Week 11.1 - Breast disease Flashcards
How would pain present in breast disease?
- Non-cyclical
- Focal
How would a malignant lump present in breast disease?
- Hard
- Craggy
- Fixed
Give 3 differential diagnoses for palpable masses
- Invasive carcinomas
- Cysts
- Fibroadenoma
What is the most common benign palpable mass?
-Fibroadenoma
Give 2 differential diagnoses for milky discharge
- Pituitary adenoma
- OCP
Give 3 differential diagnoses for bloody/serous nipple discharge
- Benign lesion eg papilloma
- Duct ectasia
- Malignancy
Why are mammographic abnormalities easier to detect in older people?
-High adipose content in breasts
What does calcification suggest on a mammograph?
- DCIS
- benign mass
What is polyethelia?
-Additional nipple
What is acute mastitis?
-Inflammatory condition of the breast from Infection from staph. aureus during lactation due to nipple cracks as can track up the lactiferous duct
What is fat necrosis?
-Inflammatory condition of the breast which presents as a mass of skin changes as a history of trauma or surgery
What is fibrocystic change?
- The most common breast lesion which presents as a mass or on mammograph
- Histology shows cyst formation, fibrosis and apocrine metaplasia
State 3 benign epithelial lesions of the breast
- Fibrocystic change
- Stromal tumour eg fibroadenoma or phyllodes
- Gynacomastia
Name 2 benign stromal tumours
- Fibroadenoma
- Phyllodes
Describe how fibroadenoma would be on presentation
- Highly mobile mass (breast mouse)
- Well circumscribed
- Can be multiple, bilateral and large
In what age group does phyllodes most oftn occur?
-Over 40 years
Describe the behaviour of malignant phyllodes
- Aggressive
- Recur
- Metastasise by blood
What is the histiological difference between phyllodes and fibroadenoma?
-Phyllodes withh have more atypical stroma
When excising phyllodes, what is the difference between that and fibroadenoma? why?
-Wide excision margin as can recur
What is gynaecomastia? In who does it most often occur?
- Enlargement of the male breast due to decreased androgens or increased oestrogens
- Young or elderly
give 3 causes of gynaecomastia
- Liver disease
- Klinefelters
- Testicular tumour
What is the most common type of breast malignancy?
-Adenocarcinoma
Describe some riskfactors for breast malignancy
- Uninteruppted menses
- Early menarche
- Late menapause
- Obesity
- OCP/HRT
What is mean by in situ carcinoma?
-Neoplastic cells are limited to ducts and lobules by BM and thus cannot metastasise
What is distinctive about DCIS histiologically?
-Central comedo necrosis
What is pagets disease of the breast?
- DCIS which has extended up to the nipple skin as does not have to cross BM to get here
- Red crusting nipple
How does DCIS most often present?
-Mammographihc calcification
By the time a breast malignancy is palpable, what % have mets?
-50%
Where does invasive carcinoma commonly metastasise first?
-Axillary LNs
What is the cause of peau d’orange?
-Blockage of the lymphatics causing odematous breast -> Hair follicles are firmly attched to dermis and pull down
What are the two types of invasive carcinoma? Which is most common?
- IDC-No special type (most common)
- Invasive lobular carcinoma
How does invasive lobular carcinoma look histologically?
-Discohesive single file infiltrating cells
How does breast cancer commonly metastasise?
- Using lymphatics
- (distant mets usually by bloodstream)
Where does breast malignancy commonly metastasise?
-ipsilateral LNs, bone, lung, liver, brain
Describe the triple approach to investigation and diagnosis
- Clinical history and examination
- Radiographic imaging
- FNA
Describe breast cancer screening
- 47-73
- 2 view mammograms every 3 years
- Aims to detect small impalpable cancers
When would a breast malignancy get treated with tamoxifen?
-If it was oestrogen receptor positive
When would a breast malignancy get treated with herceptin?
-If it was HER2 receptor positive
