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Kofi: Surgery + Gastroenterology > Breast Surgery: Non-Malignant > Flashcards

Breast Surgery: Non-Malignant Flashcards

1
Q

What are types of Benign Breast Tumours?

A
  • Fibroadenoma
  • Adenoma
  • Papilloma
  • Lipoma
  • Phyllodes Tumours
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2
Q

Describe the lesions in fibroadenomas and management?

A

Most common benign growth and occurs in women of reproductive age

  • Highly mobile, well-defined and rubbery on palpation
  • <5cm in diameter
  • Can be multiple and bilateral

Managed by reassurance and observation unless symptomatic or >3cm.

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3
Q

What are Adenomas?

A

Benign glandular tumour typically occurring in older female population

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4
Q

What are Papillomas?

A
  • Breast lesions occurring in female in their 40-50s
  • Occur mostly in subareolar region
  • Presents with bloody or clear nipple discharge.
  • Large papillomas initially have a mass
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5
Q

How are Papillomas managed?

A
  • Appear similar to ductal carcinoma on imaging and usually require biopsy
  • Risk increased with multi-ductal papilloma and most treated with mircrodeochectomy
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6
Q

What are Lipoma and how are they managed?

A
  • Soft and mobile benign adipose tumour normally asymptomatic
  • Low malignant potential
  • Only removed if significant enlarging and causing symptomatic compressive or aesthetic issues
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7
Q

What are Phyllodes Tumours and how are they managed?

A
  • Rare fibroepithelial tumours commonly occuring in older age group
  • 1/3 have malignant potential and 10% recur after excision
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8
Q

What are investigations for Benign Breast Tumours?

A

Triple Assessment

  • Examination
  • Imaging
  • Histology
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9
Q

What is Gynaecomastia?

A
  • Common condition which males develop breast tissue due to imbalanced ratio of oestrogen an androgen activity. Usually reversible
  • Usually benign disease but breast cancer develops in 1% of cases
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10
Q

What is the pathophysiology of Gynaecomastia?

A

Physiological

  • Occurs in adolescence from delayed testosterone surge relative to oestrogen at puberty.
  • Occurs secondary to decreasing testosterone level with increasing age

Pathological

  • Results form change in oestrogen: androgen activity ratio and wide variety of underlying mechanism
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11
Q

What are the forms of pathological Gynaecomastia?

A

1. Lack of testosterone

  • Causes are Klinefelter’s syndrome, Androgen Insensitivity, Testicular Atrophy or Renal Disease

2. Increased oestrogen levels

  • Causes include liver disease, hyperthyroidism, obesity, adrenal tumours or certain testicular subtypes

3. Medication

  • Common causative agents include digoxin, metronidazole, spironolactone, chemotherapy, goserelin, antipsychotics or anabolic steroids

4. Idiopathic

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12
Q

What are clinical features of Gynaecomastia?

A
  • Has insidious onet
  • Rubbery or firm mass starting from underneath the nipple and spreading outward
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13
Q

What are investigations for Gynaecomastia?

A
  • Triple assessment
  • Liver and Renal function test
  • Testicular examination essential
  • Hormone Profile
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14
Q

What are the conclusions drawn form hormone profile test in relation to Gynaecomastia?

A
  • LH high and testosterone low = testicular failure

​

  • LH low and testosterone low = increased oestrogen
  • LH high and testosterone high = androgen resistance or gonadotrophin-secreting malignancy
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15
Q

What is the management of Gynaecomastia?

A
  • Most cases should have reassurance.
  • If reversible underlying cause, then treatment or reversal of this should also allow for resolution of gynaecomastia
  • Tamoxifen can be used in cases to help alleviate symptoms especially if tender.
  • In patient with later stage of fibrosis, surgery may be only option if medical treatments fail
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16
Q

What is Mastitis?

A
  • Inflammation of breast tissue both acute or chronic.
  • Most common cause is infection typically Staph Aureus but can be granulomatous.
  • Can be classed by lactation status.
17
Q

What are the classification for Mastitis?

