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Finals Revision Flashcards > Breast - Lumps, Cysts, Abscesses, Mammary Duct Ectasia > Flashcards

Breast - Lumps, Cysts, Abscesses, Mammary Duct Ectasia Flashcards

1
Q

Criteria to refer someone onto 2 week wait suspected breast cancer pathway?

A
  1. 30 and over with UNEXPLAINED breast lump (with or without pain)
  2. 30 and over with UNEXPLAINED lump in AXILLA
  3. 50 and over with UNILATERAL changes in the nipple - discharge, retraction, other changes of concern
  4. SKIN CHANGES on breast suggestive of breast cancer
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2
Q

Fibroadenoma - what is it?

A

Most common benign tumour of the stromal/epithelial breast duct tissue

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3
Q

Fibroadenoma - what is the feel of the fibroadenoma within the breast?

A

Small, <3cm, painless, firm, mobile lumps

Referred to as breast mice, as they move around within the breast tissue

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4
Q

Fibroadenoma - what age do they commonly present in?

A

Young women (15-40)

Due to them responding to the female hormones (oestrogen and progesterone) - why they are more common in younger women and often regress after menopause

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5
Q

Fibroadenoma - what happens to them over time?

A

50% - regress spontaneously

25% - remain unchanged

25% - get bigger

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6
Q

Fibrocystic Breast Changes - what is it?

A

Benign

Connective tissue (stroma), ducts and lobules of breast, respond to oestrogen and progesterone, become fibrous (irregular and hard) and cystic, and it fluctuates with the menstrual cycle

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7
Q

Fibrocystic Breast Changes - when does it commonly occur and in which women?

A

Common in women of menstruating age

Symptoms often start prior to menstruation, and resolve once menstruation has finished

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8
Q

Fibrocystic Breast Changes - what are the symptoms?

A
  1. Lumpiness
  2. Breast pain or tenderness (mastalgia)
  3. Fluctuation of breast size
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9
Q

Fibrocystic Breast Changes - management?

A

Management involves exlcuding cancer,

Managing cyclical breast pain (mastalgia) symptoms:

  1. Wearing a supportive bra
  2. NSAIDs
  3. Avoid caffeine
  4. Applying heat to the area
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10
Q

Breast cysts - what are they?

A

Benign, individual, fluid-filled lumps

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11
Q

Breast cysts - what age and when do they most commonly occur in?

A

Women aged 30-50

Perimenopausal period

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12
Q

Breast cysts - what is the presentation?

A

Smooth, well-circumcised, mobile

Painful

Fluctuate in size over menstrual cycle

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13
Q

Breast cysts - how can you manage the pain?

A

Aspiration can help pain, whilst also helping to exclude breast cancer

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14
Q

Fat necrosis - what is it?

A

Fat necrosis causes a benign lump formed by localised degeneration and scarring of fat tissue in the breast

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15
Q

Fat necrosis - what are the causes?

A

Trauma

Radiotherapy

Surgery

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16
Q

Fat necrosis - presentation within breast?

A

Painless, frim and irregular

FIXED in local structures

There may be skin dimpling or nipple inversion

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17
Q

Fat necrosis - investigations you may need to do?

A

USS and mammogram may show similar appearance to breast cancer (BC)

Therefore need to do histology (by fine needle aspiration or core biopsy) to exclude BC

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18
Q

Fat necrosis - management?

A

Conservative management

Resolve spontaneously with time

Symptomatic - excision

19
Q

Galactocele - what is it?

A

After stopping breastfeeding, lactiferous duct gets blocked, so can’t drain

Forms breast milk filled cysts

BENIGN

20
Q

Galactocele - how do they present?

A

Firm, painless, mobile

21
Q

Galactocele - management?

A

Usually resolve without any treatment

Can drain them with a needle

Rare - become infected and require abx

22
Q

Phyllodes tumour - what is it?

A

Tumours of the connective tissue (stroma) that are large and fast growing

‘Leaf-like pattern’

23
Q

Phyllodes tumour - what proportion are benign, borderline, and malignant?

A

50% benign

25% borderline

25% malignant (can also metastasise)

24
Q

Phyllodes tumour - management?

A

Wide excision - removal of tumour and surrounding tissue

Chemo - malignant/metastasised tumours

25
Q

Intraductal Papilloma - what is it?

A

Warty lesion that grows in a breast duct

Result of proliferation of epithelial cells

26
Q

Intraductal Papilloma - what is the typical presentation?

