The Breast CH 5

Question 1

alveoli change during pregnancy and lactation

Answer 1

during pregnancy alveoli hypertrophy and the lining cells proliferate. During lactation alveolar cells secrete proteins and lipids which compromise breast milk

Question 2

breast change in puberty (pre menses)

Answer 2

breasts enlarge (due to increase in acinar tissue, ductal size, and deposits of adipose) and assume cone/sphere shape. nipple and areola enlarge become more sensitive to touch.

Question 3

breast changes after menses established

Answer 3

undergoes periodic premenstrual phase where acinar cells increase in number and size, ductal lumens widen, and breast size and turgor increase. may have breast tenderness during period. decrease in breast size after period is over

Question 4

breast changes in pregnancy

Answer 4

progesterone makes breast size and turgidity increase. There is also deepening pigmentation of nipples and areola, nipple enlargement, areolar widening, and increase and widening of lubricating glands. In late pregnancy, fatty tissue replaced with cellular breast parenchyma

Question 5

breast changes postpartum

Answer 5

progesterone and estrogen drops, breasts secrete milk, after nursing ceases breasts return to prepregnancy state

Question 6

breast changes in menopause

Answer 6

breasts undergo atrophy and involution regressing to almost infantile state.

Question 7

glands of montgomery

Answer 7

small elevated nodules under nipple, responsible for lubrication of nipple to help prevent cracks and fissures from breastfeeding. have marked hypertrophy in 3rd trimester

Question 8

superficial drainage of breasts lymphatics

Answer 8

lymphatic plexus drains areola, nipple, and deep central parenchymatous region of breast

Question 9

fibrocystic breast change patho

Answer 9

usually benign and can be seen as variant of normal breast tissue

Question 10

fibrocystic breast change clinical findings

Answer 10

asymptomatic breast lumps associated with hormonal imbalance. may have cyclic breast pain and tenderness increased in premenstrual period. may have nonbloody, green, or brown discharge.

Question 11

differential diagnosis of fibrocystic breast change

Answer 11

pain, fluctuation in size and multiplicity of lesions help to differentiate from cancers. Biopsy and US needed for final r/o. aspiration can also be used to r/o cystic vs solid mass

Question 12

fibrocystic breast change tx

Answer 12

reassure pt of normal finding, decrease caffeine consumption (not proven), tylenol and ibuprofen for pain relief. danazol and tamoxifen may also be used

Question 13

fibrocystic breast change prognosis

Answer 13

be sure to still check regularly and check for changes in lesions that can be associated with increased risk for breast CA

Question 14

Fibroadenoma pathogenesis

Answer 14

common benign neoplasm occurring frequently in younger women. hormonal relationship likely.

Question 15

fibroadenoma clinical findings

Answer 15

round firm discrete relatively movable non tender mass 1-5 cm. benign on US. managed with core needle biopsy or short term (3-6 months) follow up with repeat US and breast exam

Question 16

fibroadenoma differential diagnosis

Answer 16

only confirmed with core biopsy or excision. Cryoablation can be used afterwards. rapid growth may mean phyllodes tumor

Question 17

fibroadenoma tx

Answer 17

treat with local excision of mass with margin of surrounding normal breast tissue.

Question 18

nipple discharge pathogenesis

Answer 18

normal lactation, galactorrhea (benign physiologic nipple discharge), and pathological nipple discharge

Question 19

clinical findings of nipple discharge

Answer 19

do H&P to determine: nature of discharge, association w/wo mass, uni or bilateral, single or multiple duct discharge, is it spontaneous, persistent, intermittent or must be expressed, produced by pressure at single site or general pressure, relation to menses, pre or post menopausal, hx or oral contraceptive or estrogen use

Question 20

Galactorrhea

Answer 20

galactorrhea or physiologic nipple discharge usually caused by hyperprolactinemia secondary to meds like phenothiazines, endocrine/pituitary/ hypothalamic abnormalities. manifests as bilat multiductal milky discharge in nonlacting breast

Question 21

pathologic nipple discharge

Answer 21

usually unilateral spontaneous serous or serosangious from single duct and usually caused by intraductal papilloma or intraductal malignancy. bloody discharge may mean cancer

Question 22

nipple discharge tx

Answer 22

surgical excision of involved duct after workup rules out additional findings. Purulent discharge may require excisionof abscess

Question 23

fat necrosis

Answer 23

benign condition that produces mass often accompanied by skin or nipple retraction but clinically indistinguishable from CA. caused by trauma or surgery. if it does not resolve itself, biopsy

Question 24

breast abscess

Answer 24

area of redness, tenderness, and induration. may continue to breastfeed and tx with antibiotic. needs to be drained if mass becomes palpable with systemic signs of infection. breastfeeding can help control pain. r/o inflammatory breast CA

Question 25

amastia

Answer 25

complete absence of 1 or both breasts

Question 26

polythelia

Answer 26

presence of accessory nipples

Question 27

polymastia

Answer 27

breast tissue along embryologic milk line