inflammatory breast disease Flashcards
what is mastitis?
inflammation of the breast tissue, both acute or chronic.
most common cause is infection, typically S. Aureus, but can be granulomatous.
how can mastitis be classified?
by lactation status
- Lactation mastitis,
seen in 1/3rd of breastfeeding women, usually in first few months of breastfeeding or weening. associated with cracked nipples and milk stasis, and most common with first child. - Non-lactational mastitis,
less common but can occur especially in women with duct ectasia and peri ductal mastitis. Tobacco smoking is a risk factor, causing damage to the sub-areolar duct walls and predisposing to bacterial infection
what are the clinical features of mastitis?
tenderness, swelling and erythema over the area of infection. In the assessment, it is important to ensure there is no localised abscess formation occurring.
how is mastitis managed?
antibiotic therapy and simple analgesics.
in lactational mastitis, continued breast feeding/milk drainage is recommended.
what is a breast abscess?
collection of pus within the breast lined with granulation tissue, most commonly developing from acute mastitis.
present with tender fluctuant and erythematous masses, and can be diagnosed with USS.
how is a breast abscess treated and what complication can arise?
initial phase is often fully reversible with prompt empirical antibiotics and US-guided needle therapeutic aspiration. More advanced abscesses may require incision and drainage under a local anaesthetic.
common complication:
formation of a mammary duct fistula (a communication between the skin and a subareolar breast duct), which, whilst they can be managed surgically with a fistulectomy and antibiotics, can often recur.
what is a breast cyst?
Cysts are epithelial lined fluid-filled cavities, which form when lobules become distended due to blockage, usually in the perimenopausal age group (usually don’t occur in post menopause but can if on HRT).
what are the clinical features of breast cysts?
present singularly or with multiple lumps and can affect one or both breasts. On palpation, cysts appear as distinct smooth masses that may also be tender.
what investigations are done for breasts cysts?
identified by their typical halo shape on mammography and can usually be definitively diagnosed using ultrasound
how are breast cysts treated?
Once diagnosed, cysts usually require no further management and self-resolve
Larger cysts (aesthetically not pleasing), persisting, undeterminable or symptomatic cysts may be aspirated, either freehand or using ultrasound. Cancer may be excluded if the fluid is free of blood or the lump disappears, otherwise the cystic fluid should be sent for cytology.
what are the complications of breast cysts?
Patients with cysts have a 2-3 times greater risk of developing breast cancer in the future.
some women can develop fibroadenosis caused by multiple cysts and fibrotic areas, which can hide malignancy.
what is mammary duct ectasia?
the dilation and shortening of the major lactiferous ducts. common in peri menopausal women.
what are the clinical features of duct ectasia?
presents with coloured green/yellow nipple discharge, a palpable mass, or nipple retraction.
any blood stained discharge should be referred for triple assessment.
what investigations should be done for duct ectasia?
identified by mammography by dilated calcified ducts
If biopsied, the mass typically contains multiple plasma cells
how is duct ectasia managed?
managed conservatively, unless radiological findings cannot exclude malignancy.
Unremitting nipple discharge can be treated with duct excision (either just the affected duct = microdochectomy or all of the major ducts = a total duct excision, done under general anaesthetic)
