Women's Health : Benign Breast Disease

Question 1

What are the two main regions of the breast?

Answer 1

○ Circular body ○ Axillary tail - runs into axillary fossa

Question 2

What are the structural components of the mammary glands in the breast?

Answer 2

■ 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

Question 3

What is the function of the stroma in the breast?

Answer 3

fibrous connective tissue, supports the structure of the breast and forms the suspensory ligaments of Cooper. ■ Each lobule is demarcated by a Cooper ligament.

Question 4

The ductal-lobular system is lined by

Answer 4

cuboidal and columnar epithelial cells

Question 5

What are the three main sites of breast lymphatic drainage and their approximate percentages?

Answer 5

○ Axillary lymph nodes (75%) ○ Parasternal lymph nodes (20%) ○ Posterior intercostal lymph nodes (5%).

Question 6

What is a fibroadenoma?

Answer 6

Benign tumour of the breast

Question 7

What is a fibroadenoma made of?

Answer 7

Composed of glandular epithelium and interlobular stroma of a TDLU. Well-circumscribed, non-encapsulated.

Question 8

Does a fibroadenoma infiltrate into the parenchyma of the breast ?

Answer 8

No

Question 9

What age group is most commonly affected by fibroadenomas?

Answer 9

Women < 30 y/o

Question 10

What causes a fibroadenoma?

Answer 10

Unclear - typically sex steroid-responsive (grow in pregnancy, shrink in menopause).

Question 11

How does a fibroadenoma typically present?

Answer 11

As a solitary, mobile breast lump with a regular border.

Question 12

First line investigation for fibroadenoma

Answer 12

breast imaging (USS or mammogram) ; Typically stratified by age and clinical suspicion

Question 13

Fibroadenoma USS : Women <30: breast ultrasound.

Answer 13

Smooth, well-circumscribed mass with uniform hypoechogenic appearance.

Question 14

Fibroadenoma USS : Women >30 or highly suspicious for cancer: mammogram.

Answer 14

Distinct, well-circumscribed mass.

Question 15

Managment for fibroadenoma

Answer 15

None usually needed

Question 16

What is fibrocystic disease?

Answer 16

A condition causing multiple small breast lumps due to hormonal fluctuations.

Question 17

What is the most common benign breast disease?

Answer 17

Fibrocystic disease

Question 18

What age group is most commonly affected by fibrocystic disease?

Answer 18

Women aged 30–50.

Question 19

Aetiology and pathophysiology of fibrocystic disease

Answer 19

1. 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.

Question 20

What are the common symptoms of fibrocystic disease?

Answer 20

● Bilateral diffuse, symmetrical lumpiness. ● Breast pain (mastalgia) - often cyclical. ● (Sometimes) nipple discharge.

Question 21

First line investigation for fibrocystic disease

Answer 21

breast imaging (USS or mammogram) Stratified by age and clinical suspicion:

Question 22

Fibrocystic disease USS: Women <30: breast ultrasound.

Answer 22

Cysts / solid mass

Question 23

Fibrocystic disease USS: Women >30 or highly suspicious for cancer: mammogram.

Answer 23

Circumscribed density

Question 24

First Line Management of fibrocystic disease?

Answer 24

simple analgesia e.g. paracetamol, ibuprofen.

Question 25

Define Mastitis

Answer 25

: inflammation of the breast, typically due to infection. ○ Divided into lactational and non-lactational (duct ectasia)

Question 26

Define Breast Abscess

Answer 26

discrete collection of pus due to infection.

Question 27

What is the most common causative organism of mastitis?

Answer 27

Staphylococcus aureus.

Question 28

Causes of Lactational mastitis:

Answer 28

○ Combination of breastfeeding-related nipple trauma and milk stasis predisposes the breast to local infection.

Question 29

Causes of Duct ectasia mastitis:

Answer 29

Blockage of lactiferous ducts due to squamous metaplasia leads to dilatation and inflammation. ○ Strongly associated with cigarette smoking.

Question 30

Causes of Abscess

Answer 30

Progression of untreated infective mastitis; walled-off collection of infection forms.

Question 31

Symptoms of mastitis/absesses

Answer 31

fever, breast pain / tenderness (often during breastfeeding)

Question 32

Signs of mastitis/absesses

Answer 32

erythema, swelling, firmness

Question 33

Duct ectasia is associated with

Answer 33

nipple discharge.

Question 34

How is mastitis investigated/diagnosed

Answer 34

Mastitis is usually a clinical diagnosis based on history and examination findings.

Question 35

how are absesses diagnosed

Answer 35

Abscesses can be diagnosed with breast ultrasound and diagnostic needle aspiration.

Question 36

First line Management Lactational Mastitis

Answer 36

continued breastfeeding / milk expression plus simple analgesia

Question 37

Second line Management Lactional Mastitis

Answer 37

> 24 hour duration / severe pain - add PO flucloxacillin.

Question 38

First line management of non-lactational mastitis

Answer 38

PO flucloxacillin

Question 39

First line management of breast absesses

Answer 39

needle aspiration and drainage plus flucloxacillin (dependent on local policy).