Breast Flashcards
(65 cards)
What is a Fibroadenoma and in which patients are they most common in?
Benign growth of the breast
Proliferations of stromal and epithelial tissue of the duct lobules
Low mallignant potential
Common in women of reproductive age
Describe the findings on examination of a fibroadenoma
Highly mobile
Rubbery on palpation
Less than five cm
Multiple present, bilateral
What is the management of a fibroadenoma?
Reassuarance +/- excision if >3cm (or if patient prefers)
What is a ductal adenoma and which patients is it most common in?
Benign glandular tumour
Most common in older females
How does an adenoma present?
Nodular
Mimics mallignancy
What is an intraductal papilloma and which patients usually present with it?
Benign breast lesion
If multiductal risk of breast cancer
Females age 40-50
How do papillomas present
Larger lesion in the subareolar lesion
Rarely palpable lump
Nipple discharge - may be bloody or clear
Imagining is similar to microadeonma
Management of a papiloma?
Excision and biopsy
If multiple lesions remove
What is a lipoma?
Benign adipose tumour
Low mallignant potential
How does a lipoma present?
Soft
Mobile
Enlarging
What is the management of lipoma?
Removed only if causing symptomatic compressive or asthetic isssids
Reassuarnce
What is a phyllodes tumour and which patients usually present with?
Rare fibroelithelial tumour
Comprised of both stromal and epithelial tumour
Often rapid growing
Occur in older age group
Difficult to clinically and microscopically differentiate from fibroadenomas
What is the management of a Phyllodes Tumour and why?
Excision
1/3 mallignant potential
What features can help differentiate between a benign and mallignant breast lesion?
Benign - Smooth defined borders - Tend to be monile - Multiple lesions Mallignant - Irregular borders - Teathered to skin - Immobile - Other changes such as nipple retraction, dimpling of the skin or axillary lymph node involvement
What does the triple assesment consist of?
Examination Histology (usually core biopsy, FNA if recurrent cystic disease) Imaging - Mammogram >35 years old - Breast ultrasound scan <35 years old
What two views are given in a mammogram?
Oblique
Cranial caudal
When may MRI imaging be useful in breast cancer?
Assesment of lobular breast cancers
Assessing response to neoadjuvant therapy
Why is core biopsy usually better for assesment than FNA?
Differentiates betwee invasive and insitu carcinoma
FNA only provides cytology
What are the values for grading maliignancy overall risk index?
P1-P5
M1-M5/U1-U5
B1-B5
Describe cyclical mastalgia
Usually in luteal phase
Bilateral
Can be caused by HRT
Due to hormonal changes
Causes of non-cyclical mastalgia?
SSRIs
OCP
Antipyschotics
Causes of galactorrhea
Pregnancy
Breast feeding
Maternal oestrogen
Hyperprolactinemia
Pituaitry adenoma
Drug induced (SSRIs, anti-psychotics, H2-antagonists)
Neurological: varicellazoster infection or spinal cord pathology (neurogenic oathwaya are activated to inhibit dopamine levels)
Hypothyroidism (elevated TRH)
Cushings disease, acromegaly, addisons
Renal or liver failure
Damage to the pituitary stalk - sarcoidosis surgical resection, TB, MS
Normoprolactinaemic galactorrhlea is rare
What is Padgets Disease of the breast?
Rare disease of the nipple, 50% of patients with this disease will have an underlying breast cancer.
Features
- Eczema-like rash on the skin of the nipple and areola. This is may be itchy, red, crusty and inflamed.
- Nipple discharge which may be bloody.
- Burning sensation, increased sensitivity or pain
- Nipple changes such as nipple retraction or inverted
- In some cases there may be a palpable breast lump
- There may be a skin ulcer which does not heal
What is fibrocystic disease?
Bilateral nodularity in a younger patient which worsens in relation
to their menstrual cycle.
