Non-malignant breast disease Flashcards
What is acute pyogenic mastitis?
Painful acute inflammatory condition which usually occurs weeks after delivery. S. aureus is the most common cause.
How do organisms get into the breast tissue to cause acute pygenic mastitis?
A crack in the nipple - infection is usually confined to one segment of the breast
What can occur as a complication of acute pygenic mastitis?
Breast abscess
How do breast abscesses present?
Painful, hot swelling of breast segment
How would you manage someone with a breast abscess?
- Antibiotics
- Repeated US guided drainage as often as needed
What is ductal ectasia?
Condition in which the lactiferous duct becomes blocked or clogged. The ducts are dilated and filled with white–green viscid matter, which may be discharged from the nipple. If bloodstained, this can be mistaken for carcinoma, but there is no relationship to malignancy.
When in a womans life does ductal most commonly occur?
During menopause
How does someone with ductal ectasia present?
- Nipple discharge - green/brown/can be bloody
- Nipple retraction
- Lump
How would you manage someone with ductal ectasia?
- Refer for diagnosis
- No treatment normally needed
- Advise to stop smoking
What would you advise someone with ductal ectasia to stop doing?
Smoking
What is fat necrosis?
Fibrosis and calcification after trauma to the breast. Macroscopically, the tissue is yellow and haemorrhagic, with flecks of calcification. Fibrous tissue is also present, the amount depending on the duration of the condition.
How do those with fat necrosis of the breast present?
- Firm lump (painful/painless)
- History of trauma
How would you manage someone with fat necrosis of the breast?
- Refer for triple assessment
- No treatment once diagnosis confirmed
What is gynaecomastia?
Gynaecomastia is benign enlargement of the male breast tissue. The breast may resemble that of a young adolescent female in appearance and consistency, or there may be a firm, mobile disc beneath the nipple
What is a fibroadenoma?
Commonest type of primary benign tumour which arises from overgrowth of collagenous mesenchyme of one breast lobule. They involve proliferation of both the connective tissue stroma and the glands
How do fibroadenomas present?
Firm, smooth, painless, mobile lump in the breast
How would you manage someone with a fibroadenoma?
- Observation and reassurance
- Refer for USS +/- FNA - if unsure
- Consider surgery if large
Does a fibroadenoma progress to malignancy?
No
When do fibroadenomas tend to present?
<30 yrs
What is a duct papilloma?
Commonest cause of discharge
Arise from solitary lesion within a large duct. They consist of branching fibrvascular cores covered by epithelium.
What is the commonest cause of a mobiile lump?
Fibroadenoma
What is the commonest cause of ill-defined lump or lumpy areas?
Fibrocystic changes
What is the commonest cause of clear nipple discharge?
Duct ectasia
When do breast cysts occur most commonly?
Perimenopause
How do breast cysts present?
- Benign, fluid filled rounded lump
- Can be painful
- Not fixed to surrounding tissues
What is the most commonly implicated organism in a breast abscess?
Staph aureus
What investigation would you do if you suspected a breast abscess?
Breast USS
What could a breast abscess be linked with in elderly women?
Could be part of mammary duct ectasia
How would you manage mastalgia?
- Analgesia - paracetamol, NSAIDs
- Primrose oil/Starflower oil
- Continuous/severe - Low dose Danazol or Bromocriptine
What would be your differential diagnosis for the following?
- Eczema
- Psoriasis
- Dermatitis
- Paget’s disease
How would you investigate the following?
- Punch biopsy
- Mammogram
- Consider triple investigation
How would you investigate nipple retraction?
Mammogram and USS
How would you investigate Nipple discharge?
- Clinical exam
- Mammogram
- USS
- Discharge cytology
What would pussy nipple discharge indicate?
Infection
What might milky nipple diuscharge indicate?
- Pregnancy
- Prolactinoma
- Post-pregnancy
What might bloody nipple discharge indicate?
Intraduct papilloma/malignancy
What might toothpaste-like nipple discharge indicate as a cause?
Duct ectasia
What are causes of gynaecomastia?
- Genetic/Gender disorder (Klinefelter)
- Young boy (pubertal)*
- Neonate*
- Estrogen
- Cirrhosis/ Cimetidine/ Ca Channel blockers
- Old age*
- Marijuana
- Alcoholism
- Spironolactone
- Tumors (Testicular & adrenal)
- Isoniazid/ Inhibition of testosterone
- Antineoplastics (Alkylating Agents)/ Antifungal(ketoconazole)
What drugs can cause gynaecomastia?
- S = Spironolactone
- A = Alcohol
- C = Cimetidine
- K = Ketocanazole
- E = Estrogen
- D = Digitalis
