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
duct ectasia
- symptoms
- investigation
- what is seen on biopsy?
- what is seen on mammogram?
Benign
Smoking is a major risk factor
Nipple discharge, often blood stained
Mastalgia (non-cyclical)
Nipple inversion/retraction
Occasional associated with a palpable subareolar mass.
Treat conservatively and it often settles spontaneously.
If persists surgical excision is an option.
dilation/shortening of hte major lactiferous ducts peri menopausal women coloured green/yellow nipple discharge palpable mass nipple retraction
ix: mammogram shows calcified duct
biopsy: multiple plasma cells on histology
mx: conservative, unremitting nipple discharge
intraductal papilloma
benign breast lesion
subareolar region
40-50
warty lesion behind areolar, <1cm away from the nipple. blood/clear nipple discharge
Usually present around the post menopause
Can present with a serous or bloody discharge from the nipple. Small (2-3mm) wart like lesion within a breast duct
They can obstruct the duct causing cysts or twist and become necrotic causing bleeding
Investigate with breast ductography (injection of contrast to visualise the breast ductal system).
Benign but can represent and increase risk of cancer
Treated mostly with surgical excision and vigilant breast screening. tx: microdochectomy?
acessory 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.
periductal mastitis
ducts under the nipple become infected
pain, periareolar mass and discharge from the nipple
occurs in younger women
smoking is a risk factor
ultrasound in breast clinic
swab the discharge for microscopy and culture, FNA
staph aureus
staph eepidermidis
streptococci
abx: co-amoxiclav, flucloxacillin, surgical drainage.
breast asbsess and sepsis
tachycardia
fever
requires immediate admission
RF: prev mastitis, immunosupression, poor hygine, staph aureus colonisation
empty abscess with US-guided aspiration. if refills then surgical incision and drainage is advised. (Scarring and complications)
breast pain management
from breast or chest wall
cyclical/non-cyclical
therapeutic primrose oil EPO NSAIDs diet exercise bra OCP danazol- increase testosterone tamoxifen groserelin
nipple symptoms
inversion
supernumerary
discharge- color, stop expressing, normal duct ectasia
milking- prolactin
nipple discharge differentials:
mammary duct ectasia
intraductal papilloma
breast abscess
Paget’s
eczema of the nipple (not of the breast or areolar)
cancer changes of DCIS- breaks through on the skin of the nipple so the nipple bleeds (this isn’t the same as bloody discharge) it ulcerates.
*eczema of the breast is different
breast lymphatic drainage
75% to axillary nodes
20% to parasternal nodes
5% to posterior intercostal nodes
breast cancer metastasis through the lymph nodes. they become stony hard and fixed. from here, cancer can spread to the liver, lungs bones and ovaries.
what is involved in the triple assessment?
hospital based assessment clinic
allows for early and rapid detection of breast cancer
mainstay to distinguish between lumps / cyst / abscess / maligancy
- breast exam
- imaging (ultrasound and mammogram)
- biopsy (mostly core biopsy)
2 week wait
> 30 years with unexplained lump with or without pain
> 50 with discharge, retraction or any change causing concern
any skin changes
>30 unexplained lump in axilla
non urgent if <30 and unexplained with or without
duct ectasia
dilation and shortening of the major lactiferous ducts
peri-menopausal women
coloured green/yellow nipple discharge, palpable mass, nipple retraction
IX:
mammogram, dilated calcified ducts
biopsy contains multiple plasma cells
conservative mx
duct excision if unremitting nipple discharge
breast cancer
invasive
non invasive
invasive
most common
hx of gradual breast enlargement
personal or fhx of breast cancer
hard, fixed mass
nipple inversion, discharge, skin retraction, peau d’orange, lymphadenopathy
management: triple biopsy
non invasive (ductal carcinoma in situ)
asymptomatic
breast mass (not always) nipple discharge breast tenderness cracking of skin triple assessment
breast cancer in men
Increased age Radiotherapy exposure Family history of breast cancer High oestrogen levels (liver cirrhosis and obesity) Damage or malfunction of the testes
Presentation is similar to that of women
Most common is a lump
Can also gave nipple changes, discharge, bleeding or skin changes
Prognosis of breast cancer is worse in men due to less awareness causing a delay in initial presentation
Tamoxifen is often used for treatment
reactive lymph node
young woman, after a viral flu like illness
pain in breast
general malaise and arthralgia
palpable lump in axillary tale / supraclavicular fossa
tietze syndrome
inflammation of the costochondral junctions at the edfge of the sternum following a viral illness
(dry cough)
