Breast

Question 1

What is a breast cyst?

Answer 1

Fluid filled sacs inside the breast which are usually not cancerous

Question 2

What are the risk factors for breast cysts?

Answer 2

• Age 35-50

- Perimenopausal

Question 3

What is the epidemiology of breast cysts?

Answer 3

• Pre-menopausal women

- 7% of women develop a palpable breast cyst

Question 4

What are the signs and symptoms of breast cysts?

Answer 4

• Cysts usually round or oval lumps with distinct edges
• Feels like soft grape but can also feel firm
• Not fixed
• Can be painful but generally benign
• Increased lump size and tenderness just before menstruation

Question 5

What are the investigations for breast cysts?

Answer 5

• Breast US: sold, oval or round, circumscribed, lobulated, width more than height
• Biopsy: Epithelial, stromal elements
• Mammogram
• FNA: 22-25g needle, cells put on slide- views by cytopathologist

Question 6

What is a fibroadenoma?

Answer 6

A non cancerous tumour in the breast

Question 7

What is the aetiology of a fibroadenoma?

Answer 7

• Partially hormone-related and frequently regress after menopause

Question 8

What is the epidemiology of fibroadenomas?

Answer 8

Usually in under 30 yr olds

Question 9

What are the signs and symptoms of fibroadenomas?

Answer 9

• Firm lump: smooth, painless, rubbery, mobile, well demarcated
• No pain

Question 10

What are the investigations for fibroadenomas?

Answer 10

• 1st test=mammogram
• Breast US
• Biopsy
• FNA

Question 11

How are fibroadenomas managed?

Answer 11

Excise is painful, larger than 4cm or rapidly growing

Question 12

What is ductal carcinoma in situ?

Answer 12

Pre-cancerous or non-invasive lesion of the breast

Question 13

What is the epidemiology of ductal carcinoma in situ?

Answer 13

More frequently diagnosed with increasing use of screening mammography

Question 14

What are the causes and risk factors of ductal carcinoma in situ?

Answer 14

• FHx breast cancer
• Having periods at an early age
• Late menopause

Question 15

What are the presenting symptoms and signs of ductal carcinoma in situ?

Answer 15

• Most cases, no symptoms experiences
• May cause lump or thickening in or near the breast or under arm
• Change in size or shape of breast
• Nipple discharge or tenderness
• Ridges or pitting of breast
• Change in feel of skin of breast, areola or nipple

Question 16

What are the investigations for ductal carcinoma in sity?

Answer 16

Mammography

Biopsy

Question 17

What is fine needle aspiration?

Answer 17

A diagnostic procedure used to investigate lumps or masses

• A thin (23-25 gauge) hollow needle is inserted into the mass for sampling of cells that, after being stained, will be examined under a microscopy
• Could be cytology exam of aspirate or histological.

Question 18

What are the indications for fine needle aspiration?

Answer 18

1) Biopsy is performed on lump or tissue mass when its nature is in question
2) For known tumours, biopsy performed to assess the effect of treatment or to obtain tissue for special studies

Question 19

What are the possible complications of fine needle aspiration?

Answer 19

• Bleeding
• Swelling, soreness, pain
• Rare: haematoma, infection

Question 20

What is a breast abscess?

Answer 20

• Abscess formation in breast tissues

- 2 main forms recognised: puerperal (lactational) and nonpuerperal

Question 21

What is the aetiology of breast abscesses?

Answer 21

• Infection
• Lactational: S.aureus
• Nonpuerperal: S. aureus and anaerobes, often with enterococci or bacteroides spp

Question 22

What are the risk factors for breast abscesses?

Answer 22

• Lactation, with bacteria gaining access through cracked nipples
• Nonpuerperal: Smoking mammary duct ectasia/periductal mastitis, an associated inflammatory breast cancer should be exclude
• Wound infection after breast surgery, diabetes, steroid therapy

Question 23

What is the epidemiology of breast abscesses?

Answer 23

• Common
• Tend to occur soon after starting breastfeeding, and on weaning, when incomplete emptying of the breast results in stasis and engorgement
• Nonlactational abscesses are more common in those ages 30-60 yrs and smoekrs

Question 24

What are the presenting symptoms of breast abscesses?

Answer 24

• Pt complains of breast discomfort and the development of painful swelling in an area of the breast
• She may complain of feeling unwell and feverish
• Women with a nonpueperal abscess often have a history of previous infections and systemic upset is less pronounced

Question 25

What are the signs of a breast abscess on examination?

Answer 25

• Local: Area of breast is swollen, warm, tender and the overlying skin may be inflamed; examination of nipple may reveal cracks or fissures. In nonpueperal cases, may be evidence of scars or tissue distortion from previous episodes or signs of duct ectasia e.g. nipple retraction
• Systemic: Pyrexia, tachycardia

Question 26

What are the investigations for breast abscesses?

Answer 26

• Imaging: ultrasound

- Microbiology: microscopy, culture, sensitivity of pus samples

Question 27

How are breast abscesses managed medically?

Answer 27

Early, cellulitic phase may be treated with antibiotics (flucloxacillin in case of lactational, with addition of metronidazole in non puerperal abscesses)

Question 28

How are breast abscesses managed surgically?

Answer 28

• Lactational: Daily needle aspiration with antibiotic cover may be successful but mostly formal incision and drainage is carried out
• Non-puerperal: Open drainage should be avoid or carried out through small incision.

Question 29

What are the possible complications of a breast abscess?

Answer 29

Mammary fistula formation, rarely overlying skin undergoes necrosis

Question 30

What is the prognosis for breast abscesses?

Answer 30

• If untreated, a breast abscess will eventually point and spontaneously discharge onto skin surface
• Nonpuerperal abscesses tend to recur