Exam 2 - Common benign breast conditions Flashcards
What are the six most common benign breast conditions seen?
- Fibrocystic changes
- Breast cysts
- Fibroadenoma
- Mastalgia
- Galactorrhea
- Non-lactational mastitis
What normally causes fibrocystic changes to the breast?
Associated with hormonal stimulation
- Common but rare in postmenopausal women
- No associated with development of breast cancer
Fibrocystic changes: manifestations
- Pain or tenderness
- Lumpy, “bag of beans”
- Firm, rubbery (NOT hard)
Fibrocystic changes: management
- Aspiration for larger, more painful cysts
- OCP can decrease risk of developing fibrocystic changes
Causes of breast cysts
- Obstructed breast lobules
- Influenced by hormonal changes in pre and perimenopausal women
- Common in women ages 35-50 years
Breast cysts: manifestations
- Smooth
- Mobile
- Round/ovoid
- Fluid filled
- Well delineated
Breast cysts: diagnostic testing
- 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
Etiology of fibroadenomas
- 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
Fibroadenomas: manifestations
- Single, isolated cysts
- 2-3 cm mass with firm or rubbery consistency
- Mobile
- Well circumscribed
- Non tender
Fibroadenoma: diagnostic testing
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
Etiology of mastalgia
- 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
Mastalgia: management
- 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
Medications that can alleviate mastalgia
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
Etiology of galactorrhea
Milky, clear, green bilateral discharge
- Causes: breast manipulation, pregnancy, lactation, medications
- Can persist for months or years after breastfeeding
Galactorrhea: diagnostic testing
- 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
Etiology of non-lactational mastitis
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
Non-lactational mastitis: manifestations
- Non-cyclical mastalgia
- Nipple discharge or retraction
- Periareolar abscess
- Subareolar masses or cellulitis of overlying skin
- Pain, redness, induration of skin (peau d’orange)
Non-lactationsl mastitis: diagnostic testing
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
Non-lactational mastitis: treatment
Clindamycin or metronidazole (Flagyl) + cefazolin or nafcillin