A
  • Lactational Mastitis
    • 1/3 of breastfeeding women. Present in first 3 month of breastfeeding or during weaning. Common with 1st child.
    • Associated with cracked nipples and milk stasis
    • Caused by poor feeding technique
  • Non-lactational mastitis
    • Occur especially in women with other conditions such as Duct ectasia as peri-ductal mastitis.
    • Tobacco smoking important risk factor causing damage to sub-areolar duct wall and predisposing bacterial infection
18
Q

What are clinical features of Mastitis?

A
  • Tenderness
  • Swelling or Induration
  • Erythema over area of infection
19
Q

What is the management for Mastitis?

A
  • Systemic antibiotic therapy and simple analgesics
  • Continued milk drainage or feeding is recommended
  • Cessation of breastfeeding using dopamine agonist (Cabergoline) considered in women with persistent/multiple areas of infection
20
Q

What is a breast abscess?

A

Collection of pus within breast lined with granulation tissue developing from acute mastitis

21
Q

How do breast abscesses present?

A
  • Tender fluctuant and erythematous masses with punctum potentially present
  • Systemic symptoms include fever and lethargy
  • Confirmed via ultrasound scan if any doubt regarding diagnosis
22
Q

What is the management of breast abscesses?

A
  • Initial phase
    • Empirical antibiotics and US guided needle aspiration
  • More advanced abscesses
    • Incision and drainage under local anaesthetic
23
Q

What is a breast cyst?

A
  • Epithelial line fluid-fluid cavities formed when lobules become distended due to blockage usually in perimenopausal age group
24
Q

What are complication of breast abscesses?

A
  • Drainage of non-lactational abscess can lead to formation of mammary duct fistula which is communication between skin and sub-areolar breast duct
  • Managed surgically
    • Fistulectomy and Antibiotics
    • Can often recur
25
Q

What are clinical features of breast cysts?

A
  • Singularly or multiple lumps affecting one or both breast
  • Distinct smooth masses on palpation. Masses may be tender
26
Q

What are investigations for Breast Cysts?

A
  • Identified by typical halo shape on mammography and usually definitively diagnosed with ultrasound
  • Persisting, symptomatic or undeterminable cystic masses may be aspirated either freehand or using ultrasound.
  • Cancer excluded if fluid free from blood or lump disappear otherwise cytology
  • Most require no further management and self-resolve. Larger cysts aspirated for aesthetic reasons or reassurance
27
Q

What are complications of Breast Cysts?

A
  • Carcinoma
  • Fibroadenosis
    • Caused by multiple small cysts and fibrotic area. Although benign, often associated with tenderness and asymmetry. Fibrosis can mask malignancy.
    • Managed with appropriate Analgesia
28
Q

What is Mammary duct ectasia?

A
  • Dilatation and shortening of major lactiferous ducts
  • Common in perimenopausal women
29
Q

What are clinical features of Mammary Duct Ectasia?

A
  • Present with coloured green/yellow nipple discharge
  • Palpable mass
  • Nipple retraction
30
Q

What are investigations for Mammary Duct Ectasia?

A
  • Mammography
  • Contain multiple plasma cells on histology if biopsied
31
Q

What is Fat Necrosis?

A
  • Common condition caused by acute inflammatory response in breast leading to ischaemic necrosis of fat lobules
  • Associated with trauma and previous surgical or radiological interventions
32
Q

What are clinical features of Fat Necrosis?

A
  • Lumps
  • Fluid discharge
  • Skin dimple
  • Pain
  • Nipple inversion
  • Chronic fibrotic change
33
Q

What are investigations and management for Fat Necrosis?

A
  • Investigations
    • Positive traumatic history
    • Ultrasound shows hyperechoic mass
    • Biopsy is often taken to categorically rule out malignancy.
  • Management
    • Analgesic management and reassurances

Kofi: Surgery + Gastroenterology (14 decks)

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