Common breast conditions - teaching

Question 1

Functional unit breasts

Answer 1

• Lobules
• Consists of small alveolar sacs
• Secretion of milk into ducts

Question 2

What tethers breast onto chest wall?

Answer 2

• Suspensory ligament of cooper
• If cancer invades this, causes puckering of skin

Question 3

Causes of gynaecomastia

Answer 3

• Liver disease
• Dopamine antagonists

Question 4

Axillary lymph nodes

Answer 4

• 5 groups
• Lateral - humeral group, along margin of humerus
• Anterior - anterior axillary fold
• Posterior - posterior axillary fold
• Central - centre of axilla
• Apical - apex axillax

Question 5

Triple assessment - 3 parts

Answer 5

1. History and examination
2. Imaging - if under 35 - USS, older mammogram, MRI if younger and highly suspicious or maybe ruptured implant
3. Tissue diagnosis - FNA cytology or core biopsy

Question 6

Why do younger people have US rather than mammogram?

Answer 6

In younger women:
* Less fatty tissue
* More fibrous tissue - easier to visualise with USS

Question 7

Congenital disorders of breast

Answer 7

• Without nipples
• Accessory nipples along milk line
• Benign

Question 8

Mastitis

Answer 8

• Inflammation of breast
• Presents with painful breasts, discharge, swelling, fever
• Short history - days-weeks

Question 9

Cyst vs abscess

Answer 9

• Cyst has absent fever, not erythematous unless infected
• And usually affects older women

Question 10

Operations for abscess

Answer 10

• Incision and drainage
• Hadfields operation - circumareolar incision, open multiple ducts to allow drainage

Question 11

Duct ectasia?

Answer 11

• Means dilated
• Presents with discharge - variable colours
• Benign
• Smoking is RF

Question 12

Management duct ectasia

Answer 12

• Smoking cessation
• Conservative

Question 13

Breasts cysts

Answer 13

• More likely over 50
• Soft, fluctuant breast swelling
• Otherwise systemically well
• Should drain them as chance of malignant transformation

Question 14

Intraductal papilloma

Answer 14

• Outprojection of duct- benign tumour
• Can shear off and cause bleeding = bloody discharge
  *

Question 15

Fat necrosis

Answer 15

• Following trauma to breasts - firm lumps or lumpy breasts
• Reassure

Question 16

Fibroadenoma

Answer 16

• Breast mouse, very mobile in all planes
• Young female 18-25
• Firm
• Can become quite large - if >4cm or symptomatic have lumpectomy or quadrantectomy (if small breasts with large lump)

Question 17

Risk with fibroadenoma

Answer 17

• No risk of malignant transformation to breast cancer

Question 18

Lobular carcinoma vs ductal

Answer 18

• Lobular more likely to spread distally

Question 19

Arterial supply to breast

Answer 19

Medial:
* Internal mammary artery

Lateral:
* Lateral thoracic and thoracoacromial (axillary artery origin)
* Lateral mammary branches (intercostal arteries off aorta)
* Mammary branch (anterior intercostal artery)

Question 20

Lymphatic drainage breast

Answer 20

• Axillary
• Parasternal
• Posterior intercostal

Skin –> axillary, inferior deep cervical and infraclavicular
Nipple and areola –> subareolar lymphatic plexus

Question 21

Venous drainage breast

Answer 21

Correspond to arteries
Drain into axillary and internal thoracic veins

Question 22

Factors deciding mastectomy vs WLE

Answer 22

Mastectomy if:
* Multifocal
* Central
* Large lesion in small breast
* DCIS >4cm
* Patient choice

Question 23

Nottingham prognostic index

Answer 23

Tumour size x 0.2 + lymph node score + grade score

Question 24

Lymph node score

Answer 24

• 0 nodes = 1
• 1-3 nodes =2
• > 3 nodes = 3

Question 25

Organism involved in mastitis

Answer 25

• Staphylococcus aureus

Question 26

Tender lump around areola and green/other coloured dishcarge at age 49

Answer 26

Mammary duct ectasia

Question 27

Irregular lump following trauma

Answer 27

• Fat necrosis

Question 28

Irregular lump, 41 year old, fixed

Answer 28

Breast cancer

Question 29

Management of a symptomatic fibroadenoma or if it’s more than 3cm

Answer 29

• Surgical excision

Question 30

Bloody discharge from nipple in a younger person

Answer 30

Intraductal papilloma

Question 31

Management of breast cyst

Answer 31

• Aspiration due to small risk of progression to cancer
• Esp in younger patients

Question 32

Discharge from multiple ducts with nipple inversion, 53 year old

Answer 32

• Duct ectasia

Question 33

Most common breast cancer

Answer 33

• Ductal carcinoma in situ
• Then invasive ductal carcinoma

Question 34

Greatest risk of pathological # from cancer

Answer 34

• Peritrochanteric lesion from breast cancer - lytic lesions in hip
• Not prostate as causes sclerotic

Question 35

Soft mushy swelling between breasts that has been present for whole life

Answer 35

Lipoma - in sternal area

Question 36

Erythematous rash originating from nipple and spreading to areola and surrounding tissue

Answer 36

Pagets disease of nipple
Not eczema as this usually spares nipple

Question 37

Side effects of anastrozole

Answer 37

• Osteoporosis
• VTE
• Endometrial cancer
• Vaginal bleeding

Question 38

Surveillance for BRCA1 and TP53 mutation in young female

Answer 38

Annual MRI

Question 39

Cancer most likely to spread to opposite breast

Answer 39

Invasive lobular cancer

Question 40

Sign of cyst on mammogram

Answer 40

Halo sign