Non-malignant breast disease Flashcards

1
Q

What is acute pyogenic mastitis?

A

Painful acute inflammatory condition which usually occurs weeks after delivery. S. aureus is the most common cause.

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2
Q

How do organisms get into the breast tissue to cause acute pygenic mastitis?

A

A crack in the nipple - infection is usually confined to one segment of the breast

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3
Q

What can occur as a complication of acute pygenic mastitis?

A

Breast abscess

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4
Q

How do breast abscesses present?

A

Painful, hot swelling of breast segment

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5
Q

How would you manage someone with a breast abscess?

A
  • Antibiotics
  • Repeated US guided drainage as often as needed
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6
Q

What is ductal ectasia?

A

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.

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7
Q

When in a womans life does ductal most commonly occur?

A

During menopause

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8
Q

How does someone with ductal ectasia present?

A
  • Nipple discharge - green/brown/can be bloody
  • Nipple retraction
  • Lump
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9
Q

How would you manage someone with ductal ectasia?

A
  • Refer for diagnosis
  • No treatment normally needed
  • Advise to stop smoking
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10
Q

What would you advise someone with ductal ectasia to stop doing?

A

Smoking

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11
Q

What is fat necrosis?

A

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.

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12
Q

How do those with fat necrosis of the breast present?

A
  • Firm lump (painful/painless)
  • History of trauma
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13
Q

How would you manage someone with fat necrosis of the breast?

A
  • Refer for triple assessment
  • No treatment once diagnosis confirmed
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14
Q

What is gynaecomastia?

A

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

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15
Q

What is a fibroadenoma?

A

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

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16
Q

How do fibroadenomas present?

A

Firm, smooth, painless, mobile lump in the breast

17
Q

How would you manage someone with a fibroadenoma?

A
  • Observation and reassurance
  • Refer for USS +/- FNA - if unsure
  • Consider surgery if large
18
Q

Does a fibroadenoma progress to malignancy?

A

No

19
Q

When do fibroadenomas tend to present?

A

<30 yrs

20
Q

What is a duct papilloma?

A

Commonest cause of discharge

Arise from solitary lesion within a large duct. They consist of branching fibrvascular cores covered by epithelium.

21
Q

What is the commonest cause of a mobiile lump?

A

Fibroadenoma

22
Q

What is the commonest cause of ill-defined lump or lumpy areas?

A

Fibrocystic changes

23
Q

What is the commonest cause of clear nipple discharge?

A

Duct ectasia

24
Q

When do breast cysts occur most commonly?

A

Perimenopause

25
Q

How do breast cysts present?

A
  • Benign, fluid filled rounded lump
  • Can be painful
  • Not fixed to surrounding tissues
26
Q

What is the most commonly implicated organism in a breast abscess?

A

Staph aureus

27
Q

What investigation would you do if you suspected a breast abscess?

A

Breast USS

28
Q

What could a breast abscess be linked with in elderly women?

A

Could be part of mammary duct ectasia

29
Q

How would you manage mastalgia?

A
  • Analgesia - paracetamol, NSAIDs
  • Primrose oil/Starflower oil
  • Continuous/severe - Low dose Danazol or Bromocriptine
30
Q

What would be your differential diagnosis for the following?

A
  • Eczema
  • Psoriasis
  • Dermatitis
  • Paget’s disease
31
Q

How would you investigate the following?

A
  • Punch biopsy
  • Mammogram
  • Consider triple investigation
32
Q

How would you investigate nipple retraction?

A

Mammogram and USS

33
Q

How would you investigate Nipple discharge?

A
  • Clinical exam
  • Mammogram
  • USS
  • Discharge cytology
34
Q

What would pussy nipple discharge indicate?

A

Infection

35
Q

What might milky nipple diuscharge indicate?

A
  • Pregnancy
  • Prolactinoma
  • Post-pregnancy
36
Q

What might bloody nipple discharge indicate?

A

Intraduct papilloma/malignancy

37
Q

What might toothpaste-like nipple discharge indicate as a cause?

A

Duct ectasia

38
Q

What are causes of gynaecomastia?

A
  • 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)
39
Q

What drugs can cause gynaecomastia?

A
  • S = Spironolactone
  • A = Alcohol
  • C = Cimetidine
  • K = Ketocanazole
  • E = Estrogen
  • D = Digitalis