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Y3 - Repro > Benign Breast > Flashcards

Benign Breast Flashcards

(102 cards)

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1
Q

What are the types of benign breast lump?

A 
Fibroadenoma
Adenoma
Duct papilloma
Lipoma
Phyllodes tumour
Sclerosing adenosis
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2
Q

What are the inflammatory breast conditions?

A

Breast cystitis
Fat necrosis
Duct ectasia
Mastitis

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3
Q

What are the breast conditions associated with breastfeeding?

A

Blocked duct/galactocele
Nipple candidiasis
Engorgement
Raynaud’s disease of the nipple

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4
Q

What are the general features that differentiate benign and malignant breast lumps?

A 
Benign:
- more mobile
- smooth borders
- multiple masses
Malignant
- craggy surfaces
- firm consistency
- fixed to surrounding tissue
- single mass
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5
Q

What is a fibroadenoma?

A

Proliferation of stroll epithelial tissue of duct lobules

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6
Q

What is the most common benign breast lump?

A

Fibroadenoma

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7
Q

What is a fibroadenoma also known as, and why?

A

‘Breast mouse’ because it is so mobile

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8
Q

Who most commonly present with fibroadenomas?

A

Women of reproductive age (peak in 3rd decade)

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9
Q

What is the presentation of fibroadenoma?

A

Painless
Smooth, firm, well-defined, rubbery, highly mobile
Most <5cm in diameter
Can be multiple and bilateral

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10
Q

What are the features of fibroadenoma on mammogram?

A

Oval or round
Circumscribed
May have coarse calcification

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11
Q

What are the features of fibroadenoma on biopsy?

A

Biphasic component - stroll and epithelial component

Circumscribed edge

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12
Q

What are the management options for fibroadenoma?

A

Routine follow up

Surgical excision

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13
Q

When are fibroadenomas routinely followed up?

A

Asymptomatic

If low malignant potential

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14
Q

Why can fibroadenomas just be routinely followed up?

A

Low malignant potential

30% will get smaller over 2 years

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15
Q

When are fibroadenomas excised?

A

> 3cm in diameter
Symptomatic
Increasing size of other changes
Patient choice

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16
Q

What is a breast adenoma?

A

Benign tumour of ductal glandular tissue

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17
Q

Who most commonly present with breast adenomas?

A

Older females

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18
Q

What is the presentation of breast adenomas?

A 
Painless
Slowly enlarging 
Well circumscribed, mobile
Nodular
Can mimic malignancy
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19
Q

What are intraductal papillomas?

A

Growth of papilloma in breast ductal tissue

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20
Q

What is the presentation of intraductal papillomas?

A

Clear or blood-stained discharge originating from a single duct
Lump or multiple lumps in subareolar region - usually <1cm away from nipple

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21
Q

What is included in triple assessment for breast lumps?

A

Clinical examination
Imaging - US or mammography
Biopsy

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22
Q

What is seen on biopsy in intraductal papillomas?

A

Papillary growth pattern

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23
Q

What is the management for intraductal papillomas, and why is it done?

A

Microdochectomy - surgical excision of duct

Done because of increased risk of breast cancer with multi-ductal papilloma

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24
Q

What is a lipoma?

