Flashcards in Week 11.1 - Breast disease Deck (38):
How would pain present in breast disease?
How would a malignant lump present in breast disease?
Give 3 differential diagnoses for palpable masses
What is the most common benign palpable mass?
Give 2 differential diagnoses for milky discharge
Give 3 differential diagnoses for bloody/serous nipple discharge
-Benign lesion eg papilloma
Why are mammographic abnormalities easier to detect in older people?
-High adipose content in breasts
What does calcification suggest on a mammograph?
What is polyethelia?
What is acute mastitis?
-Inflammatory condition of the breast from Infection from staph. aureus during lactation due to nipple cracks as can track up the lactiferous duct
What is fat necrosis?
-Inflammatory condition of the breast which presents as a mass of skin changes as a history of trauma or surgery
What is fibrocystic change?
-The most common breast lesion which presents as a mass or on mammograph
-Histology shows cyst formation, fibrosis and apocrine metaplasia
State 3 benign epithelial lesions of the breast
-Stromal tumour eg fibroadenoma or phyllodes
Name 2 benign stromal tumours
Describe how fibroadenoma would be on presentation
-Highly mobile mass (breast mouse)
-Can be multiple, bilateral and large
In what age group does phyllodes most oftn occur?
-Over 40 years
Describe the behaviour of malignant phyllodes
-Metastasise by blood
What is the histiological difference between phyllodes and fibroadenoma?
-Phyllodes withh have more atypical stroma
When excising phyllodes, what is the difference between that and fibroadenoma? why?
-Wide excision margin as can recur
What is gynaecomastia? In who does it most often occur?
-Enlargement of the male breast due to decreased androgens or increased oestrogens
-Young or elderly
give 3 causes of gynaecomastia
What is the most common type of breast malignancy?
Describe some riskfactors for breast malignancy
What is mean by in situ carcinoma?
-Neoplastic cells are limited to ducts and lobules by BM and thus cannot metastasise
What is distinctive about DCIS histiologically?
-Central comedo necrosis
What is pagets disease of the breast?
-DCIS which has extended up to the nipple skin as does not have to cross BM to get here
-Red crusting nipple
How does DCIS most often present?
By the time a breast malignancy is palpable, what % have mets?
Where does invasive carcinoma commonly metastasise first?
What is the cause of peau d'orange?
-Blockage of the lymphatics causing odematous breast -> Hair follicles are firmly attched to dermis and pull down
What are the two types of invasive carcinoma? Which is most common?
-IDC-No special type (most common)
-Invasive lobular carcinoma
How does invasive lobular carcinoma look histologically?
-Discohesive single file infiltrating cells
How does breast cancer commonly metastasise?
-(distant mets usually by bloodstream)
Where does breast malignancy commonly metastasise?
-ipsilateral LNs, bone, lung, liver, brain
Describe the triple approach to investigation and diagnosis
-Clinical history and examination
Describe breast cancer screening
-2 view mammograms every 3 years
-Aims to detect small impalpable cancers
When would a breast malignancy get treated with tamoxifen?
-If it was oestrogen receptor positive