Breast Disease

Question 1

What are the lobules made up of in the breast?

Answer 1

Acini and intralobular stroma

Question 2

What changes happen during menarche?

Answer 2

Increase in number of lobules and increased volume of interlobular structure

Question 3

What changes happen to the breast throughout the menstrual cycle?

Answer 3

Follicular phase - lobules are inactive
After ovulation - cell proliferation and stromal oedema
Menstruation - decrease in the size of lobules

Question 4

What is menarche?

Answer 4

First menstrual cycle/onset of puberty

Question 5

How do the breasts change in pregnancy?

Answer 5

Increase in size and number of lobules
Decrease in stroma
Secretory changes

Question 6

What changes happen to the breast after cessation of lactation?

Answer 6

Atrophy of lobules but not to former levels

Question 7

How do breasts change with increasing age?

Answer 7

Terminal duct lobular units decrease in number and size

Interlobular stroma replaced by adipose tissue

Question 8

What makes mammograms easier to interpret in older women?

Answer 8

The interlobular stroma is replaced by adipose tissue, makes lesions more clear

Question 9

Clinical presentation of breast conditions?

Answer 9

Pain
Palpable mass
Nipple discharge
Skin changes
Lumpiness
Mammographic abnormalities

Question 10

What is physiological breast pain like?

Answer 10

Cyclical and diffuse

Question 11

What is pathological breast pain like?

Possible causes?

Answer 11

Non-cyclical and focal

Ruptured cyst, injury, inflammation, breast cancer

Question 12

What characteristics of a palpable mass make it worrying?

Answer 12

Hard
Craggy
Fixed

Question 13

Causes of a palpable mass in the breast?

Answer 13

Invasive carcinoma
Fibroadenoma
Cyst

Question 14

What makes nipple discharge more concerning?

Answer 14

Spontaneous and unilateral

Question 15

What can cause milky discharge?

Answer 15

Endocrine disorders
-pituitary adenoma
Side effect of medication
-eg OCP

Question 16

What can cause bloody or serous discharge?

Answer 16

Benign lesions eg

• papilloma
• duct ectasia
• occasionally malignant lesions

Question 17

What is duct ectasia?

Answer 17

When the lactiferous duct becomes blocked or clogged

Question 18

Between what ages are mammograms offered to women and how regularly?

Answer 18

47-73

Every 3 years

Question 19

What may be some worrying findings on a mammogram and what could the signify?

Answer 19

Densities - invasive carcinoma, fibroadenoma, cyst

Calcifications - ductal carcinoma in situ, benign changes

Question 20

What is the most common type of benign tumour of the breast?

Answer 20

Fibroadenoma

Question 21

When do fibroadenomas normally occur?

Answer 21

At any age during reproductive period, often under 30

Question 22

When are phyllodes tumours most common?

Answer 22

In 6th decade

Question 23

What are some disorders of development of the breasts?

Answer 23

Milk line remnants - polythelia

Accessory axillary breast tissue

Question 24

When does acute mastitis usually occur?

Answer 24

During lactation

Question 25

What usually occurs in acute mastitis?

Answer 25

Staphylococcus aureus infection from nipple cracks and fissures

Question 26

Signs and symptoms of acute mastitis?

Answer 26

Erythematous, painful breast Pyrexia Can get breast abscesses

Question 27

How does fat necrosis of the breast normally present?

Answer 27

A mass, skin changes or mammographic abnormality

Question 28

What is often in the history when there is fat necrosis?

Answer 28

Trauma or surgery

Question 29

What can fat necrosis of the breast mimic?

Answer 29

Carcinoma - clinically and mammographically

Question 30

How can a fibrocystic change present?

Answer 30

Mass or mammographic abnormality | Mass often disappears after fine needle aspiration if a cyst

Question 31

How does a fibrocystic change present histologically?

Answer 31

Cyst formation Fibrosis Apocrine metaplasia

Question 32

What can a fibrocystic change mimic?

Answer 32

Carcinoma - clinically and mammographically

Question 33

Give some examples of stromal tumours

Answer 33

``` Fibroadenoma Phyllodes tumour Lipoma Leiomyoma Hamartoma ```

Question 34

How do fibroadenomas present?

Answer 34

Mass, usually mobile - 'breast mouse' - mobile and elusive May be multiple and bilateral Can grow very large and replace most of breast tissue Mammographic abnormality

Question 35

What is a fibroadenoma?

Answer 35

Localised hyperplasia (rather than a true neoplasm)

Question 36

What does a fibroadenoma look like macroscopically?

Answer 36

Well circumscribed Rubbery Greyish/white

Question 37

What does a fibroadenoma look like histologically?

Answer 37

Mixture of stromal and epithelial elements

Question 38

How do phyllodes tumours present?

Answer 38

Rare before 40 Masses or mammographic abnormality Can be very large and involve the entire breast

Question 39

What are the classifications of phyllodes tumours?

Answer 39

Benign Borderline Malignant (

Question 40

Histological features of a phyllodes tumour?

Answer 40

Stroma more cellular and atypical than in fibroadenomas | Nodules of proliferating stroma covered by epithelium (phullon = leaf)

Question 41

How do malignant phyllodes tumours behave?

Answer 41

Agressively Recur locally Metastasize by blood stream

Question 42

What is gynaecomastia?

Answer 42

Enlargement of male breasts - bilateral or unilateral

Question 43

When is gynaecomastia normally seen?

Answer 43

Puberty | In the elderly

Question 44

What causes gynaecomastia?

Answer 44

Relative decrease in androgen effect or increase in oestrogen effect

Question 45

Why does gynaecomastia happen in neonates?

Answer 45

Secondary to circulating maternal and placental oestrogens and progesterone

Question 46

Why does gynaecomastia affect more than half of boys at puberty?

Answer 46

Oestrogen production happens peaks earlier than that of testosterone

Question 47

Other causes of gynaecomastia?

Answer 47

Klinefelter's syndrome Oestrogen excess - cirrhosis of liver (oestrogen not metabolised effectively) Gonadotrophin excess - functioning testicular tumour eg Leydig/Sertoli cell tumour, testicular germ cell tumours Drug-related

Question 48

What drugs can cause gynaecomastia?

Answer 48

``` Spironolactone Cimetidine Alcohol Marijuana Heroin Anabolic steroids (Chlorpromazine Digitalis) ```