Flashcards in Breast Deck (30)
What is a breast cyst?
Fluid filled sacs inside the breast which are usually not cancerous
What are the risk factors for breast cysts?
- Age 35-50
What is the epidemiology of breast cysts?
- Pre-menopausal women
- 7% of women develop a palpable breast cyst
What are the signs and symptoms of breast cysts?
- Cysts usually round or oval lumps with distinct edges
- Feels like soft grape but can also feel firm
- Not fixed
- Can be painful but generally benign
- Increased lump size and tenderness just before menstruation
What are the investigations for breast cysts?
- Breast US: sold, oval or round, circumscribed, lobulated, width more than height
- Biopsy: Epithelial, stromal elements
- FNA: 22-25g needle, cells put on slide- views by cytopathologist
What is a fibroadenoma?
A non cancerous tumour in the breast
What is the aetiology of a fibroadenoma?
- Partially hormone-related and frequently regress after menopause
What is the epidemiology of fibroadenomas?
Usually in under 30 yr olds
What are the signs and symptoms of fibroadenomas?
- Firm lump: smooth, painless, rubbery, mobile, well demarcated
- No pain
What are the investigations for fibroadenomas?
- 1st test=mammogram
- Breast US
How are fibroadenomas managed?
Excise is painful, larger than 4cm or rapidly growing
What is ductal carcinoma in situ?
Pre-cancerous or non-invasive lesion of the breast
What is the epidemiology of ductal carcinoma in situ?
More frequently diagnosed with increasing use of screening mammography
What are the causes and risk factors of ductal carcinoma in situ?
- FHx breast cancer
- Having periods at an early age
- Late menopause
What are the presenting symptoms and signs of ductal carcinoma in situ?
- Most cases, no symptoms experiences
- May cause lump or thickening in or near the breast or under arm
- Change in size or shape of breast
- Nipple discharge or tenderness
- Ridges or pitting of breast
- Change in feel of skin of breast, areola or nipple
What are the investigations for ductal carcinoma in sity?
What is fine needle aspiration?
A diagnostic procedure used to investigate lumps or masses
- A thin (23-25 gauge) hollow needle is inserted into the mass for sampling of cells that, after being stained, will be examined under a microscopy
- Could be cytology exam of aspirate or histological.
What are the indications for fine needle aspiration?
1) Biopsy is performed on lump or tissue mass when its nature is in question
2) For known tumours, biopsy performed to assess the effect of treatment or to obtain tissue for special studies
What are the possible complications of fine needle aspiration?
- Swelling, soreness, pain
- Rare: haematoma, infection
What is a breast abscess?
- Abscess formation in breast tissues
- 2 main forms recognised: puerperal (lactational) and nonpuerperal
What is the aetiology of breast abscesses?
- Lactational: S.aureus
- Nonpuerperal: S. aureus and anaerobes, often with enterococci or bacteroides spp
What are the risk factors for breast abscesses?
- Lactation, with bacteria gaining access through cracked nipples
- Nonpuerperal: Smoking mammary duct ectasia/periductal mastitis, an associated inflammatory breast cancer should be exclude
- Wound infection after breast surgery, diabetes, steroid therapy
What is the epidemiology of breast abscesses?
- Tend to occur soon after starting breastfeeding, and on weaning, when incomplete emptying of the breast results in stasis and engorgement
- Nonlactational abscesses are more common in those ages 30-60 yrs and smoekrs
What are the presenting symptoms of breast abscesses?
- Pt complains of breast discomfort and the development of painful swelling in an area of the breast
- She may complain of feeling unwell and feverish
- Women with a nonpueperal abscess often have a history of previous infections and systemic upset is less pronounced
What are the signs of a breast abscess on examination?
- Local: Area of breast is swollen, warm, tender and the overlying skin may be inflamed; examination of nipple may reveal cracks or fissures. In nonpueperal cases, may be evidence of scars or tissue distortion from previous episodes or signs of duct ectasia e.g. nipple retraction
- Systemic: Pyrexia, tachycardia
What are the investigations for breast abscesses?
- Imaging: ultrasound
- Microbiology: microscopy, culture, sensitivity of pus samples
How are breast abscesses managed medically?
Early, cellulitic phase may be treated with antibiotics (flucloxacillin in case of lactational, with addition of metronidazole in non puerperal abscesses)
How are breast abscesses managed surgically?
- Lactational: Daily needle aspiration with antibiotic cover may be successful but mostly formal incision and drainage is carried out
- Non-puerperal: Open drainage should be avoid or carried out through small incision.
What are the possible complications of a breast abscess?
Mammary fistula formation, rarely overlying skin undergoes necrosis