Breast Lumps (non cancerous) Flashcards
What is a fibroadenoma?
who gets it:
reproductive people
early 20’s. (COCP / pregnancy / menses)
what is it?
he most common benign growth. the proliferation of stromal/epithelial tissue of duct lobules. multiple and bilateral
clinical feautres: small harmless breast tissue hard / well defined / rubbery highly mobile (breast mouse) usually 1-2cm in size (<5) multiple/bilateral may get bigger with time over the years
investigate: triple assessment. diagnose with US and clinical exam
manage: left insitu. consider excision if >3cm/>5cm, if >30 or FH (2ww)
biopsy if over 25 y/o to differentiate from phyllodes
large >5cm usually in pregnancy (hormones have caused rapid growth)
remove if troublesome: Surgical lumpectomy Excisional biopsy Vaccum assisted biopsy Cryoablation High intensity focussed US for abltion of fibroadenoma tissue.
What is fat necrosis?
acute inflammation response in breast leading to ischaemic necrosis of fat lobules
trauma/previous surgical or radiological intervention
larger, fatty breast, obese. fat necrosis (deranged cell death caused by inflammation). foam cells and necrotic lipid material. lateral fibrosis and calcification.
usually asymptomatic, painless pump, skin changes, erythema, dimpling, burising. can develop into a solid irregular lump
blood test, imaging (USS), core needle biopsy. if malignancy excluded and no troubling symptoms= follow up
if symptomatic= surgical excision
Ix: USS hyperechoic mass. mammogram hyperdensity, calcification (Can mimic carcinoma)
histology to diagnose
mx: conservative
What is a breast cyst?
fluid-filled sacs in the breast
accumulation inside ethe glands. 35-50 (prenasal, rare in menopause unless HRT)
smooth, easily mobile round or oval lump tender on palpation rapid onset fluctuant
Ix: can’t distinguish from a solid tumour. ultrasound mammogram, aspirate
mx: FNA to test and treat
do not require tx unless persistent, large, painful
blood-stained or lump persists after aspirate= triple assessment
increased risk of breast cancer in younger pt
! if blood stained on aspiration= biopsy/excise
What is a Phyllode tumor?
rare fibroepithelial/stromal tumour presents like a fibroadenoma (difficult to differentiate) grow rapidly (3cm, next day 4cm) *can be malignant removed to stop recurring
40-50y/o
smooth and mobile lump
ix: triple assessment
mx: wide excision and follow up (potential to become cancerous)
What are breast buds?
puberty small swelling under nipple / areolar complex
supernumerary breast tissue can occur in axillar or upper abdo wall
An acute(usually bacterial) infection of the breast tissue May be associated with fever, pus discharge from the nipple and local erythema, tenderness and heat Treat with antibiotics. May require incision and drainage surgically.
What is gynaecomastia?
male breast tissue
one or both sides
breast disc/bud full bresat
puberty/older age
liver disease/meds
obestity/gym/aclohol/testicular cancer
reassure
surgery
tamoxifen- for pain?
What is a breast abscess?
collection of pus within the breast lined with granulation.
commonly develops from mastitis
causes:
- post-partum (milk stagnating) encourage to express and breast feeding. *flucloxacillin
- smoking- ductal abscesses. do not heal when smoking (blood supply)
- nipple piercing (group B streptococcus, mycobacterium)
symptoms:
painful, swollen lump. swelling, erythema and heat overlying skin. systemic symptoms- fever, lethargy
Ix: USS if doubt of the diagnosis
punctum on surface
Mx: refer- surgical referral for drainage
summary of breast lumps ddx
cyst
pre-menopausal
HRT - maintains the lady in menopausal state
can be multiple, painful
fat necrosis- oil cyst forming from truama. lump uner the skin not in bresat tissue.
abscess- periductal mastitis.
mondor’s- thrombophlebitis cord. tx with NSAID’s
Lymph drainage
majority drainage- axillary
medial breast- parasternal / intrathoracic
What is a fibrocystic breast
this is the hormonal one
benign breast disorder
hormonal aetiology (around period)
breast composed of tissue that feels lumpy / rope-like in texture
worse with menstruation
fluid-filled round or oval sacs
a scar-like fibrous tissue
hyperplasia
2-0-50 y/o
rarely post-menopausal unless taking HRT
nodulariy/lumpy, pain or tenderness, pain week before menstruation, decreases after
ix: USS, mammography
mx: analgesia, good bra, refferal if persists
AKA physiological mastalgia- cyclical pain. usually affects the upper outer aspect of the breast
What is mastitis?
inflammation of breast tissue
infection (Staph aureus) but can be granulomatous
lactation- more common, first 3 months of breastfeeding or during weaning. cracked nipples, milk stasis, 1st child
non-lactational is less common but can occur in duct ectasia, a tobacco risk factor
- painful breast (worse when breastfeeeding)
- tenderness
- swelling and erythema (wedge shaped)
- fever, malaise, rapid onset, unilateral
symptoms/exam: tender, swelling or induration, erythema over the area of infection. red and swollen breast. tender.
Mx: systemic abx (flucloxacillin / erythromycin or clarithromycin if allergies) analgesia, encourage milk drainage/feeding to relieve blockage.
What is a galactocele?
a cyst containing retention milk in the mammary grams. obstruction of the lactiferous duct. lacteal cyst/milk cyst
less infective picture
during pregnancy, lactation
cessation of lactation
firm, painless breast lump
increases in size over time (week/months)
similar to a cyst on exam
not typically accompanied by tender, erythema or overlying skin
mx: self limtiing, referral
What is Modor’s disease?
like DVT in a vein in your breast. thrombophlebitis of the chest wall and breast.
rare 30-60
period tenderness with redness, the cord-like structure under skin, progress to form areas of fibrosis, less painful overtime
self-limiting, triple assessment
Accessory breast tissue
congenital condition
abnormal accessory breast tissue
more aware at puberty
symmetrical
typically at the axillary tail
tender related to the menstrual cycle
supernumerary nippples
no tx required
surgical excision to relieve discomfort.
Mastitis mx
manage with antibiotics
caused by infection (periductal infection / duct ectasia / perihperal infection)
can be associated with DM, RA, corticosteroid use.
oral co amoxiclav 500/125mg x 3 per day for 14 days
