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Semester 4 > Repro 11.2.1 Breast Disease > Flashcards

Repro 11.2.1 Breast Disease Flashcards

1
Q

What happens to breasts before menarche?

A

Increase in the number of lobules in the breast and increased volume of interlobular stroma

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2
Q

How might breast conditions present?

A 
Pain
Palpable mass
Nipple discharge
Skin changes
Lumpiness
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3
Q

What type of breast masses are most worrying?

A

Hard, craggy and fixed

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4
Q

What are potential causes of palpable masses in the breast?

A

Invasive carcinoma
Fibroadenomas
Cysts

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5
Q

When is nipple discharge most concerning?

A

If spontaneous and unilateral

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6
Q

What type of pathology does milky nipple discharge suggest?

A

Endocrine disorders eg. pituitary adenoma, side effect of medicine (OCP)

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7
Q

WHat does bloody or serous nipple discharge suggest?

A

Benign lesions eg. papilloma, duct ectasia, occasionally malignant lesions

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8
Q

Who is invited to have mammography screening and how often?

A

47-53 year olds every 3 years

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9
Q

What are worrying findings in mammography?

A

Densities - invasive carcinomas, fibroadenomas, cysts

Calcifications - ductal carcinoma in situ (DCIS), benign changes

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10
Q

What is the most common benign breast tumour?

A

Fibroadenoma

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11
Q

What type of tumours does mammographic screening increase detection of?

A

Small invasive tumours (hard to feel)

In situ carcinomas

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12
Q

WHen do fibroadenomas commonly occur?

A

<30 years

Can occur at any age

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13
Q

When do phyllodes tumours commonly occur?

A

Most present in 6th decade

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14
Q

When does breast cancer most commonly occur?

A

Rare before 25years (except for some familial cases)
Incidence increases with age
77% occur in women >50 years
Average age at diagnosis is 64 years

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15
Q

Name some disorders of development.

A

Milk line remnants
Polythelia
Accessory axillary breast tissue

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16
Q

Name some inflammatory disorders of the breast.

A

Acute mastitis
Duct ectasia
Fat necrosis

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17
Q

What is acute mastitis?

A

Usually a Staph aureus infection from nipple cracks and fissures
Erythemous painful breast, often pyrexia
Almost always occurs during lactation

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18
Q

What may be a complication of acute mastitis?

A

May produce breast abscesses

19
Q

How is acute mastitis treated?

A

Expressing milk

Antibiotics

20
Q

What is duct ectasia?

A

Duct dilation and inflammation of uncertain aetiology
My have periareolar mass and/or nipple discharge
Can mimic carcinoma
Often in patients in 50/60s

21
Q

How does fat necrosis present?

A

Presents as a mass, skin changes or mammographic abnormality
Often history of trauma or surgery
Can mimic carcinoma clinically and mammographically

22
Q

Name some benign lesions.

A

Fibrocystic change
Epithelial hyperplasia
Papilloma

23
Q

How do fibrocystic changes commonly present?

A

Mass or mammographic abnormality which often disappears after aspiration with a fine needle (FNA)

24
Q

What is the histology of fibrocystic change?

A

Cyst formation
Fibrosis
Apocrine metaplasia

25
Q

How is epithelial hyperplasia usually detected?

A

Mammographic abnormality or as incidental fining in biopsies

26
Q

What is epithelial hyperplasia?

A

Proliferation of epithelial cells which fill and distend ducts and lobules
Associated with a slight increased risk of carcinoma (even higher if atypical)

27
Q

Where are large duct papillomas commonly found?

A

Lactiferous ducts near nipple

28
Q

Where are small duct papillomas commonly found?

A

Often multiple and situated deeper in the breast

29
Q

What type of papillomas are associated with increased risk of carcinoma?

A

Small duct papillomas

30
Q

How do papillomas commonly present?

A

Nipple discharge (may be bloody)
Small palpable mass
Mammographic abnormality

31
Q

What is the common histological appearance of papilloma?

A

Intraduct lesion consisting of multiple branching fibrovascular cores covered by myoepithelial and epithelial cells

32
Q

Name some stromal breast tumours.

A 
Fibroadenoma
Phyllodes tumours
Lipoma
Leiomyoma
Hamartoma
33
Q

How do fibroadenomas usually present?

A

Mass, usually mobile and elusive (mouse breast)
Mammographic abnormality
Can be multiple and bilateral
Can grow very large and replace most of the breast
Can mimic carcinoma clinically and mammographically but it is a localised hyperplasia rather than a true neoplasm

34
Q

How do fibroadenomas appear macroscopically?

A

Well circumscribed, rubbery, greyish/white

35
Q

How do fibroadenomas appear histologically?

A

Composed of a mixture of stromal and epithelial elements

36
Q

How do phyllodes tumours present?

A

Mass or mammographic abnormality. Can be very large and involve entire breast

37
Q

What type of tumour is a phyllode?

A

Can be benign, malignant or borderline

Most are benign <5% malignant

38
Q

How do phyllodes tumours apear histologically?

A

Nodules of proliferating stroma covered by epithelium

Stroma more cellular and atypical than that in fibroadenomas

39
Q

How are phyllodes tumours treated?

A

Need to be excised with wide margin or may recur

Malignant types behave aggressively, recur locally and metastasise in blood stream

40
Q

What is gynaecomastia?

A

Enlargement of male breast (unilateral or bilateral)

Can mimic male breast cancer especially if unilateral but no increased risk of cancer

41
Q

When is gynaecomastia usually seen?

A

At puberty and in the elderly

42
Q

What causes gynaecomastia?

A

Relative decrease in androgen effect or increase in oestrogen effect:
Seen in neonates secondary to circulating maternal and placental oestrogens and progesterone
Klinefelter’s syndrome
Oestrogen excess due to liver cirrhosis
Gonadotrophin excess - functioning testicular tumours, testicular germ cell tumours
Drug related

43
Q

How common is gynaecomastia?

A

Transient gynaecomastia affects more than half of boys in puberty as oestrogen production peaks earlier than that of testosterone

44
Q

What drugs can cause gynaecomastia?

A 
Spironolactone
Chlorpromazine
Digitalis
Cimetidine
Alcohol
Marijuana
Heroin
Anabolic steroids

Semester 4 (21 decks)

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