Non-malignant breast disease Flashcards
What is acute pyogenic mastitis?
Painful acute inflammatory condition of the lactigerous duct which usually occurs weeks after delivery.
S. aureus is the most common cause (transmitted y infant during lactation).
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. Erythema and tenderness wtih palpable lump.
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 - normal changes where ducts dilate with age.
How does someone with ductal ectasia present?
- Nipple discharge - green/brown/can be bloody “cheesy”
- Nipple retraction - due to eventual duct fibrosis
- Lump
May also present with microcalcification on routine mamogram.
Non cyclical mastalgia.
How would you manage someone with ductal ectasia?
- Refer for diagnosis
- No treatment normally needed
- Advise to stop smoking
- Exision of duct in persistant/recurrent cases
What would you advise someone with ductal ectasia to stop doing?
Smoking
What is fat necrosis?
Fibrosis and calcification after trauma to the breast eg seatbelt injury/prior surgical intervetnion.
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
(Can mimic carcinoma clinically and mammographically)
More likely to occur in overweight women.
How would you manage someone with fat necrosis of the breast?
- Refer for triple assessment
- No treatment once diagnosis confirmed - usually resolves spontaneously
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.
Peak incidence fibroadeoma
20-24 years
How do fibroadenomas present?
Firm, smooth, painless, well-circumscribed mobile lump in the breast
May be multiple
How would you manage someone with a fibroadenoma?
- Observation and reassurance
- Refer for USS +/- FNA - if unsure
- Consider surgery if large (>3cm)
Does a fibroadenoma progress to malignancy?
No
When do fibroadenomas tend to present?
<30 yrs
Partially hormone regulated so may regress after menopause
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
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
