Exam 2 - Common benign breast conditions

Question 1

What are the six most common benign breast conditions seen?

Answer 1

• Fibrocystic changes
• Breast cysts
• Fibroadenoma
• Mastalgia
• Galactorrhea
• Non-lactational mastitis

Question 2

What normally causes fibrocystic changes to the breast?

Answer 2

Associated with hormonal stimulation

• Common but rare in postmenopausal women
• No associated with development of breast cancer

Question 3

Fibrocystic changes: manifestations

Answer 3

• Pain or tenderness
• Lumpy, “bag of beans”
• Firm, rubbery (NOT hard)

Question 4

Fibrocystic changes: management

Answer 4

• Aspiration for larger, more painful cysts
• OCP can decrease risk of developing fibrocystic changes

Question 5

Causes of breast cysts

Answer 5

• Obstructed breast lobules
• Influenced by hormonal changes in pre and perimenopausal women
• Common in women ages 35-50 years

Question 6

Breast cysts: manifestations

Answer 6

• Smooth
• Mobile
• Round/ovoid
• Fluid filled
• Well delineated

Question 7

Breast cysts: diagnostic testing

Answer 7

• Confirmed with fine needle aspiration (can also be therapeutic)
  
  • Ultrasound done in 2-4 months to document any changes after fine needle aspiration (for simple cysts)
• Biopsy for more complex cysts

Question 8

Etiology of fibroadenomas

Answer 8

• Contain epithelial tissue and stromal cells
• Common in adolescents and young women (peaks at 20-30 years old)
• Can increase in size during pregnancy or estrogen therapy
  
  • Regress after menopause

Question 9

Fibroadenomas: manifestations

Answer 9

• Single, isolated cysts
• 2-3 cm mass with firm or rubbery consistency
• Mobile
• Well circumscribed
• Non tender

Question 10

Fibroadenoma: diagnostic testing

Answer 10

Observe for changes throughout entire menstrual cycle

• Evaluate with ultrasound in younger women
• Confirm with biopsy
  
  • If pathology indicates fibroadenoma, excision NOT necessary unless mass becomes enlarged and distorts breast
  • Excision considered for women 35+ years old, cysts are immobile, poorly circumscribed, biopsy inconclusive, size >2.5 cm

Question 11

Etiology of mastalgia

Answer 11

• Associated with luteal phase (resolves with onset of menses)
• Common in women ages 30-50 years and postmenopausal women
• Associated with hormonal stimulation, mastitis, cysts, tumors, previous breast surgery, medications

Question 12

Mastalgia: management

Answer 12

• Wear well-fitting supportive bra
• Topical or oral NSAIDs
• Primrose oil and flaxseed oil
• Adjust estrogen or hormone exposure in contraception
• Caffeine restriction NOT recommended

Question 13

Medications that can alleviate mastalgia

Answer 13

Danazol, tamoxifen, bromocriptine

• Danazol side effects: depression, acne, hirsutism, hot flashes, menstrual irregularities, amenorrhea, weight gain, nausea, alters OCP effectiveness
• Bromocriptine first line in low doses for 6 months
  
  • Side effects: hot flashes, menstrual irregularity, amenorrhea, nausea, vaginal dryness, bloating

Question 14

Etiology of galactorrhea

Answer 14

Milky, clear, green bilateral discharge

• Causes: breast manipulation, pregnancy, lactation, medications
  
  • Can persist for months or years after breastfeeding

Question 15

Galactorrhea: diagnostic testing

Answer 15

• Prolactin level
  
  • If elevated, obtain thyroid hormone level, creatinine level, MRI of pituitary gland
• Unilateral serous or bloody discharge that occurs spontaneously indicative of cancer
  
  • Esp in conjunction with breast mass and women older than 40 years

Question 16

Etiology of non-lactational mastitis

Answer 16

Spontaneous peripheral breast abscesses in non-lactating women

• Associated with diabetes, immunocompromised, smoking, nipple rings
• Obstruction with cellular debris and lipid-laden material
  
  • Periareolar abscesses and erythema from periductal inflammation
• Patients often young and smoke

Question 17

Non-lactational mastitis: manifestations

Answer 17

• Non-cyclical mastalgia
• Nipple discharge or retraction
• Periareolar abscess
• Subareolar masses or cellulitis of overlying skin
• Pain, redness, induration of skin (peau d’orange)

Question 18

Non-lactationsl mastitis: diagnostic testing

Answer 18

If mastitis occurs, recurs, or fails to resolve - biopsy to rule out inflammatory breast disease

Ultrasonography for breast abscesses with mastitis

• Palpation will be difficult, elicits pain

Want to repeat aspirations rather than I&Ds to avoid formation of fistulas and poor cosmetic appearance

Question 19

Non-lactational mastitis: treatment

Answer 19

Clindamycin or metronidazole (Flagyl) + cefazolin or nafcillin