L4: Miscellaneous Breast Conditions Flashcards
1
Q
Def of Nipple Discharge
A
- Secretions persistent enough to DISCHARGE SPONTANEOUSLY
- either Physiologic or Pathologic
2
Q
Incidence of Nipple Discharge
A
- 5% of the referrals to breast clinics.
- 10 - 15% of patients with benign breast disease.
- 3% of patients with carcinoma.
3
Q
Etiology of Nipple Discharge
A
4
Q
Etiology of Nipple Discharge
- Physiological
A
5
Q
Etiology of Nipple Discharge
- Pathological
A
6
Q
Pathological Causes of Nipple Discharge
- Bloody
A
6
Q
Pathological Causes of Nipple Discharge
- necrotic
A
Degenerative carcinoma.
7
Q
Pathological Causes of Nipple Discharge
- Serous, green, brown or black
A
Fibroadenosis
8
Q
Pathological Causes of Nipple Discharge
- Purulent
A
breast abscess
9
Q
Pathological Causes of Nipple Discharge
- Milky
A
- Galactorrhea
- Galactocele
- Contraceptive pills
10
Q
Pathological Causes of Nipple Discharge
- Greenish or creamy paste discharge
A
Mammary duct ectasia
11
Q
- …… is most common cause of discharge > 55 yrs
- ……… is most common cause of discharge < 55 yrs
- Bloody unilateral nipple discharge in a woman older > 60 years is suggestive of …….
A
- Duct ectasia
- Duct papilloma
- cancer
12
Q
Nipple discharge is suspected to be pathological if ……..
A
13
Q
INVx for Nipple Discharge
A
14
Q
INVx for Nipple Discharge
- Localization Test
A
By differential pressure to localize the offending duct.
15
Q
INVx for Nipple Discharge
- Bemzidine Test
A
- To detect occult blood in the discharge.
16
Q
INVx for Nipple Discharge
- Sonomammography
A
- To detect impalpable mass.
17
Q
INVx for Nipple Discharge
- Ductography
A
- To diagnose duct papilloma and duct carcinoma.
18
Q
INVx for Nipple Discharge
- Ductoscopy
A
….
19
Q
INVx for Nipple Discharge
- Cytology & Biopsy
A
- of mass if present.
- Cytology may not add much to imaging and examination findings.
20
Q
INVx for Nipple Discharge
- Serum PRL
A
If persistent elevated, search for pituitary adenoma.
21
Q
Multiductal discharge:
- Does not appear to be a sign of ………
- It may be possible to ……. investigation in this group of patients
A
- malignancy or papilloma
- omit
22
Q
DDx of Galactorrhea
A
23
Q
CP of Galactorrhea
A
24
Etiology of **Galactorrhea**
25
TTT of **Galactorrhea**
26
Swellings of **Breast**
- Solid
- Cystic
27
Swellings of **Breast**
- Solid
28
Swellings of **Breast**
- Cystic
29
Cystic Swellings of **Breast**
- Acinar (Duct System)
30
Cystic Swellings of **Breast**
- Inter-Acinar (Stroma)
31
Causes of massive breast swelling
32
Types of **Mastalgia**
- Cyclic
- Non-Cyclic
32
Management of Breast Lump
Management is according to Hedley-Atkins classification "with lump"
33
Def of **Cyclic Mastalgia**
Related to menstrual cycle.
34
Fate of **Cyclic Mastalgia**
Self limiting.
35
Pathology in **Cyclic Mastalgia**
Salt & water retention + Hormonal imbalance → Estrogen dominance
36
Causes of **Cyclic Mastalgia**
- Obesity
- Drugs as COCs.
37
TTT of **Cyclic Mastalgia**
38
Def of **Non-Cyclic Mastalgia**
- Not related to menstrual cycle.
39
Incidence of **Non-Cyclic Mastalgia**
30% of mastalgia
40
Causes of **Non-Cyclic Mastalgia**
41
Causes of **Non-Cyclic Mastalgia**
- Breast Origin
42
Causes of **Non-Cyclic Mastalgia**
- Non-Breast Origin
43
Tietze's syndrome
Costochondral pain
44
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Male Breast Diseases
45
Def of **Gynecomastia**
- Hypertrophy of the male breast, resembling that of a female due to an excess of estrogen in relation of circulating testosterone.
46
Types of **Gynecomastia**
47
Types of **Gynecomastia**
- Primary
48
Types of **Gynecomastia**
- Secondary
49
Causes of 2ry **Gynecomastia**
- Congenital
Klinefilter's syndrome
50
Causes of 2ry **Gynecomastia**
- Traumatic
Atrophy of testis due to trauma, after castration.
51
Causes of 2ry **Gynecomastia**
- Inflammatory
- Atrophy of testis due to orchitis e.g. mumps.
- Leprosy due to bilateral testicular atrophy
52
Causes of 2ry **Gynecomastia**
- Neoplastic
- Atrophy of testis due to neoplasms.
53
Causes of 2ry **Gynecomastia**
- Neoplastic
- Atrophy of testis due to neoplasms.
54
Causes of 2ry **Gynecomastia**
- Paraneoplastic
Ectopic hormonal production
55
Causes of 2ry **Gynecomastia**
- Metabolic
- Liver cirrhosis: due to failure of liver to metabolize estrogens.
56
Causes of 2ry **Gynecomastia**
- Drugs
- Estrogen (for cancer prostate)
- digitalis
- INH
- Aldactone
- Cimetidine
57
CP of **Gynecomastia**
Mass
- Bilateral, mobile, tender, retroareolar, discoid,
58
DDx of **Gynecomastia**
59
TTT of **Gynecomastia**
60
TTT of **Gynecomastia**
- Medical
1. Androgens
2. Anti-estrogens
3. Aromatase
61
TTT of **Gynecomastia**
- Surgical