A

Benign adipose tumour

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25
What is the presentation of a breast lipoma?
Soft and mobile | Can feel under it on palpation
26
What are the features of breast lipoma on mammography?
Thin smooth border
27
What is seen on biopsy of breast lipoma?
Only adipose cells
28
What is the management of breast lipoma?
May require excision to confirm diagnosis | Excise if significantly enlarging, causing symptomatic compression or aesthetic issues
29
What is a phyllodes tumour?
Rare fibroepithelial tumours | Comprised of both epithelial and stromal tissue
30
What is the malignant potential of a phyllodes tumour?
Majority benign | 1/3 have malignant potential
31
Who are most likely to present with a phyllodes tumour?
Older - 40-60
32
What is the presentation of a phyllodes tumour?
``` Larger Well delineated Unilateral Grow rapidly Firm lump ```
33
What is the management for phyllodes tumour?
Wide local excision | Mastectomy for larger tumours
34
What is sclerosing adenosis?
Includes radial scars and complex sclerosing lesions | Distortion of the distal lobular with or without hyperplasia
35
What is the difference between radial scars and complex sclerosing lesions?
Radial scars - distortion of the distal lobular unit without hyperplasia Complex sclerosing lesions - if hyperplasia is present
36
What is the presentation of sclerosing adenosis?
Breast lump or breast pain | Asymptomatic incidental finding
37
What is the management of sclerosing adenosis?
Excision - but not mandatory
38
What are breast cysts?
Epithelial lined, fluid-filled cavities
39
Why do breast cysts form?
When lobules become distended due to blockage
40
Are breast cysts common?
Yes
41
Who are breast cysts most common in?
Peri-menopausal women
42
What is the presentation of breast cysts?
``` Breast lumps May be painful and tender - pain often cyclical, worse before menstruation Single or multiple, can be bilateral Character of masses: - distinct - smooth - fluctuant or solid - mobile ```
43
What investigation gives the definitive diagnosis for breast cysts?
USS
44
What sign of beast cysts is seen on mammogram?
Halo shape
45
What is the management of breast cysts?
FNA of persisting, symptomatic or undeterminable lumps | Otherwise none needed
46
What may need to be done post-aspiration of breast cysts?
Cytology if aspirated fluid is bloody | Biopsy if any residual lump left after aspiration
47
What is the prognosis of breast cysts?
Risk of recurrence | Small increased risk of breast cancer in the future
48
What is fat necrosis?
Acute inflammatory response leading to ischaemic necrosis of fat lobules
49
What is the pathophysiology of fat necrosis?
Damage and disruption of adipocytes Infiltration of acute inflammatory cells 'Foamy' macrophages Subsequent fibrosis and scarring
50
Who are most likely to present with fat necrosis?
Obese women with large breasts
51
What is the common cause of fat necrosis?
Trauma to breast - blunt trauma, previous surgical o radiological intervention, seatbelts in RTA
52
What is the presentation of fat necrosis?
``` Firm lump May have associated haematoma Fluid discharge Nipple pain and inversion Skin dimpling If fibrotic change - solid, irregular lump ```
53
What are the investigation findings in fat necrosis?
USS - hyper echoic mass | Mammogram - can mimic carcinoma - core biopsy needed to rule out malignancy
54
What is the management of fat necrosis?
Self-limiting, usually resolves spontaneously | Conservative - reassurance, analgesia
55
What is duct ectasia?
The dilation and shortening of the major lactiferous ducts A normal change occurring during breast involution Followed by periductal inflammation, fibrosis, scarring and distortion
56
Which breast ducts does duct ectasia affect?
Sub-areolar ducts
57
Which benign breast condition is associated with smoking?
Duct ectasia
58
What is the presentation of duct ectasia?
Lump Nipple discharge (brown-green/yellow/creamy) Nipple retraction (slit-like) Pain - accentuated by acute episodic inflammatory changes Fistulation
59
What is seen on investigation of duct ectasia?
Mammogram - dilated calcify ducts without any other features of malignancy Biopsy - mass typically containing plasma cells
60
If bloody nipple discharge is seen in a presentation of duct ectasia, what is needed?
Triple assessment
61
What is the management of duct ectasia?
Conservative Surgical excision if excessive, unremitting nipple discharge Treat acute infection
62
What is mastitis?
Inflammation of breast tissue
63
What are the classifications of mastitis?
Acute vs chronic | Lactational vs non-lactational
64
What is the presentation of mastitis?
``` Pain Tenderness Swelling Erythema Pyrexia Lump ```
65
What feature on presentation of mastitis suggests abscess?
Fluctuant mass
66
What is more common, lactational or non-lactational mastitis?
Lactational mastitis
67
What organism is most common in lactational mastitis?
Staph aureus
68
Who are affected by lactational mastitis?
Breastfeeding women - usually in the first 3 months or during weaning
69
What is lactational mastitis often caused by?
Poor feeding technique
70
What is the features presentation of mastitis is specific to lactational mastitis?
