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Reproductive - Breast > Benign Breast Conditions - Clinical > Flashcards

Benign Breast Conditions - Clinical Flashcards

1
Q

Which benign breast condition is usually diagnosed as a palpable mass in the early reproductive years?

A

Fibroadenoma

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2
Q

How is a diagnosis of fibroadenoma confirmed?

A

Ultrasound guided core needle biopsy

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3
Q

Is a fibroadenoma painful?

A

No

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4
Q

How would you describe the mass of a fibroadenoma?

A

Firm, mobile, smooth with distinct borders

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5
Q

What is the relationship between fibroadenoma and carcinoma?

A

No significant predisposition to carcinoma, very rarely certain histological changes in the fibroadenoma or surrounding stroma could convey an increased risk

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6
Q

Once a fibroadenoma has been definitely diagnosed, what is the management?

A

Usually nothing, only excise if it is growing or changing

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7
Q

What happens to a fibroadenoma after the menopause?

A

Usually become non-palpable and decrease in size

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8
Q

Some women will choose to have a fibroadenoma excised, how can this be performed electively?

A

Open lumpectomy or percutaneous vacuum assisted core biopsy

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9
Q

What other uncommon condition can resemble fibroadenoma in clinical presentation and cytology?

A

Phyllodes tumour

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10
Q

What are 3 factors which would make you more suspicious of a Phyllodes tumour over a fibroadenoma?

A

They will be bigger (3-6cm), occur in older women and tend to increase in size

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11
Q

What is the definitive test to tell between a fibroadenoma and Phyllodes tumour?

A

Histopathology

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12
Q

How should a Phyllodes tumour be managed?

A

Excised with 1cm clear margins and carefully followed up

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13
Q

Mastalgia is a common breast symptom for women when?

A

During the reproductive years

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14
Q

Mastalgia is usually cyclic - when is it the most intense?

A

During the immediate premenstrual stage

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15
Q

Is cyclic mastalgia more likely to be bilateral or unilateral?

A

Bilateral

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16
Q

Describe non-cyclic mastalgia?

A

Usually localised, often persistent and less responsive to treatment

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17
Q

Clinically, it is important when a patient presents with mastalgia that it is definitely coming from the breast and not where?

A

Anterior chest wall

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18
Q

What is the association between mastalgia and malignancy?

A

It is rarely associated with malignancy unless there is a palpable mass

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19
Q

What is the appropriate investigation for a woman presenting with mastalgia?

A

Complete evaluation and examination, including a mammogram for a woman aged 35+

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20
Q

After investigation of a woman with mastalgia, what is usually the management?

A

Reassurance

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21
Q

There is good evidence that simple measures such as what are useful for mastalgia?

A

Using a well-fitting firm bra and regular exercise

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22
Q

Palpable breast cysts most commonly occur when?

A

During the later reproductive years

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23
Q

How would you describe the mass of a breast cyst?

A

Soft, mobile, smooth and with well-defined borders

24
Q

What is the main difference between a cyst and fibroadenoma on palpation?

A

A cyst is soft while a fibroadenoma is firm

25
Q

Are breast cysts painful?

A

They can be tender, especially before menstruation

26
Q

What is the most effective way of both investigating and treating a breast cyst?

A

FNA, aspire as much fluid as possible

27
Q

Should FNA fluid from a breast cyst be sent for cytological evaluation?

A

Only if it is bloody

28
Q

What should you do after FNA for a breast cyst?

A

Palpate the area of the cyst to be certain there is no residual mass

29
Q

If there is bloody fluid on FNA for a breast cyst, what could this be indicative of?

A

Papilloma or intracystic carcinoma

30
Q

If there is a solid lesion within a breast cyst or an irregular cystic wall, what investigation should be performed?

A

Ultrasound guided core biopsy

31
Q

What is physiologic nipple discharge?

A

Clear, yellow, watery discharge can be elicited from the nipples of most women of reproductive age

32
Q

What is pathological nipple discharge?

A

Bloody discharge, especially from a single duct

33
Q

What is the most common aetiology of spontaneous nipple discharge? Are these benign or malignant?

A

Intraductal papilloma, benign

34
Q

What is the association between nipple discharge and malignancy?

A

Discharge is rarely a sign of malignancy, unless there is an associated palpable mass

35
Q

What is the management of all intraductal lesions? Why is this?

A

Excision and histological evaluation, not to miss rare, intraductal carcinoma

36
Q

What are some investigations which may be done on a patient presenting with nipple diacharge?

A

Mammography, ultrasound

37
Q

What condition may present as an erythematous, weeping lesion on the surface of the nipple and areola OR a dry, scaly erythematous lesion?

A

Paget’s disease of the nipple (DCIS)

38
Q

How is the diagnosis of Paget’s disease of the nipple made?

A

Histological biopsy (incisional or punch)

39
Q

What is often found underlying a diagnosis of Paget’s disease of the nipple?

A

A palpable mass or radiological abnormality

40
Q

What is the most common causative organism for puerperal mastitis?

A

Staph Aureus

41
Q

What antibiotics can be given for puerperal mastitis?

A

Flucloxacillin or augmentin

42
Q

When should antibiotics be administered for puerperal mastitis?

A

As soon as clinical signs appear e.g. fever, erythema, tenderness, swelling

43
Q

How often should a patient with mastitis be examined and why?

A

Every 3 days to assess response to treatment and make sure there isn’t an abscess developing

44
Q

What should be done if there is no response to treatment in a person with mastitis?

A

Try a different antibiotic

45
Q

What advice should you give to a patient with mastitis about breastfeeding?

A

Should be continued if already started, and/or the infected breast can be pumped until the infection clears

46
Q

How does a breast abscess present?

A

A floculent, sometimes bulging mass usually in the central area of the mastitis

47
Q

What imaging technique is used to assess a breast abscess?

A

Ultrasound

48
Q

What are the management options for a breast abscess?

A

Aspiration, or surgical drainage if this doesn’t work

49
Q

Should antibiotics be given for a breast abscess?

A

Yes, they should be continued until evidence of inflammation has cleared

50
Q

What antibiotics are first and second line for non-puerperal mastitis?

A

Augmentin and cephalexin

51
Q

Chronic mastitis can be associated with what? What can this lead to?

A

Sub-areolar abscess, can lead to periareolar fistula

52
Q

What should you consider if a case of mastitis is unresponsive to therapy or if it seems to spread all over the entire breast?

A

Inflammatory carcinoma

53
Q

What is a galactocele?

A

A palpable milk filled cyst

54
Q

How can a galactocele be diagnosed and drained?

A

FNA

55
Q

What is Mondor’s disease?

A

Phlebitis and sebsequent clot formation in the superficial veins of the breast

56
Q

Mondor’s disease is usually caused by what?

A

Trauma to the breast e.g. surgery

57
Q

How is Mondor’s disease treated?

A

It will resolve spontaneously within 8-12 weeks

Reproductive - Breast (10 decks)

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