Week 11.1 - Breast disease

Question 1

How would pain present in breast disease?

Answer 1

• Non-cyclical

- Focal

Question 2

How would a malignant lump present in breast disease?

Answer 2

• Hard
• Craggy
• Fixed

Question 3

Give 3 differential diagnoses for palpable masses

Answer 3

• Invasive carcinomas
• Cysts
• Fibroadenoma

Question 4

What is the most common benign palpable mass?

Answer 4

-Fibroadenoma

Question 5

Give 2 differential diagnoses for milky discharge

Answer 5

• Pituitary adenoma

- OCP

Question 6

Give 3 differential diagnoses for bloody/serous nipple discharge

Answer 6

• Benign lesion eg papilloma
• Duct ectasia
• Malignancy

Question 7

Why are mammographic abnormalities easier to detect in older people?

Answer 7

-High adipose content in breasts

Question 8

What does calcification suggest on a mammograph?

Answer 8

• DCIS

- benign mass

Question 9

What is polyethelia?

Answer 9

-Additional nipple

Question 10

What is acute mastitis?

Answer 10

-Inflammatory condition of the breast from Infection from staph. aureus during lactation due to nipple cracks as can track up the lactiferous duct

Question 11

What is fat necrosis?

Answer 11

-Inflammatory condition of the breast which presents as a mass of skin changes as a history of trauma or surgery

Question 12

What is fibrocystic change?

Answer 12

• The most common breast lesion which presents as a mass or on mammograph
• Histology shows cyst formation, fibrosis and apocrine metaplasia

Question 13

State 3 benign epithelial lesions of the breast

Answer 13

• Fibrocystic change
• Stromal tumour eg fibroadenoma or phyllodes
• Gynacomastia

Question 14

Name 2 benign stromal tumours

Answer 14

• Fibroadenoma

- Phyllodes

Question 15

Describe how fibroadenoma would be on presentation

Answer 15

• Highly mobile mass (breast mouse)
• Well circumscribed
• Can be multiple, bilateral and large

Question 16

In what age group does phyllodes most oftn occur?

Answer 16

-Over 40 years

Question 17

Describe the behaviour of malignant phyllodes

Answer 17

• Aggressive
• Recur
• Metastasise by blood

Question 18

What is the histiological difference between phyllodes and fibroadenoma?

Answer 18

-Phyllodes withh have more atypical stroma

Question 19

When excising phyllodes, what is the difference between that and fibroadenoma? why?

Answer 19

-Wide excision margin as can recur

Question 20

What is gynaecomastia? In who does it most often occur?

Answer 20

• Enlargement of the male breast due to decreased androgens or increased oestrogens
• Young or elderly

Question 21

give 3 causes of gynaecomastia

Answer 21

• Liver disease
• Klinefelters
• Testicular tumour

Question 22

What is the most common type of breast malignancy?

Answer 22

-Adenocarcinoma

Question 23

Describe some riskfactors for breast malignancy

Answer 23

• Uninteruppted menses
• Early menarche
• Late menapause
• Obesity
• OCP/HRT

Question 24

What is mean by in situ carcinoma?

Answer 24

-Neoplastic cells are limited to ducts and lobules by BM and thus cannot metastasise

Question 25

What is distinctive about DCIS histiologically?

Answer 25

-Central comedo necrosis

Question 26

What is pagets disease of the breast?

Answer 26

- DCIS which has extended up to the nipple skin as does not have to cross BM to get here - Red crusting nipple

Question 27

How does DCIS most often present?

Answer 27

-Mammographihc calcification

Question 28

By the time a breast malignancy is palpable, what % have mets?

Answer 28

-50%

Question 29

Where does invasive carcinoma commonly metastasise first?

Answer 29

-Axillary LNs

Question 30

What is the cause of peau d'orange?

Answer 30

-Blockage of the lymphatics causing odematous breast -> Hair follicles are firmly attched to dermis and pull down

Question 31

What are the two types of invasive carcinoma? Which is most common?

Answer 31

- IDC-No special type (most common) | - Invasive lobular carcinoma

Question 32

How does invasive lobular carcinoma look histologically?

Answer 32

-Discohesive single file infiltrating cells

Question 33

How does breast cancer commonly metastasise?

Answer 33

- Using lymphatics | - (distant mets usually by bloodstream)

Question 34

Where does breast malignancy commonly metastasise?

Answer 34

-ipsilateral LNs, bone, lung, liver, brain

Question 35

Describe the triple approach to investigation and diagnosis

Answer 35

- Clinical history and examination - Radiographic imaging - FNA

Question 36

Describe breast cancer screening

Answer 36

- 47-73 - 2 view mammograms every 3 years - Aims to detect small impalpable cancers

Question 37

When would a breast malignancy get treated with tamoxifen?

Answer 37

-If it was oestrogen receptor positive

Question 38

When would a breast malignancy get treated with herceptin?

Answer 38

-If it was HER2 receptor positive