Breast

Question 1

Define Mastitis?

Answer 1

Inflammation of the breast tissue. There are two types, lactational and duct ectasia.

Question 2

Define breast abscess?

Answer 2

Localised infection of breast tissue with a walled off collection of pus.

Question 3

What bacteria predominantly causes mastitis/abscess?

Answer 3

Staph A = bigboy

Chron cases = anaerobes

Question 4

What are the RFs for mastitis/breast abscess?

Answer 4

Female, Hx mastitis, poor nutrition,
15-45, shaving nipple hair, nipple piercings, Skin infection
Lactation, mild stasis, cigarette smoking, anatomical defects,
Poor breast feeding technique,
Trauma

Question 5

What are the symptoms of mastitis/breast abscess?

Answer 5

Flu like symptoms - fever, myalgia, breast pain
Swollen/firm/tender/warm boobs
Erythema/discharge/mass/nipple inversion/lyphadenopathy

Extramammary skin lesions, lymphadenopathy

Question 6

What are the investigations for breast abscesses/mastitis?

Answer 6

FBC - possible inc WCC/evidence of infection
USS - circumscribed, macrolobulated, fluid filled lesion, can be irregular
Fine needle aspiration - cytology = evidence of infection
Culture of FNA/swab/milk
Milk testing - WCC/bacteria
Pregnancy test

Question 7

What is a breast cyst?

Answer 7

A fluid filled sack within the breast that forms as a result of milk gland overgrowth

Question 8

What are the RFs for breast cysts?

Answer 8

30-40s premenopausal = common
Disappear after menopause
Pain/swelling worse before menstrual cycle

7% of all Western females will present with a breast cyst

Question 9

What are the signs/symptoms for breast cysts?

Answer 9

Smooth, mobile, breast lump with distinct edges

Pain and tenderness - may be worse before menstruation, relief after menstruation

Question 10

What are the investigations that confirm a breast cyst?

Answer 10

USS = 95-100% accurate. Distinguishes between solid + fluid filled
Can do needle aspiration - cytology (CAUTION IF BLOODY)

Cysts should be aspirated, those which are blood stained or persistently refill should be biopsied or excised

Question 11

Define fibroadenoma.

Answer 11

A benign tumour of the breast characterised by a mixture of stromal and epithelial tissue.

Question 12

What ages are commonly affected by fibroadenomas?

Answer 12

Most prevalent tumour in adolescent women, with most before 30. Dec incidence with increased age

Question 13

What are the signs/symptoms of fibroadenomas?

Answer 13

Painless, smooth, firm, mobile, (some macro >5cm), slow growing, majority - solitary, rubbery firmness

Question 14

What investigations are performed for fibroadenomas?

Answer 14

E1-5 clinical assessment
USS if young, mammography is greater than 30
FNA if inconclusive - see spindle cells+honeycombing

Question 15

What are the Rxs for fibroadenomas?

Answer 15

Often conservative, but dependant on age and RFs
If young and little/no RFs for carcinoma = observe and 6 monthly checkups
If >35/very large/symptomatic/Hx cancer - surgical excision

Question 16

Prognosis of fibroadenomas

Answer 16

Excellent prognosis
Slight inc risk of breast cancer later in life
Complications - chronic pain/scarring/wound infection/abscess (surgery)

Question 17

What is FNA?

Answer 17

Sampling of cells using a 23-25gauge needle - cytology

Question 18

What are the conmplications of FNA?

Answer 18

Bleeding, infection, pain, pneumothorax (rare)

Question 19

What preparation is required for FNA?

Answer 19

NO NSAIDs/aspirin for 1 week before
No food 2 hrs before
Potentially prophylaxis 
Local An
Suspend a/c therapy

Question 20

Define duct ectasia

Answer 20

Duct ectasia is a dilatation and shortening of the terminal breast ducts within 3cm of the nipple.

Question 21

Epidemiology of duct ectasia

Answer 21

It is common and the incidence increases with age.

It is a disorder of peri- or post-menopausal age

Question 22

RFs of duct ectasia

Answer 22

Smokers seem more often affected by duct ectasia syndrome although the reported results are not entirely consistent.

Question 23

Sx of duct ectasia

Answer 23

Signs of duct ectasia can include nipple retraction, inversion, pain, and classic green-brown discharge.

It typically presents with nipple retraction and occasionally creamy nipple discharge. It may be confused with periductal mastitis, which presents in younger women, the vast majority of whom are smokers.
Periductal mastitis typically presents with periareolar or subareolar infections and may be recurrent.

Question 24

Ix for duct ectasia

Answer 24

Clinical +/- histological biopsy

Question 25

Rx of duct ectasia

Answer 25

Patients with troublesome nipple discharge may be treated by microdochectomy (if young) or total duct excision (if older).

Question 26

Define papilloma

Answer 26

Intraductal papillomas of the breast are benign lesions with an incidence of approximately 2-3% in humans. Two types of intraductal papillomas are generally distinguished. The central type develops near the nipple.

Question 27

Epidemiology of papilloma

Answer 27

Arise near menopause most frequently

Question 28

RFs for papilloma

Answer 28

Menopause

Question 29

Ix for papilloma

Answer 29

Galactogram = most definitive but also invasive Generally don't show up on mammography due to size Often undetectable on USS

Question 30

Rx of papilloma

Answer 30

Excision is sometimes performed. | Microdochectomy/microdochotomy (removal of a breast duct) is the treatment of choice.

Question 31

Rx of papilloma

Answer 31

Excision is sometimes performed. | Microdochectomy/microdochotomy (removal of a breast duct) is the treatment of choice.

Question 32

What is sentinel node biopsy?

Answer 32

A sentinel lymph node biopsy (SLNB) is a procedure in which the sentinel lymph node is identified, removed, and examined to determine whether cancer cells are present. It is used in people who have already been diagnosed with cancer. First, the sentinel lymph node (or nodes) must be located. To do so, a surgeon injects a radioactive substance, a blue dye, or both near the tumor. The surgeon then uses a device to detect lymph nodes that contain the radioactive substance or looks for lymph nodes that are stained with the blue dye. Once the sentinel lymph node is located, the surgeon makes a small incision (about 1/2 inch) in the overlying skin and removes the node.

Question 33

What is wide local excision?

Answer 33

A wide local excision of the breast aims to remove benign and malignant lesions while conserving the normal shape of the breast as much as possible. A WLE can only be used for lesions up to 4 cm in diameter, as removal of any larger lesions could leave a visibly dented area in the breast. The extent of excision is variable, ranging from lumpectomy to quadrantectomy. A larger excision would be categorised as a mastectomy instead. A quadrantectomy, also referred to as a segmental or partial mastectomy, is a surgical procedure for breast cancer in which one quarter of breast tissue is removed along with muscles of the chest wall within a 2 to 3 centimeter radius of a tumor. This procedure is an alternative to a radical or simple mastectomy, in which an entire breast is removed.