A

Clear or blood-stained discharge

Tenderness or pain

Palpable lump

27
Q

Intraductal Papilloma - investigations?

A 
Triple assessment:
1. Clinical assessment
2. Imaging 
3. Histology 
To exclude cancer

Ductography - inject contrast into abnormal duct and perform a mammogram to visualise - papilloma seen as area that does not fill with contrast (a “filling defect”).

28
Q

Intraductal papilloma - management?

A

Complete surgical excision

29
Q

Lactational Mastitis - what is mastitis?

A

Inflammation of breast tissue

30
Q

Lactational Mastitis - what are the causes of mastitis?

A

Obstruction - in ducts, accumulation of milk, milk stasis

Infection - bacteria enters at nipple, back-tracks to ducts, most common S.AUREUS

31
Q

Lactational Mastitis - what is the presentation?

A

Pain and tenderness (unilateral)

Erythema in a focal area of breast tissue

Hot and swollen

Nipple discharge

Fever - when bacterial infection is the cause

32
Q

Lactational Mastitis - management?

A

Obstruction - conservative, hot compress, analgesia, express milk regularly, continue breastfeeding

Infection - 1ST LINE: FLUCLOXACILLIN as Staph Aureus, (500mg QDS 10-14 days), penicillin allergy: erythromycin

33
Q

Lactational Mastitis - should women continue breastfeeding their babies?

A

Women should be encouraged to continue breastfeeding, even when an infection is suspected

It will not harm the baby and will help to clear the mastitis by encouraging flow

34
Q

Lactational Mastitis - what is a rare complication?

A

If not adequately treated - breast abscess

35
Q

Breast Abscess - what is it?

A

Collection of pus within an area of the breast, usually caused by a bacterial infection

36
Q

Breast Abscess - what are the two types of abscesses?

A

Lactational abscess (associated with breastfeeding)

Non-lactational abscess (unrelated to breastfeeding)

37
Q

Breast Abscess - presentation?

A

Acute - few days

Nipple changes
Purulent nipple discharge
Localised pain
Tenderness
Warmth
Erythema
Swelling

Key feature - FLUCTUANT, being able to move fluid around within the lump using pressure during palpation

Where there is infection without an abscess, there can still be hardness of the tissue, forming a lump, but it will not be fluctuant as it is not filled with fluid

38
Q

Breast Abscess - management?

A

Management of a breast abscess requires:

Referral to the on-call surgical team in the hospital for management
Antibiotics
Ultrasound (confirm the diagnosis and exclude other pathology)
Drainage (needle aspiration or surgical incision and drainage)
Microscopy, culture and sensitivities of the drained fluid

39
Q

Breast Abscess - what antibiotics would you give?

A

Antibiotics for non-lactational mastitis need to be broad-spectrum

  1. Co-amoxiclav
  2. Erythromycin/clarithromycin plus metronidazole
40
Q

Mammary Duct Ectasia - what is it?

A

Benign condition, dilation of the large ducts in the breasts

Ectasia means dilation

Inflammation in the ducts, leading to intermittent discharge from the nipple

The discharge may be white, grey or green

41
Q

Mammary Duct Ectasia - presentation?

A

Nipple discharge

Tenderness or pain

Nipple retraction or inversion

A breast lump (pressure on the lump may produce nipple discharge)

42
Q

Mammary Duct Ectasia - investigations?

A

Need to exclude breast cancer, so triple assessment:

  1. Clinical assessment
  2. Imaging
  3. Histology

Microcalcifications are a key finding on a mammogram

Other Ix:

  1. Ductography – contrast is injected into an abnormal duct, and mammograms are performed to visualise the duct
  2. Nipple discharge cytology
  3. Ductoscopy – inserting a tiny endoscope (camera) into the duct
43
Q

Mammary Duct Ectasia - management?

A

Mammary duct ectasia may resolve without any treatment

  1. Reassurance after excluding cancer may be all that is required
  2. Symptomatic Rx of mastalgia (supportive bra and warm compresses)
  3. Abx if infection suspected or present
  4. Surgical excision of the affected duct (microdochectomy)
44
Q

What antibiotics do you give in non-lactational mastitis and lactational mastitis?

A

Non-lactational mastitis gets co-amoxiclav, lactational mastitis gets flucloxacillin

Finals Revision Flashcards (49 decks)

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