Breast Disease

Question 1

Name 4 types of Non Malignant Breast Disease

Answer 1

Mammary Duct Ectasia

Periductal Mastitis

Intraductal Papilloma

Breast Abscess

Question 2

Define Mammary Duct Ectasia

Answer 2

Describes a dilatation and shortening of the terminal breast ducts within 3cm of the nipple.

Inflammation in the ducts leads to intermittent discharge from the nipple (may be white, green or grey).

(Ectasia = Dilation)

Question 3

In whom does mammary duct ectasia most commonly present?

Answer 3

Perimenopausal women (Older Women)

Question 4

Name 1 significant risk factor for Mammary Ductal Ectasia

Answer 4

Smoking

Question 5

Gave 4 presenting features of Mammary Duct Ectasia

Answer 5

Nipple discharge (thick and green)

Tenderness or Pain

Nipple retraction or inversion

Breast Lump (pressure on lump may cause discharge)

Question 6

What does the triple assessment for exclusion of breast cancer involve?

Answer 6

Clinical assessment (history and examination)

Imaging (ultrasound, mammography and MRI)

Histology (fine needle aspiration or core biopsy)

Question 7

What seen on mammography is considered a robust marker of breastcancer?

Answer 7

Microcalcifications

Question 8

Define Periductal Mastitis

Answer 8

Describes a benign breast condition commonly affecting younger women who smoke.

Question 9

Give 4 clinical features of Periductal Mastitis

Answer 9

Tender, hot or reddened breast

Bloody Discharge

Lump felt behind the nipple or Nipple inversion

High temperature/fever

Question 10

What is periductal mastitis strongly associated with?

Answer 10

Smoking

Question 11

How is periductal mastitis managed? (2)

Answer 11

Antibiotics

Abscesses require drainage

Question 12

Describe Intraductal Papilloma (3)

Answer 12

Describes a warty lesion growing within one of the ducts in the breasts.

Occurs due to proliferation of epithelial cells.

Are benign tumours but can be associated with atypical hyperplasia or breast cancer.

Question 13

How does Intraductal Papilloma typically present? (3)

Answer 13

Typically presents with clear or blood-stained nipple discharge

Tenderness or pain

A palpable lump

Question 14

How are intraductal papilloma’s managed?

Answer 14

Complete surgical excision.

Question 15

Describe a breast abscess

Answer 15

Describes a collection of pus within an area of the breast, usually caused by bacterial infection.

Question 16

Name 2 types of breast abscess

Answer 16

Lactational abscess (associated with breastfeeding)

Non-lactational abscess (unrelated to breastfeeding)

Question 17

What is the most common bacteria causing breast abscesses?

Answer 17

Staphylococcus aureus

Question 18

Give 4 presenting features of breast abscess

Answer 18

Infection (tenderness, warmth, redness)

Nipple changes

Purulent nipple discharge (pus from the nipple)

Swollen, fluctuant (fluid filled), tender lump within the breast

Question 19

How are breast abscesses managed? (3)

Answer 19

Antibiotics (flucloxacillin)

Ultrasound Guided Aspiration (drainage)

Microscopy, culture and sensitivities of drained fluid.

Question 20

How is lactational breast mastitis managed? (3)

Answer 20

Continue breast feeding, expressing milk and breast massage.

Heat packs, warm showers and simple analgesia for symptoms.

Antibiotics (Flucloxacillin or Erythromycin/Clarithromycin)

Question 21

How is non-lactational mastitis managed? (3)

Answer 21

Analgesia

Antibiotics (Co-amoxiclav)

Treat underlying cause (eczema or candida)

Question 22

Define Mammary Duct Fistula

Answer 22

Describes a connection between the skin and a major subareolar breast duct.

Question 23

Give 3 causes of mammary duct fistula

Answer 23

Complication of incision and drainage of non-lactating abscess.

Complication of spontaneous discharge of a peri areolar mass.

Complication following biopsy of a periductal inflammatory mass.

Question 24

Define fibroademoma

Answer 24

Describes common benign tumours of stromal/epithelial breast duct tissue.

Often small and mobile within the breast tissue (can move)

Question 25

In whom are breast fibroadenomas most common and why?

Answer 25

Most common in younger women (20-40).

Respond to female hormones (oestrogen and progesterone) so tend to regress after menopause.

Question 26

Give 3 clinical features of breast fibroadenoma on examination.

Answer 26

Smooth, Firm, Round and Painless lump

Mobile (a breast mouse)

Well circumscribed (well defined borders)

Question 27

When are breast fibroadenomas surgically removed?

Answer 27

When >3cm

Question 28

Define Fibroadenosis (Fibrocystic breast disease)

Answer 28

Describes a benign breast condition characterised by multiple lumps within breast tissue

Question 29

Give 4 clinical features of Fibrocystic Breast Disease

Answer 29

Lumpiness

Breast Pain or Tenderness (mastalgia)

Fluctuation in breast size

Symptoms occur prior to menstruation and resolve once menstruation begins.

Question 30

Give 3 management options for fibrocystic breast disease

Answer 30

NSAIDs

Supportive bra and warm compress

Hormonal treatments (danazol and tamoxifen) under specialist guidance.

Question 31

Describe a fat necrosis of breast tissue

Answer 31

Describes a benign lump formed by localised degeneration and scarring of fat tissue in the breast

Question 32

What is common cause of fat necrosis in the breast?

Answer 32

Localised trauma, radiotherapy or surgery.

Question 33

In whom is fat necrosis common?

Answer 33

Obese women with large breasts