Breast path

Question 1

physiologic galactorrhea

Answer 1

• bilateral gray, non bloody discharge
• guiac negative
• no signs of malignancy
• can be a sign of significant disorder

WORKUP

• prolactin
• TSH
• pregnancy test

Question 2

hyperprolactinemia

Answer 2

-most common cause of galactorrhea

CAUSES

• pituitary prolactinoma
• medications
• hypothyroidism
• pregnancy
• chest wall/nipple stimulation

WORKUP
-pituitary imaging

Question 3

lactational mastitis

Answer 3

PATHO

• skin flora enters ducts through nipple and multiplies in stagnant milk
• Staph aureus

RISK

• history of mastitis
• engorgement and inadequate milk drainage due to
• sudden increase in sleep duration
• replacing nursing with formula or pumped milk
• weaning
• pressure on the duct from tight clothing
• cracked or clogged nipple pore
• poor latch

CLINICAL

• fever
• firm, red, tender, swollen quadrant of unilateral breast
• myalgia, chills malaise

TREAT

• analgesia
• frequent breast feeding or pumping
• antibiotics

Question 4

Intraductal papilloma

Answer 4

PATHO

• benign
• nonpalpable due to small size of the papilloma inside duct

CLINICAL

• unilateral bloody nipple discharge
• no associated mass or LAD

MANAGEMENT

• mammography and ultrasound
• biopsy +/- excision

Question 5

simple breast cyst

Answer 5

• tender, mobile mass
• patient less than 30
• ultrasound showing posterior acoustic enhancement and no echogenic debris (solid components)
• aspiration shows clear fluid and results in disappearance of the mass
• patient should return in 2-4 months because cystic fluid can re accumulate

Question 6

inflammatory breast carcinoma

Answer 6

• rare but agressive
• rapid onset edematous cutaneous thickening “peau d’orange”
• erythematous, painful
• itching
• palpable mass
• nipple discharge
• axillary LAD

mammagram
U/S
biopsy