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Repro > Breast Disease > Flashcards

Breast Disease Flashcards

1
Q

What are the lobules made up of in the breast?

A

Acini and intralobular stroma

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2
Q

What changes happen during menarche?

A

Increase in number of lobules and increased volume of interlobular structure

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3
Q

What changes happen to the breast throughout the menstrual cycle?

A

Follicular phase - lobules are inactive
After ovulation - cell proliferation and stromal oedema
Menstruation - decrease in the size of lobules

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4
Q

What is menarche?

A

First menstrual cycle/onset of puberty

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5
Q

How do the breasts change in pregnancy?

A

Increase in size and number of lobules
Decrease in stroma
Secretory changes

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6
Q

What changes happen to the breast after cessation of lactation?

A

Atrophy of lobules but not to former levels

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7
Q

How do breasts change with increasing age?

A

Terminal duct lobular units decrease in number and size

Interlobular stroma replaced by adipose tissue

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8
Q

What makes mammograms easier to interpret in older women?

A

The interlobular stroma is replaced by adipose tissue, makes lesions more clear

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9
Q

Clinical presentation of breast conditions?

A 
Pain
Palpable mass
Nipple discharge
Skin changes
Lumpiness
Mammographic abnormalities
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10
Q

What is physiological breast pain like?

A

Cyclical and diffuse

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11
Q

What is pathological breast pain like?

Possible causes?

A

Non-cyclical and focal

Ruptured cyst, injury, inflammation, breast cancer

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12
Q

What characteristics of a palpable mass make it worrying?

A

Hard
Craggy
Fixed

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13
Q

Causes of a palpable mass in the breast?

A

Invasive carcinoma
Fibroadenoma
Cyst

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14
Q

What makes nipple discharge more concerning?

A

Spontaneous and unilateral

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15
Q

What can cause milky discharge?

A

Endocrine disorders
-pituitary adenoma
Side effect of medication
-eg OCP

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16
Q

What can cause bloody or serous discharge?

A

Benign lesions eg

  • papilloma
  • duct ectasia
  • occasionally malignant lesions
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17
Q

What is duct ectasia?

A

When the lactiferous duct becomes blocked or clogged

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18
Q

Between what ages are mammograms offered to women and how regularly?

A

47-73

Every 3 years

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19
Q

What may be some worrying findings on a mammogram and what could the signify?

A

Densities - invasive carcinoma, fibroadenoma, cyst

Calcifications - ductal carcinoma in situ, benign changes

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20
Q

What is the most common type of benign tumour of the breast?

A

Fibroadenoma

21
Q

When do fibroadenomas normally occur?

A

At any age during reproductive period, often under 30

22
Q

When are phyllodes tumours most common?

A

In 6th decade

23
Q

What are some disorders of development of the breasts?

A

Milk line remnants - polythelia

Accessory axillary breast tissue

24
Q

When does acute mastitis usually occur?

A

During lactation

25
Q

What usually occurs in acute mastitis?

A

Staphylococcus aureus infection from nipple cracks and fissures

26
Q

Signs and symptoms of acute mastitis?

A

Erythematous, painful breast
Pyrexia
Can get breast abscesses

27
Q

How does fat necrosis of the breast normally present?

A

A mass, skin changes or mammographic abnormality

28
Q

What is often in the history when there is fat necrosis?

A

Trauma or surgery

29
Q

What can fat necrosis of the breast mimic?

A

Carcinoma - clinically and mammographically

30
Q

How can a fibrocystic change present?

A

Mass or mammographic abnormality

Mass often disappears after fine needle aspiration if a cyst

31
Q

How does a fibrocystic change present histologically?

A

Cyst formation
Fibrosis
Apocrine metaplasia

32
Q

What can a fibrocystic change mimic?

A

Carcinoma - clinically and mammographically

33
Q

Give some examples of stromal tumours

A 
Fibroadenoma
Phyllodes tumour
Lipoma
Leiomyoma
Hamartoma
34
Q

How do fibroadenomas present?

A

Mass, usually mobile - ‘breast mouse’ - mobile and elusive
May be multiple and bilateral
Can grow very large and replace most of breast tissue
Mammographic abnormality

35
Q

What is a fibroadenoma?

A

Localised hyperplasia (rather than a true neoplasm)

36
Q

What does a fibroadenoma look like macroscopically?

A

Well circumscribed
Rubbery
Greyish/white

37
Q

What does a fibroadenoma look like histologically?

A

Mixture of stromal and epithelial elements

38
Q

How do phyllodes tumours present?

A

Rare before 40
Masses or mammographic abnormality
Can be very large and involve the entire breast

39
Q

What are the classifications of phyllodes tumours?

A

Benign
Borderline
Malignant (

40
Q

Histological features of a phyllodes tumour?

A

Stroma more cellular and atypical than in fibroadenomas

Nodules of proliferating stroma covered by epithelium (phullon = leaf)

41
Q

How do malignant phyllodes tumours behave?

A

Agressively
Recur locally
Metastasize by blood stream

42
Q

What is gynaecomastia?

A

Enlargement of male breasts - bilateral or unilateral

43
Q

When is gynaecomastia normally seen?

A

Puberty

In the elderly

44
Q

What causes gynaecomastia?

A

Relative decrease in androgen effect or increase in oestrogen effect

45
Q

Why does gynaecomastia happen in neonates?

A

Secondary to circulating maternal and placental oestrogens and progesterone

46
Q

Why does gynaecomastia affect more than half of boys at puberty?

A

Oestrogen production happens peaks earlier than that of testosterone

47
Q

Other causes of gynaecomastia?

A

Klinefelter’s syndrome
Oestrogen excess - cirrhosis of liver (oestrogen not metabolised effectively)
Gonadotrophin excess - functioning testicular tumour eg Leydig/Sertoli cell tumour, testicular germ cell tumours
Drug-related

48
Q

What drugs can cause gynaecomastia?

A 
Spironolactone
Cimetidine
Alcohol
Marijuana
Heroin
Anabolic steroids
(Chlorpromazine
Digitalis)

Repro (31 decks)

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