Benign conditions

Question 1

3(4) types of benign breast conditoins

Answer 1

Inflammatory
Proliferative
Benign neoplastic
(other)

Question 2

Inflammatory Breast Conditions (3)

Answer 2

Fat Necrosis
Infection
Mammary duct ectasia

Question 3

Proliferative Breast Conditions (2)

Answer 3

Fibrocystic change

Gynaecomastia

Question 4

Benign Neoplastic Conditions (2)

Answer 4

Fibroadenoma

Duct Papilloma

Question 5

“Other” Condtitions (3)

Answer 5

Peri-ductal mastitis
Galactocele
Mondor’s disease

Question 6

Aetiology of Fat necrosis

Answer 6

Trauma>inflammatory response>mass

Question 7

Characteristics of Fat necrosis

Answer 7

Firm, round irregular lump (may mimic ca.)

PAINLESS

Question 8

Main groups affected by fat necrosis

Answer 8

Obese women with large breasts

Question 9

Aetiology of mastitis

Answer 9

Infection of mammary duct with Staph. Aureus.

Associated with breast feeding.

Question 10

Ix in Mastitis

Answer 10

USS to assess severity

Question 11

Rx of mastitis

Answer 11

flucloxacillin

Question 12

Characteristics and Rx of Breast abscess

Answer 12

hot, tender, painful swelling

excise and drain

Question 13

Aetiology of Mammary duct ectasia

Answer 13

mammary duct blocked>secretions accumulate>dilatation>inflammation

Question 14

At risk group of duct ectasia

Answer 14

peri-menopausal women

Question 15

Presentation of duct ectasia (4)

Answer 15

Brown/bloody/green THICK nipple discharge (often bilateral)
Nipple RETRACTION+slit-like appearance
Lump
pain +erythema (ca. less likely)

Question 16

Mx of duct ectasia

Answer 16

Usually no Rx needed.

Question 17

Features of fibrocystic change

Answer 17

Lumpy breasts and cobblestone texture

commonest cause of breast lumps

Question 18

Pathophysiology (2) and Epidemiology (1) of fibrocystic change

Answer 18

Affected by hormone levels (stops post-menopause)
Several years of fluctuating hormone levels>formation of multiple fibrous areas and cysts.
Mainly affects peri-menopausal women

Question 19

Presentation of fibrocystic change (3)

Answer 19

Nodularity
Discrete lump (cyst)
Diffuse/ill-defined thickening

Question 20

Types of Fibrocystic change (7)

Answer 20

Adenosis(enlarge lobules, increased number of adeni, breast lump/pain, more common in young women)
Cysts (smooth discrete lump, halo sign on imaging, can be aspirated if symptomatic, may be fluctuant)
Epithelial hyperplasia (can have increased malignancy risk)
Lipoma
Apocrine metaplasia
Papillomatosis (finger-like projections)
Fibrosis

Question 21

Features(1)/Pathophysiology of gynaecomastia

Answer 21

Benign enlargement of male breast-75% unilateral
Ductal proliferation (male breast has no lobules)

Question 22

Causes of gynaecomastia (7)

Answer 22

Physiological e.g. puberty (usually unilateral)
Endocrine disorders e.g. Kleinfelter’s (usually bilateral)
Endocrine therapy
Drugs (spironolactone,5-ARIs, ketoconazole, antipsychotics)
Malnutrition
Cirrhosis
Obesity (increased oestrogen)

Question 23

Pathophysiology of Fibroadenomas

Answer 23

Benign proliferation of collagenous mesenchyme

develop from a whole lobule

Question 24

Presentation of Fibroadenomas (4)

Answer 24

Usually single lump
Mobile-"breast mice"
Smooth
Painless
(may grow rapidly in pregnancy)

Question 25

USS appearance of fibroadenomas

Answer 25

well-defined, oval lump

Question 26

Epidemiology of fibroadenomas

Answer 26

usually <30 yrs (most common lesion <35)

Question 27

Management of fibroadenomas

Answer 27

Observe | If suspicious USS +/-FNAC

Question 28

Features of duct papilloma (4)

Answer 28

Single CENTRAL finger-like projection surrounded by benign epithelium

Question 29

Presentation of duct papilloma (2)

Answer 29

Nipple discharge-secretion +/- blood | Palpable breast lump

Question 30

Imaging and histology of duct papilloma

Answer 30

lump seen protruding into duct

Question 31

Rx of duct papilloma

Answer 31

microdochectomy (surgical removal of lactiferous duct)

Question 32

Presentation of peri-ductal mastitis

Answer 32

Presents at younger age than ductal ectasia | may present with features of inflammation, abscess or mammary duct fistula

Question 33

Associations of peri-ductal mastitis

Answer 33

associated with nipple inversion and purulent discharge. | STRONG association with smoking

Question 34

Treatment of peri-ductal mastitis

Answer 34

antibiotics | incision and drainage of abscesses

Question 35

Galactocele pathophysiology

Answer 35

Lactiferous duct blocked by milk protein

Question 36

Features of galactocele (3)

Answer 36

similar to fibroadenoma-smooth, mobile lump in breast-feeding woman mild pain (fibroadenoma+breast feeding=galactocele)

Question 37

Definition of Mondor's disease

Answer 37

Thrombophlebitis of superficial veins of the breast | Causes tender, subcutaneous cords

Question 38

Acute and Chronic Features of Mondor's Disease

Answer 38

Acute phase: erythema, redness and cord-like structure | Chronically: heals to form area of fibrosis that may be tethered to skin.