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Y3 - BREAST > Ductal disease > Flashcards

Ductal disease Flashcards

1
Q

What is ductal disease?

A

abnormality in the breast ductal tissue

aka ductal carcinoma

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2
Q

Main types of ductal disease?

A

o Ductal carcinoma in situ

o Invasive ductal carcinoma

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3
Q

Types of benign disease?

A

Ductal ectasia
Periductal mastitis
Papillomas
Papillomastosis

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4
Q

Define ductal ectasia

A
  • Nonspecific dilatation of one or more ducts (>2mm)
  • Typically filled with fluids/thick secretions/cellular debris
  • When located peripherally, favours a malignant process
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5
Q

Define periductal mastitis

A
  • Pre-menopausal women
  • Ducts beneath the nipple become inflamed and infected
  • Nipple rings are a risk factor
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6
Q

Define papillomas

A
  • Epithelial proliferation on a fibrovascular stalk in major ducts
  • Usually within a few centimeters of the nipple
  • Increased risk of breast cancer
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7
Q

Define papillomastosis

A
  • Multiple papillomas

* Tend to occur in distal ducts

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8
Q

Name the types of malignant disease

A

 In situ papillary carcinoma (often deemed pre-malignant)

 Invasive papillary carcinoma

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9
Q

What is the aetiology of malignant disease?

A

• Genetic mutations in lobular cells causing uncontrolled overgrowth of abnormal cells

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10
Q

RF of malignant DD?

A 
•	Family history
o	1.5x increased risk
o	BRCA1 or BRCA2
•	Prior benign breast disease
•	Hereditary breast ovarian cancer
•	Li-Fraumeni syndrome
•	Cowden’s syndrome
o	PTEN gene mutations
o	25-50% will develop BC
•	Klinefelter’s syndrome
•	Old age of menopause
•	Old age of first full-term pregnancy
•	Nulliparity (never been pregnant)
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11
Q

Aetiology of ductal ectasia?

A

• Breast changes due to aging (glandular to fatty = involution)

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12
Q

RF of ectasia?

A
  • Smoking

* Nipple inversion

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13
Q

Aetiology of periductal mastitis?

A

• Caused by bacteria infection entering through a cracked nipple or nipple piercing

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14
Q

RF of periductal mastitis?

A

Smoking

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15
Q

Epidemiology of DCIS?

A

o More common than lobular CIS
o 20-30% of untreated go on to develop BC
o 80% detected on mammography screening
o Diagnosis peaks age 70-75
o Only 7% of all male carcinomas
o Lower incidence in Black, Hispanic and Chinese
o No link with HRT

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16
Q

Epidemiology of IDC

A

o Accounts for 80% of all BC

o 2/3 women are diagnosed over age of 55

17
Q

Presenting symptoms of ductal disease (malignant)?

A 
•	In situ
o	Nipple discharge
	Serous or sanguineous (bloody)
	Unilateral
o	Breast mass
•	Invasive
o	Breast mass
	Usually painless (95%)
	Does not fluctuate with menstrual cycle
o	Nipple discharge
	Increased risk of invasive cancer with nipple discharge with age
18
Q

Presenting symptoms of ductal ectasia?

A
  • Nipple discharge – green/brown/blood
  • Pain
  • Nipple retraction
  • Breast lump (not always)
19
Q

Presenting symptoms of periductal mastisis?

A
  • Tender breast

* Nipple discharge

20
Q

Presenting symptoms of intraductal papillomas?

A
  • Bloody nipple discharge

* Pain between breast and nipple

21
Q

Signs of malignant ductal disease?

A 
•	In situ
o	Breast mass (usually not present)
	Smooth or nodular
•	Invasive
o	Axillary lymphadenopathy
o	Skin changes (20%)
	Peau d’orange (dimpling), erythema, ulceration
22
Q

Signs of periductal mastitis?

A
  • Tender, erythematous and warm

* Inverted nipple

23
Q

Signs of intraductal papillomas?

A

• Small breast mass

24
Q

What investigations would you do to diagnose a breast lump?

A

triple assessment

  1. Clinical breast examination
  2. Imaging (mammography, US)
  3. Biopsy (pathology)
25
Q

Investigations for a DCIS?

A 
o	Mammography = first line
	Calcifications
o	Biopsy (fine-needle/core)
	Necrosis and high nuclear grade
o	Sentinel node biopsy
	Metastasis
o	MRI
o	Ultrasonography
	Cystic or solid lesion
o	Genetic testing for BRCA
o	Oestrogen receptor testing
26
Q

Investigations for IDC

A

o Mammography = first line
 Irregular, speculated mass with clustered micro-calcifications
o US
 Hypoechoic irregular mass with internal calcifications
 Enlarged axillary lymph nodes
o MRI
o Biopsy

27
Q

Investigations for ductal ectasia?

A
  • US

* Mammography

28
Q

Investigations for periductal mastitis?

A
  • Swab C+S
  • Mammogrophy
  • US
29
Q

Investigations for intraductal papillomas?

A 
•	Breast US
o	Dilated duct with oval mass
•	Mammogram
o	May be negative
•	Ductogram = galactography
o	Filling defect of duct
•	Breast biopsy

Y3 - BREAST (6 decks)

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