Repro 11.2.1 Breast Disease

Question 1

What happens to breasts before menarche?

Answer 1

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

Question 2

How might breast conditions present?

Answer 2

Pain
Palpable mass
Nipple discharge
Skin changes
Lumpiness

Question 3

What type of breast masses are most worrying?

Answer 3

Hard, craggy and fixed

Question 4

What are potential causes of palpable masses in the breast?

Answer 4

Invasive carcinoma
Fibroadenomas
Cysts

Question 5

When is nipple discharge most concerning?

Answer 5

If spontaneous and unilateral

Question 6

What type of pathology does milky nipple discharge suggest?

Answer 6

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

Question 7

WHat does bloody or serous nipple discharge suggest?

Answer 7

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

Question 8

Who is invited to have mammography screening and how often?

Answer 8

47-53 year olds every 3 years

Question 9

What are worrying findings in mammography?

Answer 9

Densities - invasive carcinomas, fibroadenomas, cysts

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

Question 10

What is the most common benign breast tumour?

Answer 10

Fibroadenoma

Question 11

What type of tumours does mammographic screening increase detection of?

Answer 11

Small invasive tumours (hard to feel)

In situ carcinomas

Question 12

WHen do fibroadenomas commonly occur?

Answer 12

<30 years

Can occur at any age

Question 13

When do phyllodes tumours commonly occur?

Answer 13

Most present in 6th decade

Question 14

When does breast cancer most commonly occur?

Answer 14

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

Question 15

Name some disorders of development.

Answer 15

Milk line remnants
Polythelia
Accessory axillary breast tissue

Question 16

Name some inflammatory disorders of the breast.

Answer 16

Acute mastitis
Duct ectasia
Fat necrosis

Question 17

What is acute mastitis?

Answer 17

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

Question 18

What may be a complication of acute mastitis?

Answer 18

May produce breast abscesses

Question 19

How is acute mastitis treated?

Answer 19

Expressing milk

Antibiotics

Question 20

What is duct ectasia?

Answer 20

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

Question 21

How does fat necrosis present?

Answer 21

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

Question 22

Name some benign lesions.

Answer 22

Fibrocystic change
Epithelial hyperplasia
Papilloma

Question 23

How do fibrocystic changes commonly present?

Answer 23

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

Question 24

What is the histology of fibrocystic change?

Answer 24

Cyst formation
Fibrosis
Apocrine metaplasia

Question 25

How is epithelial hyperplasia usually detected?

Answer 25

Mammographic abnormality or as incidental fining in biopsies

Question 26

What is epithelial hyperplasia?

Answer 26

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

Question 27

Where are large duct papillomas commonly found?

Answer 27

Lactiferous ducts near nipple

Question 28

Where are small duct papillomas commonly found?

Answer 28

Often multiple and situated deeper in the breast

Question 29

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

Answer 29

Small duct papillomas

Question 30

How do papillomas commonly present?

Answer 30

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

Question 31

What is the common histological appearance of papilloma?

Answer 31

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

Question 32

Name some stromal breast tumours.

Answer 32

``` Fibroadenoma Phyllodes tumours Lipoma Leiomyoma Hamartoma ```

Question 33

How do fibroadenomas usually present?

Answer 33

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

Question 34

How do fibroadenomas appear macroscopically?

Answer 34

Well circumscribed, rubbery, greyish/white

Question 35

How do fibroadenomas appear histologically?

Answer 35

Composed of a mixture of stromal and epithelial elements

Question 36

How do phyllodes tumours present?

Answer 36

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

Question 37

What type of tumour is a phyllode?

Answer 37

Can be benign, malignant or borderline | Most are benign <5% malignant

Question 38

How do phyllodes tumours apear histologically?

Answer 38

Nodules of proliferating stroma covered by epithelium | Stroma more cellular and atypical than that in fibroadenomas

Question 39

How are phyllodes tumours treated?

Answer 39

Need to be excised with wide margin or may recur | Malignant types behave aggressively, recur locally and metastasise in blood stream

Question 40

What is gynaecomastia?

Answer 40

Enlargement of male breast (unilateral or bilateral) | Can mimic male breast cancer especially if unilateral but no increased risk of cancer

Question 41

When is gynaecomastia usually seen?

Answer 41

At puberty and in the elderly

Question 42

What causes gynaecomastia?

Answer 42

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

Question 43

How common is gynaecomastia?

Answer 43

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

Question 44

What drugs can cause gynaecomastia?

Answer 44

``` Spironolactone Chlorpromazine Digitalis Cimetidine Alcohol Marijuana Heroin Anabolic steroids ```