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Flashcards in BENIGN BREAST DISEASE Deck (49):
1

What are the commonly seen causes of benign breast lesions or lumps?

Fibroadenoma

Fibroadenosis / fibrocystic breast disease

Sclerosing adenosis

Breast cysts

Epithelial hyperplasia

Fat necrosis

Duct papilloma

Mammary duct ectasia

2

What are fibroadenomas?

Tumours of stromal and epithelial tissue that arise in the terminal duct lobular unit of the breast

3

What is the lay term sometimes used to describe fibroadenomas of the breast?

Breast mice - due to their mobility

4

What are the risk factors for developing fibroadenomas of the breast?

15-25 years old

Black race

5

What are the clinical features of fibroadenomas?

Highly mobile

Firm

Non-tender

Usually under 3 cm

Usually solitary

Slow growing

6

What percentage of all breast masses do fibroadenomas make up?

12%

7

What is the increase in risk of malignancy with fibroadenomas?

None - they are not pre-cancerous

8

What percentage of fibroadenomas will regress in size over 2 years?

30%

9

How do we manage a painless, highly mobile breast lump suggestive of fibroadenoma?

Imaging to confirm diagnosis

If more than 3 cm can be surgically resected

10

What age group are most commonly affected by fibroadenosis or fibrocystic breast disease?

Middle age, pre-menopausal

Affect 50% of women of child bearing age

11

What are the clinical features of fibrocystic breast disease?

Lumpy / cobblestone texture to breasts

Pain which is often periodically related to menstrual cycle

May be tender breasts

May be itchy

12

Are fibrocystic breast lesions pre-cancerous?

No, however, they may increase risk of morbidity and mortality from breast cancer by inhibiting more cancerous lumps from being detected

13

How do we manage a lady with a periodically painful breast lumps suggestive of fibrocystic breast disease?

Triple assessment to rule out cancer

Treated on a symptomatic basis with NSAIDs, but Danazol and Tamoxifen may be used to block oestrogen input into cyclical pain.

Closer follow up may be required to make sure no cancerous lumps are being missed.

14

What are the clinical features of sclerosing adenosis?

Multiple lumps

Small

Firm

Painful

Cause mammographic changes that may mimic carcinoma

15

Are sclerosing adenosis breast lesions pre-cancerous?

They are part of a group of diseases that fall under the heading of borderline breast disease:

"group of conditions while being not completely malignant are still concerning"

16

How do we manage a lady who presents with multiple small painful lumps in her breast suggestive of sclerosing adenosis?

Triple assessment - need biopsy to exclude malignant potential

Excision is not mandatory

17

What percentage of Western women will present with a breast cyst?

7%

18

What are the clinical features of breast cysts?

Smooth lump

Discrete

Fluctuant

Often come on very quickly

19

Are breast cysts pre-cancerous?

They can be. More likely to be malignant if found in younger patients.

20

How do we manage a lady who presents with smooth discrete fluctuant lumps suggestive of cysts?

Triple assessment

Cysts should be aspirated - those which are blood stained or persistently refill should be biopsied or excised.

21

What is epithelial hyperplasia of the breast?

Increase in number of the cells in the lining of the ducts (ductal hyperplasia) or lobules (lobular hyperplasia) in the breast.

22

What are the clinical features of ductal or lobular hyperplasia?

Variable presentation

Sometimes generalised lumpiness

Sometimes discrete lumps

Often asymptomatic and picked up on mammogram screening

23

Is ductal or lobular hyperplasia of the breast pre-cancerous?

Those found to have atypical features on histology can be

24

How do we manage a lady who is found to have ductal or lobular hyperplasia?

Triple assessment

Those found to have atypical features should have close monitoring or excision

25

What are the risk factors for developing fat necrosis of the breast?

40% have a traumatic aetiology

Surgery

Obesity

Large breasts

26

What are the clinical features of fat necrosis in the breast?

Initial inflammatory response

Lesion is typical firm and round

May develop into a hard, irregular breast lump

Mimics features of carcinoma so further assessment is required.

27

How do we manage an obese woman who presents with an irregular hard lump following surgery to the breast suggestive of fat necrosis?

Triple assessment - mimics carcinoma so needs fully investigating with core biopsy

28

What are the clinical features of duct papillomas?

Wart like lump

Usually develops near or behind the areolar

Nipple discharge

Non-tender

29

Do women with duct papilloma have an increased chance of developing cancer?

Intraductal papillomas generally don’t increase the risk of developing breast cancer. However, when an intraductal papilloma contains atypical cells (cells which are abnormal but not cancer), this has been shown to slightly increase the risk of developing breast cancer in the future.

30

How should we manage a women with a warty lump behind the areolar and nipple discharge suggesting duct papilloma?

Triple assessment

Microdochectomy - surgical excision

31

What is mammary duct ectasia?

Dilatation of large breast ducts due to blockage

32

What are the risk factors for mammary duct ectasia?

Peri-menopausal / post-menopausal women are most at risk

33

What are the clinical features of mammary duct ectasia?

Painful lump

Around the areolar

Green nipple discharge

Can rupture and cause local inflammation

34

What do we call rupture mammary duct ectasia?

Plasma cell mastitis

35

Is mammary duct ectasia pre-cancerous?

No.

36

How do we manage a women who presents with green nipple discharge and a painful areolar lump suggestive of mammary duct ectasia?

Triple assessment - can mimic carcinoma so requires biopsy

Excision not required

37

What are the two main types of mastitis?

Lactational mastitis

Periductal mastitis

38

What proportion of breast feeding women develop mastitis?

10%

39

What is the organism most commonly responsible for lactational mastitis?

S. aureus

40

What are the clinical features of lactational mastitis?

Tender areolar

Erythema

Warm

Fever

41

What are the indications for treating mastitis with antibiotics?

Systemically unwell

Presence of nipple fissures

If symptoms do not improve after 12-24 hours of milk removal

If blood cultures are positive

42

What is the first line antibiotic for mastitis?

Flucloxacillin for 10-14 days

43

Should a mother continue to breast feed if she is found to have mastitis?

Yes

44

What are the complications of untreated lactational mastitis?

Breast abscess

45

What are the features of breast abscess?

Tender

Fluctuant mass

Lactating woman

Necrotic tissue overlying abscess

46

What investigations should be done in a woman who presents with a suspected breast abscess?

FBC

CRP

USS

47

How do we manage a patient with a breast abscess?

USS guided drainage

Surgical debridement if patient has necrotic tissue

48

What is the main risk factor for developing periductal mastitis?

Smoking

49

What are the clinical features of periductal mastitis?

Inflammation

Abscess

Mammary duct fistula