Gynaecology Flashcards
What are the differential diagnoses for a breast lump?
- Fibroadenoma
- Breast cyst
- Fat necrosis
- Intraductal papilloma
- Ductal carcinoma in situ (DCIS)
- Invasive carcinoma
- Breast abscess
What is a fibroadenoma? (clinical presentation, investigation, management)
Clinical presentation:
- very common in pre-menopausal women
- smooth, rubbery, well-defined, mobile mass
- may have mobile, bilateral
Investigations:
- U/S (homogeneous, low density, well-defined, hypoechoic, no shadow)
- core biopsy to rule out malignancy
Management:
- don’t have malignant potential
- excision for cosmetic purposes
What is hormonal mastalgia?
This is simply breast pain that relates to the menstrual cycle.
- breast tenderness +/- presence of mass
- worse leading up to and during period
What is a breast cyst? (clinical presentation, investigations, management)
Clinical presentation:
- painful lumps
- short, sudden onset
- fluctuate with menstrual cycle
- rubbery, well-circumscribed, mobile mass
Investigations
- U/S (hypoechoic, thin wall, whiteness at back)
Management:
- cysts do not predispose to cancer (benign)
- aspirate cyst for pain control
What is an intraductal papilloma? (clinical presentation, investigations, management)
Clinical presentation:
- bloody nipple discharge
- may present with small mass, not always palpable
Investigations:
- mammogram: may be negative
- U/S: dilated duct with oval mass
- breast ductogram: filling defect of duct
Management:
- benign, low malignant chance
- excision
What are the different breast imaging modalities?
Mammogrpahy Ultrasound Tomosynthesis MRI Imaging-guided biopsy
What is mammography, when is it indicated and how is it performed?
Mammography involves a low-dose X-ray of the breast.
- breast tissue is compressed between a detector and a perspex plate
- both cranial-caudal (CC) or medial lateral oblique (MLO) view
It is usually indicated in women >35 years old because breast tissue is less dense after this age (in general). Women <35 years old generally have an ultrasound first before a mammogram, while women <35 have both mammogram and ultrasound.
What can be seen on a normal mammogram?
Whiter fibroglandular tissue
Darker grey = normal subcutaneous fat
Only thin skin line may be seen
Ideally see nipple in profile
What is the dual issue with naturally denser breasts?
- Increased breast tensity makes it harder to identify breast pathology (e.g. cancer) on mammography.
- There is an increased risk of developing breast cancer.
What are the four main pathologies we are looking for on mammography?
- mass
- calcification
- architectural distortion
- asymmetric density
What are features of a benign mass on mammography and what features would you be concerned about?
Benign:
- smooth
- well-circumscribed
Concerning features:
- new mass
- indistinct or irregular margins
- spiculations (desmoplastic response)
What are the concerning features of calcifications?
Microcalcifications that are pleomorphic (varying size and shape), particularly if linear or branching (indication of DCIS).
What are the features of a benign cyst on ultrasound?
- hypoechoic (fluid just transmits sound waves) -usually completely black
- well-defined
- almost no perceptible wall
- tissue deeper to the cyst has acoustic enhancement (receives more sound waves)
What are the features of a complex cyst on ultrasound?
- thicker wall
- solid nodular components projecting into it
- irregular shape
What are the features of a benign solid lesion on ultrasound?
- well-circumscribed
- smooth
- ovoid or round
- not completely black (cyst)
