Breast Lesions

Question 1

How does a breast cyst present?

Answer 1

painful or painless mass in the breast that can arise suddenly or enlarge acutely

Question 2

What will physical exam demonstrate for breast cysts?

Answer 2

Smooth, firm, discrete with texture like a grape or hard mass

Question 3

What is a simple breast cyst?

Answer 3

Benign and well-circumscribed

Question 4

How are simple breast cysts managed?

Answer 4

My aspirate if pain is severe:

Question 5

What is a complicated breast cyst?

Answer 5

Homogenous: low level echoes due to debris

Question 6

How do you manage a complicated breast cyst?

Answer 6

Biopsy to confirm it is benign then repeat imaging in 6 months to document stability

Question 7

What is a complex breast cyst?

Answer 7

Mass with thick walls, septa, and cystic and solid components

Question 8

How do you manage a complex breast cysts?

Answer 8

Biopsy to confirm

Question 9

What are the most common benign breast lesions?

Answer 9

Fibrocystic changes
Fibroadenoma
Fat Necrosis
Intraductal Papilloma
Mastitis
Breast Abscess

Question 10

What is the etiology of Fibrocystic changes of the breast?

Answer 10

Cyclical breast pain: increases with approach of menses and returns to normal once menstruation starts

Question 11

What physical exam findings are seen with Fibrocystic changes?

Answer 11

Nodular tissue bilaterally with diffuse tenderness
Masses are not discrete or well-defined

Question 12

How do you diagnose Fibrocystic changes?

Answer 12

Physical exam

Question 13

How do you manage fibrocystic changes?

Answer 13

Observation

Question 14

What is the etiology of a Breast Fibroadenoma?

Answer 14

Benign solid tumors with glandular and fibrous tissues that may increase in size with pregnancy and decrease with menopause

Question 15

How do Breast Fibroadenoma present?

Answer 15

Well-defined mobile mass

Question 16

How do you diagnose breast Fibroadenoma?

Answer 16

US: definitive diagnose with Core needle biopsy

Question 17

How do you manage breast Fibroadenoma?

Answer 17

Observation + repeat US in 3-6 months

Excise if size increases to r/o malignancy

Question 18

What is the etiology of breast fat necrosis?

Answer 18

Breast trauma or surgery

Question 19

What physical exam findings are present in breast fat necrosis?

Answer 19

Clinically detected as hard lump

Question 20

How is breast fat necrosis diagnosed?

Answer 20

Mammogram

Question 21

How is breast fat necrosis managed?

Answer 21

Observation

Question 22

What is the etiology of Breast Intraductal Papilloma?

Answer 22

Papillary cells growing into cyst lumen

Question 23

What physical exam findings are seen in Breast Intraductal pappilloma?

Answer 23

Bloody nipple discharge

Question 24

How are breast intraductal papilloma diagnosed?

Answer 24

Core needle biopsy

Question 25

How are breast intraductal papilloma managed?

Answer 25

Surgical excision to r/o hidden cancer

Question 26

What is the etiology of breast Mastitis?

Answer 26

Prolonged engorgement in breastfeeding women or inflammation in non-breastfeeding women

Question 27

What physical exam findings are present in breast mastitis?

Answer 27

Painful, swollen, erythematous breast(s)

Question 28

How do you diagnose breast mastitis?

Answer 28

Clinical: if severe infection you can culture breast milk

Question 29

How do you manage breast mastitis?

Answer 29

Cover S. aureus: Dicloxacillin or Cephalexin

Question 30

What is the etiology of a breast abscess?

Answer 30

Localized collection of pus in breast tissue

Question 31

What physical exam findings are seen in a breast abscess?

Answer 31

Fluctuant, tender, palpable mass with fever and malaise

Question 32

How do you diagnose a breast abscess?

Answer 32

Clinical, US confirms diagnosis, Cx the aspirate

Question 33

How do you manage a breast abscess?

Answer 33

Needle aspiration, surgical drainage and abx: Dicloxacillin or cephalexin If MRSA is suspected: TMP-SMX or clindamycin