lumps

Question 1

The most significant differential of a breast lump is…

Answer 1

Breast cancer

Question 2

What clinical features may suggest breast cancer?

Answer 2

• Lumps that are hard/irregular and/or tethered to the skin or chest wall
• Nipple changes (e.g. retraction, discharge)
• Skin changes (Paget’s disease of the nipple, peau d’orange)

Question 3

What is a fibroadenoma?

Answer 3

Benign tumour of stromal/epithelial breast duct tissue

Question 4

What is the other name for a fibroadenoma?

Answer 4

“Breast mouse”

Question 5

Describe the features of a fibroadenoma on examination

Answer 5

Smooth, firm and mobile

Question 6

Fibroadenomas commonly affect which age group?

Answer 6

20-40 years old

Question 7

Are fibroadenomas associated with an increased risk of developing breast cancer?

What treatment is advised for large fibroadenomas (>3cm)?

Answer 7

• No usually not, however…
• Complex fibroadenomas and a positive family history of breast cancer may indicate a higher risk

Excision

Question 8

What is a breast cyst?

Answer 8

Benign, fluid-filled lump of the breast

Question 9

What is the most common cause of breast lumps?

Answer 9

Breast cyst

Question 10

Which age group do breast cysts most commonly affect?

Answer 10

Perimenopausal

Question 11

Describe the clinical features of a breast cyst on examination

Answer 11

Similar to a fibroadenoma (smooth, firm, mobile)

Question 12

Is there any association between breast cysts and breast cancer?

Answer 12

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

Question 13

Which intervention may help to relieve pain for a patient with a breast cyst?

Answer 13

Aspiration

Question 14

What is fat necrosis? What triggers this process?

Answer 14

An inflammatory process - fibrosis and necrosis of fat tissue results in formation of benign lump

This is commonly triggered by localised trauma, radiotherapy or surgery

Question 15

Describe the clinical features of fat necrosis on examination

Answer 15

Fat necrosis may have some features which can also be present in breast cancer e.g. irregular lump, nipple changes, tethering

Question 16

In fat necrosis, USS and mammogram may show…

Answer 16

A similar appearance to breast cancer (therefore histology may be required to confirm the diagnosis and exclude breast cancer)

Question 17

Describe the management of fat necrosis

Answer 17

• Usually treated conservatively (may resolve spontaneously with time)
• Surgical excision may be required

Question 18

What is a lipoma?

Answer 18

Benign tumour of fat tissue

Question 19

Describe the clinical features of a lipoma

Answer 19

• Can occur anywhere on the body

- Typically soft, mobile and painless

Question 20

Typically how is a lipoma managed?

Answer 20

Conservatively with reassurance

Question 21

What is a galactocele? Who gets this type of breast lump?

Answer 21

Cyst filled with breast milk, caused by a blocked lactiferous dust

These commonly occur in women who are lactating (often after stopping breastfeeding)

Question 22

Describe the clinical features of a galactocele

Answer 22

Firm, mobile and painless lump (usually beneath the areola)

Question 23

How is a galactocele managed?

Answer 23

Conservatively with reassurance (usually resolve spontaneously)