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Flashcards in Approach to a breast mass Deck (36):
1

Differential diagnosis

Fibroadenoma
Fibrocystic changes
Fat necrosis
Intraductal papilloma
Breast abscess
Atypical ductal/lobular hyperplasia
DCIS
Invasive breast cancer

2

Percentage of women presenting with a breast mass that are malignant

10%

3

Triple test

Physical examination
Imaging
Biopsy

4

Most common cause of breast mass

Fibroadenoma

5

Risk of breast cancer in women with fibroadenomas

Twice the risk

6

What does fibrocystic disease encompass, and when is it more common

Pre/perimenopauses

7

Are breast cysts common in post-menopausal

Cysts
Epithelial hyperplasia
Apocrine metaplasia
Cystic dilation
Fibrosis

8

Bloody nipple discharge, typical of what lesion

Intraductal papilloma

9

When are breast abscess more common

Breastfeeding

10

Types of premalignant breast lesions

Atypical ductal hyperplasia
Atypical lobular hyperplasia

11

What causes dimpling of the skin in breast cancer

Malignant infiltration of fibrous contraction of coopers ligaments

12

Arterial supply of the breast

Axillary artery
Internal thoracic

13

Lymphatic drainage of the breast

Axillary:
Apical= infraclavicular
Anterior= pectoralis major
Posterior= subscapular
Lateral= axillary vein
Cantral= axillary fat

Internal mammary:
Drains medial breast

14

Proliferative (non-neoplastic) changes in breast

Metaplasia
Adenosis
Simple cysts
Diabetic fubrous matopathy
Fibrocystic

15

Management of likely benign lesion on USS

Clinical and ultrasonographic surveillance every 6 months for 2 years, to document stability
Core needle biopsy to make a definitive diagnosis while leaving the lesion in situ
Surgical removal of the mass, particularly if the lesion is bothersome to the patient.

16

Benign neoplastic proliferations

Fibroadenoma
Atypical ductal/lobular
Sclerosing adenosis
Ductal papilloma

17

What imaging method is preferred in women >30 and

Mammography preferred in women >30 yo
USS preferred in women

18

BIRADS categories, description and recommmendation

0= need more info, further imaging
1= normal, routine screening mammography
2= benign, routine screening mammography
3= probably benign, short term f/u in 6 months
4= highly suspicious, biopsy
5= malignant, biopsy
6= known cancer, treat malignancy

19

Algorithm for breast USS

Solid-->
1. Suspicious= biopsy
2. Probably benign= biopsy or f/u

Cystic-->
1. Simple= follow or aspirate
2. Complex= biopsy

20

Main types of biopsy

FNA
Core needle
Excisional

21

FNA advantages and disadvantages

A: easy, painless, office, small needle
D: expert cytopathologist, cannot evaluate histology

22

Core needle advantages and disadvantages

A: easy, painless, office, histopathology, tissue, receptor status
D: slightly larger needle

23

Excisional advantages and disadvantages

A: histopathology, tissue architecture, receptor status
D: need OT, larger incision, painful

24

When would cystic fluid be sent for cytology

When blood

25

Investigations for fibroadenoma

In women physical
In >35-> U/S, biopsy

26

Biopsy in fibroadenoma, when to review and management if stable vs growing

Review in 3 months

Stable->USS and review in 12/12->stable = d/c. Growth->refer for surgical

Growth->surgical opinion

27

Progress of fibroadenoma

Usually doesn't change
Hormone responsive
Not in itself pre-malignant

28

What is phylloides tumor

Intralobular stroma, leaf like protrusions
+Cellularity, mitosis, pleomorphism, +infiltration
Does not regress
8% malignant

29

Causes of nipple discharge

Physiologic->pregnancy, lactation
Galactorrhea
Duct ectasia
Ductal papilloma
Cyst
Malignancy
Idiopathic

30

Relative risk of malignant breast disease when presenting with benign breast disease

Moderately increased risk (4–5×)
Atypical ductal hyperplasia
Atypical lobular hyperplasia
Radial scar

Slightly increased risk (1.5–2.0×)
Moderate or florid hyperplasia
Multiple papilloma

No increased risk
Cysts
Fibroadenoma
Duct ectasia
Mild hyperplasia
Sclerosing adenosis
Apocrine change

31

When is nipple discharge likely to represent a physiologic process

Clear
Yellow or green
Multiple ducts
On nipple stimulation

32

When is nipple discharge more suggestive of a pathalogic process and common etiologies

Spontaneous
Persistent
Bloody
Associated with a mass

1. Ductal papilloma
2. Ductal ectasia
3. Cancer
4. Infection

33

Definition of galactorrhea

Discharge of milk/serous fluid in the abscence of parturition or beyond 6 months post partum in a non-breast-feeding woman

34

Etiology of galactorrhea

stress,
physical irritation,
hypothyroidism,
chronic renal failure,
hypothalamic-pituitary disorders,
hormone-secreting neoplasms (most commonly pituitary adenomas), or
may be idiopathic but is not associated with breast cancer.
can block dopamine and histamine receptors, deplete dopamine stores, inhibit dopamine release, and stimulate lactotrophs.
Common medications and classes
of medications: SSRIs, TCAs, atenolol,
verapamil, antipsychotics, H2 histamine blockers (cimetidine), and opiates,
Estrogen in oral contraceptives can cause galactorrhea by suppressing the hypothalamic secretion of prolactin inhibitory factor and by direct stimulation of the pituitary lactotrophs

35

Investigations in galactorrhea

Discontinue offending agents
UEC
TSH
Prolactin
Pregnancy test in reproductive age
MRI if ++prolactin

36

Management of glactorrhea

Manage underlying conditions
Bromocriptine is preferred treatment for hyper-prolactin induced anovulatory infertility