Disorders of the Breast

Question 1

Fibrocystic breast disease: nonproliferative lesions

Answer 1

Include:
Cysts
Epithelial-related calcifications
Mild hyperplasia
Ductal ectasia

Question 2

Fibrocystic breast disease: proliferative lesions without atypia

Answer 2

Moderate or florid ductal hyperplasia
Sclerosing adenosis
Radial scar
Intraductal papilloma

Question 3

Fibrocystic breast disease: proliferative lesions with atypia

Answer 3

Atypical ductal and lobular hyperplasia, which MAY be a risk for breast CA, depending on histological findings

Question 4

Intraductal papilloma

Answer 4

Small, benign, usually in women 35-55
Grows in a milk duct of a breast
Causes and risk factors are unknown

Question 5

Sx of intraductal papilloma

Answer 5

Breast enlargement
Breast lump
Breast pain
Nipple d/c (clear or bloody)

Question 6

Dx of intraductal papilloma

Answer 6

H&P
Can do cytology of the nipple d/c
Can order a ductogram or galactogram which uses contrast to visualize the breast ducts

Question 7

Tx of intraductal papilloma

Answer 7

Observation or removal

Question 8

Ductal ectasia

Answer 8

Primarily middle aged premenopausal and parous
More common in smokers
Present with nipple d/c (usually thick, sticky, green; possibly bloody), a palpable subareolar mass (inflamed tissue), noncyclical mastalgia, and/or nipple inversion or retraction
Nipple d/c, if present, should be sent for cytology
Mammogram will ID characteristic calcifications behind the areola
Managed conservatively

Question 9

Sclerosing adenosis

Answer 9

Composed of small breast lumps caused by enlarged lobules
May be felt and may be painful
May be found on a mammogram and may be mistaken for breast CA
A bx may be needed to confirm the dx
Benign condition and does not need tx

Question 10

Radial scars

Answer 10

AKA complex sclerosing lesions
Have a core of connective tissue fibers with ducts and lobules growing out from it
Can look like breast CA on a mammogram and are found most often during a bx
No consensus on whether they increase risk of breast CA

Question 11

Most common finding in fibrocystic breast dz

Answer 11

Ridges of tissue, can have multiple or single cysts, can feel rough, can be difficult to assess for change. Compare bilat. Easier to assess the week after menses.

Question 12

Dx of fibrocystic breast dz

Answer 12

U/s or mammography as appropriate by age and breast tissue

Needle aspiration of palpable cysts

Question 13

Tx of fibrocystic breast dz

Answer 13

Observation
Decrease caffeine intake
Vit E supplementation

Question 14

Fibroadenoma

Answer 14

Usually appear before age 30
Usually near nipple
Can increase in size
Not associated with fibrocystic changes
Usually solid, mobile, rubbery
Usually unilateral
Frequently found in teenagers and pregnant women
Pregnancy can cuase them to increase in size
Can be associated with watery pink nipple d/c

Question 15

Dx of fibroadenoma

Answer 15

Have a stereotypical appearance on u/s
Are visible on mammography
Can undergo fine needle bx for more conclusive dx

Question 16

Tx of fibroadenoma

Answer 16

Observation or removal if pt desires

Needs to be removed if it changes in mobility or texture

Question 17

Mastitis

Answer 17

An infection of the breast that causes pain, swelling, redness, warmth, fatigue, malaise
Generally occurs in lactating or recently lactating women and is particularly associated with incomplete emptying of the breast or plugged duct(s)
Caused by bacteria that enter through broken skin
Can be infectious or non-infectious

Question 18

Pathogens of mastitis

Answer 18

MC pathogesn are S. aureus, streptococcus, and E. coli

More rarely mycobacteria, candida, salmonella, and cryptococcus

Question 19

Tx of mastitis

Answer 19

Continue breastfeeding
If mother adamant about d/c-ing breast-feeding she should express as much milk as possible while showering…pumping controversial b/c of potential increase trauma/pain
Abx are seldom necessary

Question 20

What should be done about an inflammatory mass without pus on multiple u/s exams which fails to decrease in size on abx?

Answer 20

Shoudl be fully investigated with bxs to exclude underlying carcinoma
All abscesses should be followed clinically as well as with ultrasound till completely resolved