Week 8 The Breast Flashcards
What nodes are accessible to palpation?
midaxillary supraclavicular lateral axillary (brachial) subscapular anterior axillary (pectoral) subclavicular (infraclavicular)
What 3 tests are used to dianosis benign breast disorders?
Mammography
ultrasonography
biopsy
What does an US differentiates between ?
solid and cystic masses
Young women’s breasts are?
radiodense
What are s/s of Mastodynia (Mastalgia)?
common and cyclical breast tenderness or pain
swelling from edema and engorgement of the vasculature and ductal systems
What is the treatment options of Mastodynia (Mastalgia)?
A. Reassurance B. Acetaminophen NSAIDs C. Vitamin B6 D. Bromocriptine E. Tamoxifen F. Danazol
What is role of Vitamin B6 in Mastodynia (Mastalgia)?
can relieve breast pain in both cyclical and noncyclical mastalgia but is more effective in cyclical mastalgia by reducing the prevalence of severe pain
What is role of Bromocriptine in Mastodynia (Mastalgia)?
dopaminergic agonist inhibits the release of prolactin from the anterior pituitary.
Effective, but side effects of HA and dizziness severe.
Danazol preferred > bromocriptine
What is role of Tamoxifen in Mastodynia (Mastalgia)?
Low dose (10 mg) tamoxifen has been found to have a high response rate (90%) in patients with severe mastalgia.
Side-effects were relatively few in short term use.
What is role of Danazol in Mastodynia (Mastalgia)?
synthetic testosterone which binds to progesterone and androgen receptors; precise mechanism of action for treatment of mastalgia is unknown
Response rate has been reported as 70% in cyclical mastalgia and 31% in noncyclical mastalgia.
Don’t use with DVT hx; is potentially teratogenic and can interact with OCPs - need barrier contraception.
What is most common benign breast condition between the ages of 30 and 50?
Fibrocystic Disease
What is Fibrocystic Disease cause by and what is it associated with?
Due to exaggerated stromal response to hormones
Associated with a long follicular or luteal phase of the menstrual cycle
What does Fibrocystic Disease cause?
cysts papillomatosis fibrosis adenosis ductal epithelial hyperplasia
What are the clinical manifestations Fibrocystic Disease?
A. May be asymptomatic B. breast swelling pain, and tenderness. C. May involve both breasts D. Are typically multiple, well demarcated, and mobile.
What condition has no axillary LN involement or nipple d/c?
Fibrocystic Disease
What is important to know in regards to lesions in Fibrocystic Disease?
Multiple lesions distinguish fibrocystic changes from carcinoma
Sizes vary through menstrual cycle.
What is the diagnosis of Fibrocystic Disease?
Biopsy for carcinoma
FNA is both diagnostic and therapeutic
Cysts usually contain straw-colored fluid
What is the treatment of Fibrocystic Disease?
supportive bra
Decrease nicotine and caffeine
low-salt diet
Vit E supplements
HCTZ prementrually
If symptoms are severe s/s => danazol
What is Mastitis?
Regional infection of the breast.
lactating women!!
What causes Mastitis?
patient’s skin flora or oral flora of infant
S. aureus
Organism enters through erosion or crack in the nipple.
What are the clinical manifestations of Mastitis?
fever
chills
malaise/flu-like sxs.
unilateral
tenderness
red
warm to the touch
one quadrant or a lobule of one breast
elevated WBC count
How is Mastitis diagnosed?
physical exam findings
What is the treatment of Mastitis?
A. PCN-resistant antibiotic dicloxacillin nafcillin OR cephalosporin B. hot compress
What is important for a new mother to know with Mastitis?
Patients should be instructed to continue to breast-feed or use a breast pump to prevent accumulation of infected material.
Source is likely the infant’s mouth
What are the complications of Mastitis?
breast abscess
duct ectasia
May require surgical intervention
What are many breast abscesses?
lactational
d/t S. aureus
A breast abscess may develop in patients with?
acute mastitis
Subareolar breast abscess is typically due to?
a mixed infection
anaerobes
staphylococci
streptococci
What are the clinical manifestations of a breast abscess?
painful erythematosus mass
drainage through the skin or nipple duct
What is the treatment of a Breast Abscess?
Incision and drainage required
r/o carcinoma
Antibiotics are needed
What is treatment of Lactational abscess?
nafcillin
cefazolin
vancomycin
What is the treatment of Subareolar abscess?
broad-spectrum antibiotics
What is a complication of a subareolar abscess?
Fistula
What is Galactorrhea?
Lactation or nipple discharge
not associated with childbearing
What cause Galactorrhea?
Elevated levels of prolactin ->
milk production ->
a result of disruption of the communication between the pituitary and hypothalamus glands
What are the clinical features of Galactorrhea?
random/bilateral/ multiductal serous or milky nipple discharge in the nonlactating breast
No mass
How can you clue in on the involved duct in Galactorrhea?
may be identified by pressure at different sites around the nipple at the margin of the areola.
The most common causes of pathologic nipple discharge are?
Intraductal papillomas
Carcinoma and fibrocystic change with ectasia of the ducts (less frequent)
What are the clinical features of pathologic nipple discharge involved in Galactorrhea?
unilateral from a single duct, and can
serous, bloody, or serosanguinous
+/- mass
What are the common causes of
Galactorrhea?
CNS lesions Hypothalamic-pituitary disorders Systemic diseases Medications and herbs Chest wall lesions
What is involved with CNS lesions causing Galactorrhea?
Pituitary secreting tumors
empty sella
hypothalamic tumor
head trauma
What is involved with Systemic diseases causing Galactorrhea?
Chronic renal failure sarcoidosis Schüller-Christian disease Cushing's disease hepatic cirrhosis hypothyroidism
What is involved with Chest wall lesions causing Galactorrhea?
Thoracotomy, herpes zoster
What is diagnosis of Galactorrhea with normal physical examination, negative imaging, and the discharge is multiductal and nonbloody?
Pregnancy test
Prolactin levels
Renal and thyroid function tests
Endocrinology follow-up
What is the diagnosis Galactorrhea with pathologic discharge?
Cytologic examination NOT helpful
mammography and/or US may reveal underlying abnormalities in the duct
ductography can be used to delineate an intraductal filling defect, which may be causing the nipple discharge.
What is Fibroadenoma?
Benign tumors composed of stromal and epithelial elements that represent a hyperplastic or proliferative process in a single terminal ductal unit
Second most common benign breast disorder?
Fibroadenoma
Clinical manifestations od Fibroadenoma ?
smooth/well-circumscribed/rubbery/nontender, mobile/firm lesion
Usually bilateral; single or multiple
change during menstrual cycle or pregnancy.
1 to 5 cm
No axillary involvement or nipple discharge.
What is the diagnosis of Fibroadenoma?
based on physical examination and biopsy results
What is the treatment of Fibroadenoma?
If no FH of breast cancer and the patient is stable => followed clinically.
> 25 yo => biopsy
If suspicious for cancer => FNA
Large fibroadenoma => excisional biopsy
Fibrocystic Changes
20 to 49 Usually bilateral Multiple or single Round Soft to firm; tense Mobile Absent retraction signs Usually tender Well delineated boarders Varies with menses
Fibroadenoma
15 to 55 Usually bilateral Single; may be multiple Round or discoid Firm, rubbery Mobile Absent retraction signs Usually nontender Well delineated boarders No variation with menses
Cancer
30 to 80 Usually unilateral Single Irregular or stellate Hard, stonelike Fixed Often present retreaction signs Usually nontender Poorly delineated; irregular boarders No variation with menses
