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Pass Medicine > Breast > Flashcards

Breast Flashcards

1
Q

What is the breast triple assessment?

A

A hospital-based assessment clinic that allows for the early and rapid detection of cancer.

Components:
History/examination
Investigation
Histology

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2
Q

Imaging in the triple assessment?

A

Mammography

Ultrasound scanning

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3
Q

What is the scoring system in the triple assessment?

A

Exam score starts with P, imagine score starts with M or U, and histology score starts with B.

There is then a number that denotes the result of each component.
1 = Normal
2 = Benign
3 = Uncertain/likely benign
4 = Suspicious of malignancy
5 = Malignant

So e.g.
P1/M1/B1 would be a normal finding

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4
Q

When to use mammography or ultrasound?

A

Ultrasound is more useful in women <35 and in men.

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5
Q

What is mastitis?

A

Inflammation of the breast tissue, usually due to infection (s. aureus)

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6
Q

How can we classify mastitis?

A 
Lactational mastitis (more common)
Non-lactational mastitis
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7
Q

What are the clinical features of mastitis?

A

Tenderness
Swelling
Induration
Erythema

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8
Q

How do you manage mastitis?

A

Simple analgesics
Abx
If lactational, continued milk drainage/feeding is recommended

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9
Q

What is a breast abscess?

A

A collection of pus within the breast lined granulation tissue, most commonly developing from acute mastitis

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10
Q

How does a breast abscess present?

A

A tender fluctuant and erythematous mass, with potentially a punctum present

They can also have systemic symptoms, including:
Fever
Lethargy

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11
Q

How can we diagnose a breast abscess?

A

Ultrasound

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12
Q

How do we manage breast abscesses?

A

Initial phase - prompt empirical abx and US guided needle therapeutic aspiration
Advanced - incision and drainage under local anaesthetic

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13
Q

Complications of a breast abscess?

A

If non-lactational, it can cause formation of a mammary duct fistula (communication between the skin and subareolar breast duct)

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14
Q

What is a breast cyst?

A

An epithelial lined fluid-filled cavity which occurs when lobules become distended due to blockage, usually in the perimenopausal age group

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15
Q

Features of a breast cyst?

A

Can be singular or with multiple lumps
May affect one or both breasts
On palpation they appear as distinct smooth masses

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16
Q

How can we investigate a breast cyst?

A

Mammography - halo shape
Ultrasound
Aspiration (freehand or with US) and cytology

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17
Q

Management of a breast cyst?

A

No treatment, they self resolve

Larger cysts can be aspirated for aesthetic reasons

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18
Q

Does previous cysts affect your likelihood to have cancer in the future?

A

Yes. Patients with cysts are 2-3 times more likely to develop breast cancer in the future

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19
Q

What is mammary duct ectasia?

A

Dilation and shortening of the major lactiferous ducts

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20
Q

How does mammary duct ectasia present?

A

Yellow/green nipple discharge
Palpable mass
Nipple retraction

21
Q

How do we investigate mammary duct ectasia?

A

Mammography - dilated, calcified ducts seen with no features of malignancy

22
Q

How do we manage mammary duct ectasia?

A

Conservatively

Unremitting nipple discharge can be managed with duct excision

23
Q

What is fat necrosis?

A

A common condition caused by an acute inflammatory response in the breast, leading to ischaemic necrosis of fat lobules

Often associated with trauma

24
Q

Fat necrosis clinical features

A

Asymptomatic

Lump
Fluid discharge
Skin dimpling
Pain
Nipple inversion

If the inflammation persists, can cause a chronic fibrotic change leading to a solid irregular lump

25
Q

Investigating fat necrosis

A

A hyperechoic mass on ultrasound

If they’re more developed they often feel a bit more irregular and as a result are more suspicious of cancer. Core biopsy will often be taken to rule out malignancy

26
Q

Management of fat necrosis

A

Self-limiting
Analgesia
Reassurance

27
Q

What is a fibroadenoma?

A

The most common benign growth. They are proliferations of stromal and epithelial tissue of duct lobules

Usually found in women of reproductive age

28
Q

What are the examination findings of a fibroadenoma?

A 
Highly defined
Mobile
Rubbery
Less than 5cm usually
They can be multiple and bilateral
29
Q

Management of fibroadenoma

A

Left in situ with routine follow up appointments

Main indications for excision are >3cm in diameter or patient preference

30
Q

What is a ductal adenoma?

A

A benign glandular tumour that typically occurs in the older female population

31
Q

What are the features of a ductal adenoma?

A

Nodular

Mimic malignancy

32
Q

Management of ductal adenoma?

A

As they are nodular and mimic malignancy, most cases undergo triple assessment

33
Q

What is an intraductal papilloma?

A

A benign breast lesion that usually occurs in women in their 40/50s, mostly in the subareolar region

34
Q

How does an intraductal papilloma present?

A

Clear or bloody nipple discharge

Sometimes as a mass

35
Q

How do we treat intraductal papillomas?

A

As they can appear similar to a ductal carcinoma on imaging, they usually require biopsy
If multi-ductal papilloma, microdochectomy

36
Q

What is a lipoma?

A

A soft and mobile benign adipose tumour

We don’t usually remove, but can if it’s causing symptomatic compression/aesthetic reasons

37
Q

What are Phyllodes tumours?

A

These are rare fibroepithelial tumours composed of both epithelial and stromal tissue

38
Q

What are the features of Phyllodes tumours?

A

Older age
Rapid growth
Often difficult to differentiate from fibroadenomas

39
Q

Are Phyllodes tumours malignant?

A

10% have malignant potential

As a result they are usually widely excised (or mastectomy)

40
Q

What causes gynaecomastia?

A

An imbalanced ratio of oestrogen and androgen activity

41
Q

What are physiological causes of gynaecomastia?

A

Delayed testosterone surge relative to oestrogen during puberty
Older age - secondary to decreasing testosterone levels w/age

42
Q

What are pathological gynaecomastia causes?

A 
Lack of testosterone:
Klinefelter's
Androgen insensitivity
Testicular atrophy
Renal disease
Increased oestrogen levels:
Liver disease
Hyperthyroid
Obesity
Adrenal tumours
Leydig cell tumours
Medication:
Digoxin
Metronidazole
Spironolactone
Chemo
Anabolic steroids
Antipsychotics

Idiopathic

43
Q

Examination findings in gynaecomastia?

A

Rubbery/firm mass (>2cm in diameter) starting from underneath the nipple and expanding outward

44
Q

Differentials of gynaecomastia?

A

Pseudogynaecomastia (basically they’re overweight)

45
Q

Investigations in gynaecomastia?

A

To investigate the cause
If expecting malignancy, triple assessment
If unknown cause - check liver/renal function and hormone profile

46
Q

Hormone profile results interpretation (gynaecomastia)?

A

LH high + low testosterone - testicular failure
LH low and testosterone low - increased ostrogen
LH high and testosterone high - androgen resistance or gonadotrophin secreting malignancy

47
Q

How do we manage gynaecomastia?

A

Depnds on the causative factors
In many cases, just reassurance
Tamoxifen can alleviate symptoms (tenderness)

48
Q

Paget’s disease of the nipple

A

Eczematous change of the nipple associated with invasive ductal carcinoma

49
Q

Complications of axillary node clearance

A

Lymphoedema and functional arm impairment

Pass Medicine (24 decks)

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