Women's Health : Benign Breast Disease Flashcards
What are the two main regions of the breast?
○ Circular body ○ Axillary tail - runs into axillary fossa
What are the structural components of the mammary glands in the breast?
■ Lactiferous Ducts - one per lobe, exiting at the nipple. ■ Lobes - 15-20 per breast, each made up of 20-40 TDLUs. ■ TDLUs (terminal duct lobular units) - secretory functional units, made up of approximately 100 acini that drain into a terminal duct
What is the function of the stroma in the breast?
fibrous connective tissue, supports the structure of the breast and forms the suspensory ligaments of Cooper. ■ Each lobule is demarcated by a Cooper ligament.
The ductal-lobular system is lined by
cuboidal and columnar epithelial cells
What are the three main sites of breast lymphatic drainage and their approximate percentages?
○ Axillary lymph nodes (75%) ○ Parasternal lymph nodes (20%) ○ Posterior intercostal lymph nodes (5%).
What is a fibroadenoma?
Benign tumour of the breast
What is a fibroadenoma made of?
Composed of glandular epithelium and interlobular stroma of a TDLU. Well-circumscribed, non-encapsulated.
Does a fibroadenoma infiltrate into the parenchyma of the breast ?
No
What age group is most commonly affected by fibroadenomas?
Women < 30 y/o
What causes a fibroadenoma?
Unclear - typically sex steroid-responsive (grow in pregnancy, shrink in menopause).
How does a fibroadenoma typically present?
As a solitary, mobile breast lump with a regular border.
First line investigation for fibroadenoma
breast imaging (USS or mammogram) ; Typically stratified by age and clinical suspicion
Fibroadenoma USS : Women <30: breast ultrasound.
Smooth, well-circumscribed mass with uniform hypoechogenic appearance.
Fibroadenoma USS : Women >30 or highly suspicious for cancer: mammogram.
Distinct, well-circumscribed mass.
Managment for fibroadenoma
None usually needed
What is fibrocystic disease?
A condition causing multiple small breast lumps due to hormonal fluctuations.
What is the most common benign breast disease?
Fibrocystic disease
What age group is most commonly affected by fibrocystic disease?
Women aged 30–50.
Aetiology and pathophysiology of fibrocystic disease
- Normal menstrual cycle oestrogen fluctuation leads to epithelial proliferation and stromal fibrosis in the TDLUs. 2. This can lead to obstruction of ductules and terminal ducts. 3. Obstruction causes cyst formation or degeneration of the ductules. 4. Cyst rupture leads to inflammation and subsequent fibrosis.
What are the common symptoms of fibrocystic disease?
● Bilateral diffuse, symmetrical lumpiness. ● Breast pain (mastalgia) - often cyclical. ● (Sometimes) nipple discharge.
First line investigation for fibrocystic disease
breast imaging (USS or mammogram) Stratified by age and clinical suspicion:
Fibrocystic disease USS: Women <30: breast ultrasound.
Cysts / solid mass
Fibrocystic disease USS: Women >30 or highly suspicious for cancer: mammogram.
Circumscribed density
First Line Management of fibrocystic disease?
simple analgesia e.g. paracetamol, ibuprofen.
Define Mastitis
: inflammation of the breast, typically due to infection. ○ Divided into lactational and non-lactational (duct ectasia)
Define Breast Abscess
discrete collection of pus due to infection.
What is the most common causative organism of mastitis?
Staphylococcus aureus.
Causes of Lactational mastitis:
○ Combination of breastfeeding-related nipple trauma and milk stasis predisposes the breast to local infection.
Causes of Duct ectasia mastitis:
Blockage of lactiferous ducts due to squamous metaplasia leads to dilatation and inflammation. ○ Strongly associated with cigarette smoking.
Causes of Abscess
Progression of untreated infective mastitis; walled-off collection of infection forms.
Symptoms of mastitis/absesses
fever, breast pain / tenderness (often during breastfeeding)
Signs of mastitis/absesses
erythema, swelling, firmness
Duct ectasia is associated with
nipple discharge.
How is mastitis investigated/diagnosed
Mastitis is usually a clinical diagnosis based on history and examination findings.
how are absesses diagnosed
Abscesses can be diagnosed with breast ultrasound and diagnostic needle aspiration.
First line Management Lactational Mastitis
continued breastfeeding / milk expression plus simple analgesia
Second line Management Lactional Mastitis
> 24 hour duration / severe pain - add PO flucloxacillin.
First line management of non-lactational mastitis
PO flucloxacillin
First line management of breast absesses
needle aspiration and drainage plus flucloxacillin (dependent on local policy).