Cracked nipples and milk stasis
71
What general measures should be taken in lactational mastitis?
Continue breastfeeding Express milk Massage breast
72
When should breastfeeding be stopped in lactational mastitis, and how should this be done?
If persistent or multiple areas of infection | Cessation of breastfeeding by cabergoline (a dopamine agonist)
73
When should antibiotics be given in lactational mastitis, and which one?
If: - systemically unwell - nipple fissure - positive culture - symptoms not improving after 12-24 hours of effective milk removal If nipple fissure infected - topical fusidic acid Flucloxacillin
74
Who most commonly get non-lactational mastitis?
Smokers | Association with duct ectasia, periductal mastitis
75
How does smoking predispose to non-lactational mastitis?
Damage to sub-areolar duct walls | And predisposes to bacterial infection
76
What is the management of non-lactational mastitis?
Antibiotics (flucloxacillin/clindamycin) Simple analgesia Aspiration, incision, drainage of abscess
77
What is the complication of non-lactational mastitis, and how is it treated?
Mammary duct fistula - communication between skin and scubareolar duct Surgical excision
78
What is a blocked duct/galactocele?
Milk bleb - little milk blister on nipple
79
Who most commonly get a blocked duct/galactocele?
Recent cessation of breastfeeding
80
What is the presentation of a blocked duct/galactocele?
Visible milk bleb | Pain when breastfeeding
81
What is the management of a blocked duct/galactocele?
Diagnosis and drainage by FNA | Continue breastfeeding, massage breast
82
What is nipple candidiasis?
Fungal infection of the nipple | Candida albicans
83
What is the presentation of nipple candiasis?
Pain when breastfeeding
84
What is the treatment for nipple candidiasis?
Miconazole cream for mother | Nystatin suspension for the baby
85
What is engorgement?
When milk isn't fully removed front he breast
86
Who most commonly presents with engorgement?
Breastfeeding women, usually in the first few days after baby born
87
What is the presentation of engorgement?
Bilateral erythema Breast pain, typically worse just before a feed Fever may be present, styles within 24 hours Milk doesn't flow well - infant finds it difficult to attach and suckle
88
What is the management of engorgement?
Moist heat on breasts before feed Cold compresses after feed to reduce swelling Gently massage and compress the breasts during breastfeeding when baby pauses between sucks
89
What complications of engorgement can occur?
Blocked ducts | Mastitis
90
What is the presentation of Raynaud's disease of the nipple?
Nipples blanch, followed by cyanosis or erythema Pain during and immediately after feeding Nipple pain resolves when it returns to normal colour
91
What is the management of Raynaud's disease of the nipple?
Advise to minimise cold exposure Head packs following breastfeeding Lifestyle changes - avoid caffeine, stop smoking
92
What is mastalgia?
Breast pain
93
What is the management of mastalgia not associated with a breast lump?
Reassurance Recommend better fitting bra or soft-support bra at night Simple analgesia Medications to stop (or reduce): COCP, antidepressants, anti-psychotics
94
What is galactorrhoea?
Copious bilateral multi-ductal milky discharge | Not associated with pregnancy or lactation
95
What is the normal physiology of breastfeeding?
Regulated by prolactin Polypeptide hormone is produced and secreted by the anterior pituitary gland Inhibited by dopamine Stimulated by oestrogen and TRH (thyrotropin releasing hormone)
96
What are the causes of hyperprolactinaemic galactorrhoea?
Idiopathic Prolactinoma Hypothyroidism Neurological conditions lowering dopamine - spinal cord injury, varicella zoster Drugs - SSRIs, antipsychotics, H2 antagonists
97
What is done for investigation of galactorrhoea?
``` Exclude pregnancy Serum prolactin (>1000 in absence of drug cause is suggestive of prolactinoma - do MRI head with contrast) Further endocrine blood tests ```
98
What is the management of galactorrhoea?
Treat underlying cause Pituitary tumors - dopamine agonists - cabergoline, bromocriptine - neurosurgery - trans-sphenoidal surgery
99
What is gynaecomastia?
Benign breast tissue growth in males
100
What are causes of gynaecomastia?
Physiological - delay in testosterone surge relative to oestrogen at puberty, decreasing testosterone with age Idiopathic Medications - digoxin, spironolactone, H2 antagonist, metronizadole, chemotherapy, gosterelin, antipsychotics, anabolic steroids Lack of testosterone - Klinefelter's, androgen insensitivity, testicular atrophy, renal disease Increased oestrogen - liver disease, hyperthyroidism, obesity, adrenal tumours, Lydia cell tumour
101
What is the presentation of gynaecomastia?
Insidious onset of rubbery or firm mass Starts from underneath nipple and spreads outwards over breast region Uni or bilateral
102
What is the management of gynaecomastia?
Treat underlying cause Medication - tamoxifen (relieves symptoms), danazol Surgery if later stages and medical treatments have failed

Y3 - Repro (13 decks)

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