Breast: Breast Lumps Flashcards
Name the 4 most common diagnoses for breast lumps.
- Benign cystic change (fibrocystic change): benign collection of fibrous tissue +/- cysts
- Fibroadenoma: benign breast tumour made up of stromal and epithelial tissue
- Cyst: benign fluid-filled sac
- Carcinoma
What type of breast lumps are common in lactating women?
- abscess
- galactocoele: firm mass caused by obstruction of lactiferous duct which becomes distended with milk and epithelial cells
- mastitis: usually caused by skin commensals like S. aureus or S. epidermis
What is the likely diagnosis if the lump appeared very fast? Slow?
Fast: abscess or cyst
Slow: fibroadenoma or carcinoma
Trauma (e.g. injury, cyst aspiration) predisposes to what type of breast lump?
fat necrosis
If the lump is painful, what diagnoses are more likely?
- benign cystic change
- acute mastitis
- abscesses
- cysts
What is the likely diagnosis if a lady presents with discharge that is:
- bloody
- serous/serosanguinous
- green/brown/yellow
- milky?
- bloody: carcinoma
- serous: intraductal papilloma
- green/brown/yellow: periductal mastitis
- milky: galactocoele
Lump feels:
- irregular surface
- indistinct contours
- mixed consistency
- immobile
- not fixed
Diagnosis?
benign cystic change
Lump feels:
- smooth surface
- distinct contours
- firm-lax consistency
- immobile
- not fixed
Diagnosis?
solitary cyst
Lump feels:
- irregular surface
- indistinct contours
- hard consistency
- immobile
- maybe fixed
Diagnosis?
carcinoma
Lump feels:
- smooth surface
- distinct contours
- rubbery consistency
- mobile
- not fixed
Diagnosis?
fibroadenoma (breast mouse)
A pt presents with a breast lump. How would you investigate?
Triple assessment:
- clinical examination
- radiological examination
- USS if <35yrs (breast tissue too dense for mammography)
- 2-view mammogram (+/- USS) if >35yrs - fine needle aspiration or core biopsy: FNA provides info on cell type/dysplasia whilst core biopsy also informs on local architecture
How would you manage a pt with fibroadenoma?
- Conservative: reassure Pt maj. of fibroadenomas resolve over several years and pose no increased risk of malignancy.
- Excisional biopsy: if pt preference, lump increasing in size, lump causing discomfort.
How should a pt with a breast abscess be treated?
- antibiotics
- surgical drainage or aspiration
Suggest possible causes for gynaecomastia.
- physiological/hormonal fluctuations
- liver disease
- drugs, e.g. cimetidine, spironolactone, phenothiazines, finasteride, anabolic steroids
- primary testicular failure, e.g. anorchia, bilateral cryptorchidism
- acquired testicular failure, e.g. mumps orchitis
- secondary testicular failure, e.g. panhypopituitarism
- endocrine tumours, E.g. testicle, adrenal, pituitard
- non-endocrine tumours, e.g. bronchial carcinoma
