Repro 11.2.1 Breast Disease Flashcards
What happens to breasts before menarche?
Increase in the number of lobules in the breast and increased volume of interlobular stroma
How might breast conditions present?
Pain Palpable mass Nipple discharge Skin changes Lumpiness
What type of breast masses are most worrying?
Hard, craggy and fixed
What are potential causes of palpable masses in the breast?
Invasive carcinoma
Fibroadenomas
Cysts
When is nipple discharge most concerning?
If spontaneous and unilateral
What type of pathology does milky nipple discharge suggest?
Endocrine disorders eg. pituitary adenoma, side effect of medicine (OCP)
WHat does bloody or serous nipple discharge suggest?
Benign lesions eg. papilloma, duct ectasia, occasionally malignant lesions
Who is invited to have mammography screening and how often?
47-53 year olds every 3 years
What are worrying findings in mammography?
Densities - invasive carcinomas, fibroadenomas, cysts
Calcifications - ductal carcinoma in situ (DCIS), benign changes
What is the most common benign breast tumour?
Fibroadenoma
What type of tumours does mammographic screening increase detection of?
Small invasive tumours (hard to feel)
In situ carcinomas
WHen do fibroadenomas commonly occur?
<30 years
Can occur at any age
When do phyllodes tumours commonly occur?
Most present in 6th decade
When does breast cancer most commonly occur?
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
Name some disorders of development.
Milk line remnants
Polythelia
Accessory axillary breast tissue
Name some inflammatory disorders of the breast.
Acute mastitis
Duct ectasia
Fat necrosis
What is acute mastitis?
Usually a Staph aureus infection from nipple cracks and fissures
Erythemous painful breast, often pyrexia
Almost always occurs during lactation
What may be a complication of acute mastitis?
May produce breast abscesses
How is acute mastitis treated?
Expressing milk
Antibiotics
What is duct ectasia?
Duct dilation and inflammation of uncertain aetiology
My have periareolar mass and/or nipple discharge
Can mimic carcinoma
Often in patients in 50/60s
How does fat necrosis present?
Presents as a mass, skin changes or mammographic abnormality
Often history of trauma or surgery
Can mimic carcinoma clinically and mammographically
Name some benign lesions.
Fibrocystic change
Epithelial hyperplasia
Papilloma
How do fibrocystic changes commonly present?
Mass or mammographic abnormality which often disappears after aspiration with a fine needle (FNA)
What is the histology of fibrocystic change?
Cyst formation
Fibrosis
Apocrine metaplasia
How is epithelial hyperplasia usually detected?
Mammographic abnormality or as incidental fining in biopsies
What is epithelial hyperplasia?
Proliferation of epithelial cells which fill and distend ducts and lobules
Associated with a slight increased risk of carcinoma (even higher if atypical)
Where are large duct papillomas commonly found?
Lactiferous ducts near nipple
Where are small duct papillomas commonly found?
Often multiple and situated deeper in the breast
What type of papillomas are associated with increased risk of carcinoma?
Small duct papillomas
How do papillomas commonly present?
Nipple discharge (may be bloody)
Small palpable mass
Mammographic abnormality
What is the common histological appearance of papilloma?
Intraduct lesion consisting of multiple branching fibrovascular cores covered by myoepithelial and epithelial cells
Name some stromal breast tumours.
Fibroadenoma Phyllodes tumours Lipoma Leiomyoma Hamartoma
How do fibroadenomas usually present?
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
How do fibroadenomas appear macroscopically?
Well circumscribed, rubbery, greyish/white
How do fibroadenomas appear histologically?
Composed of a mixture of stromal and epithelial elements
How do phyllodes tumours present?
Mass or mammographic abnormality. Can be very large and involve entire breast
What type of tumour is a phyllode?
Can be benign, malignant or borderline
Most are benign <5% malignant
How do phyllodes tumours apear histologically?
Nodules of proliferating stroma covered by epithelium
Stroma more cellular and atypical than that in fibroadenomas
How are phyllodes tumours treated?
Need to be excised with wide margin or may recur
Malignant types behave aggressively, recur locally and metastasise in blood stream
What is gynaecomastia?
Enlargement of male breast (unilateral or bilateral)
Can mimic male breast cancer especially if unilateral but no increased risk of cancer
When is gynaecomastia usually seen?
At puberty and in the elderly
What causes gynaecomastia?
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
How common is gynaecomastia?
Transient gynaecomastia affects more than half of boys in puberty as oestrogen production peaks earlier than that of testosterone
What drugs can cause gynaecomastia?
Spironolactone Chlorpromazine Digitalis Cimetidine Alcohol Marijuana Heroin Anabolic steroids
