Week 8 The Breast Flashcards by James Kinnick

What nodes are accessible to palpation?

midaxillary
supraclavicular 
lateral axillary (brachial)
subscapular
anterior axillary (pectoral)
subclavicular (infraclavicular)

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What 3 tests are used to dianosis benign breast disorders?

Mammography
ultrasonography
biopsy

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What does an US differentiates between ?

solid and cystic masses

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Young women’s breasts are?

radiodense

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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

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What is the treatment options of Mastodynia (Mastalgia)?

A. Reassurance
B. Acetaminophen NSAIDs 
C. Vitamin B6 
D. Bromocriptine
E. Tamoxifen 
F. Danazol

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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

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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

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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.

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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.

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What is most common benign breast condition between the ages of 30 and 50?

Fibrocystic Disease

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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

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What does Fibrocystic Disease cause?

cysts
papillomatosis
fibrosis
adenosis
ductal epithelial hyperplasia

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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.

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What condition has no axillary LN involement or nipple d/c?

Fibrocystic Disease

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What is important to know in regards to lesions in Fibrocystic Disease?

Multiple lesions distinguish fibrocystic changes from carcinoma

Sizes vary through menstrual cycle.

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What is the diagnosis of Fibrocystic Disease?

Biopsy for carcinoma

FNA is both diagnostic and therapeutic

Cysts usually contain straw-colored fluid

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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

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What is Mastitis?

Regional infection of the breast.

lactating women!!

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What causes Mastitis?

patient’s skin flora or oral flora of infant

S. aureus

Organism enters through erosion or crack in the nipple.

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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

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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 ```