Breast Disorders Flashcards
Mastitis
Inflammation of the breast parenchyma (Cellulitis)
MC Staph Aureus
Bacterial induced: 10-14 days Cephalexin
Non-bacterial: Pain control and CONTINUE breastfeeding/pumping
Abscess <3 cm bedside >3cm Sx consult
Periductal Mastitis
Vit A deficiency results in squamous cell metaplasia of the ducts, causing blockage and inflammation
-Commonly seen in SMOKERS
-Duct blockage (Non-bacterial)
Congestive Mastitis
Bilateral breast engorgement 2-3 postpartum d/t milk stasis
-Duct blockage (Non-bacterial)
Fibroadenoma
R/F:
MC breast tumor in women <30 y.o
African Americans
Arise from periductal stromal tissue
Painless/non-tender
Rubbery mass, VERY mobile
Can enlarge during pregnancy and does NOT change with menstruation
Fibrous collagen arranged in a “swirl”
NOT at risk for breast cancer
Tx:
Observation
Regress with menopause
Fibrocystic Changes
MC Benign lesions
R/F:
PREMENOPAUSAL females 20-50
S/sx:
Premenstrual breast pain
Multiple tender lumps in upper lateral quadrant
Non-bloody green or brown discharge
Initial: U/S
Mammography to R/O cancer
Tx:
Lymphadenopathy, skin ulcer, fixation, lesion or arm edema -> URGENT Surgical referral
BC
FNA
Galactorrhea
Milk secretion from the breast in a non-breastfeeding woman
Causes:
Drug induced (BC, methyldopa, amphetamine, metoclopramide)
Non-CNS conditions (renal failure, sarcoidosis, cushing, cirrhosis, hypothyroidism)
CNS lesions (pituitary adenoma, hypothalamic tumor, traumatic brain injury)
Dx: Prolactin levels, FSH, LH, TSH, GH, ACTH levels
Tx: Dopamine agonist
Prolactinoma
Usually benign tumor on the anterior pituitary that results in inappropriately high levels of prolactin
Negative feedback, in which a sufficient level of prolactin stimulates the hypothalamus to release Dopamine, which in turn inhibits the pituitary’s release of prolactin is no longer functional
Gynecomastia
Benign breast enlargement in males due to increased ESTROGEN activity and decreased androgen activity
Causes:
Maternal estrogen: Infants
During puberty
Idiopathic
Syndromes causing hypogonadism (Klinefelter)
Dx: check testosterone levels, Mammogram
Tx:
Tamoxifen (androgen supplementation
Surgery
What medications cause gynecomastia?
Spironolactone
Ketoconazole
Digoxin
Thiazides
Verapamil
Anabolic steroids
Breast trauma/hematoma
D/t blunt trauma or peri/post operative
Not all ecchymosis=hematoma
Isolated breast injury should raise concern for abuse
S/sx:
Pain/ecchymosis
Edema
Hypovolemic shock
1.5 L of blood can drain into the breast BUT depends on size. (Bigger=more blood)
Dx:
U/S to r/o hematoma
Angiography
+/- H&H
PT/INR if on thinners
Tx:
Surgery
Blood transfusion if needed
Infiltrative Ductal Carcinoma
Peau d’ orange
INVASIVE
Most Common type of breast cancer
S/Sx:
Most common in superior-lateral quadrant
Almost always presents as palpable mass
Usually PAINLESS
Hard fixed immobile breast lump with irregular borders
Peau d’orange: If Copper ligament involved it causes dimpling appearance similar to an orange peel
MC sites of metastasis
Bone
Lung
Liver
Infiltrative Lobular Carcinoma
INVASIVE
Usually palpable mass but approx. 25% are much more difficult to both palpate and detect on mammogram bc the tumor infiltrates that tissue diffusely
Metastasis to:
Peritoneum/retroperitoneum
Meninges
GI tract
Ovaries
Uterus
Intraductal Papilloma
Fibroepithelial papillary tumor within the lactiferous ducts
Under 35 y.o Premenopausal at highest risk
ASSOCIATED SLIGHTLY WITH INCREASED RISK OF BREAST CANCER DEVELOPMENT
S/sx:
Tumor often so small they cannot be seen or palpated
MC just beneath areola
MCC of Serous or bloody nipple discharge
Usually unilateral
W/O Assoc. Lymphadenopathy
Dx: Biopsy to r/o papillary carcinoma
Galactogram is MOST specific imaging
Tx: Microdochectomy: Excision of lactiferous duct
Phyllodes Tumor
Large mass of connective tissue and cysts with “leaf-like” projections
Commonly seen in POSTmenopausal women
CAN become MALIGNANT
S/Sx:
Painless mass
Often shows clinically noticeable growth from week to week
Dx:
Test of choice is core needle biopsy
Appear as well circumscribed lesions on mammogram
Tx: Surgical excision (REFER to SX)
