1
Q
Define (lactational) acute mastitis
A
Acute inflammation of breasr tissue
2
Q
What is the aetiology/risk factors for (lactational) acute mastitis
A
- Cause: Staph aureus (usually)
- Post-partum, breastfeeding patient
‘puerpural’ = pregnancy-related
3
Q
What is the clinical features of (lactational) acute mastitis
A
- Painful, erythematous swelling of the breast
2. Skin is ‘hot to touch’
4
Q
What is the management for (lactational) acute mastitis
A
Antibiotics
5
Q
What are the complications of (lactational) acute mastitis
A
- Abscesses
6
Q
Define periductal mastitis
A
inflammation around dilated milk ducts
7
Q
What is the aetiology/risk factors for periductal mastitis
A
- Smoker
2. Non-lactating young woman (30 years)
8
Q
What are the clinical features of periductal mastitis
A
- Painful, erythematous subareolar mass
2. inverted nipple
9
Q
What is the management for periductal mastitis
A
- Antibiotics
2. Stop smoking
10
Q
What are the complications for periductal mastitis
A
- Abscesses
11
Q
Define breast abscess
A
collection of pus in the breast
12
Q
What are the clinical features of breast abscess
A
- febrile patient
2. Painful, erythematous lump near nipple
13
Q
What is the management for breast abscess
A
- Aspirate (FNA)
OR - Surgical drainage
14
Q
Define fibroadenoma
A
benign neoplasm of a lobule arising from stroma (‘fibro’) and glandular epithelium (‘adenoma’)
15
Q
What is the aetiology/risk factors of fibroadenoma
A
- Young women - aged 20-30 years old
16
Q
What are the clinical features of fibroadenoma
A
- breast mouse
2. Painless, smooth, well circumscribed, mobile mass
17
Q
What is the management for fibroadenoma
A
- Observe. Excision if in doubt
18
Q
What is the prognosis for fibroadenoma
A
- most regress
- some stay the same
- some may enlarge ( lead to excision)
19
Q
Define breast cyst
A
fluid-filled cavity in the breast
20
Q
What are the risk factors for breast cyst
A
- peri-menopausal women
2.
21
Q
What are the risk factors for breast cyst
A
- peri-menopausal women (around 40-50)
22
Q
What are the clinical features for breast cyst
A
- fluctuant, distinct round mass
2. Often tender (painful)
23
Q
What is the management for a breast cyst
A
May resolve naturally or Aspirate (FNA)
- aspirate is usually clear/green/brown/yellow
24
Q
What are the buzzwords for breast cysts
A
- Fluctuant
2. Tender
25
Define Duct ectasia
Dilation of ducts due to blockage. clogging of lactiferous ducts
26
What are the risk factors for duct ectasia
1. peri- or post-menopausal women 50-60 y/o
27
What are the clinical feature s of duct ectasia
1. Can appear similar to cancer (so exclude)
2. Nipple retraction/slit-like nipple
3. Cheesy, thick discharge (white/green/yellow)
4. subareolar mass
5. Micro-calcification on imaging
28
What is the management for duct estasia
1. reassure and discharge
| 2. surgical duct excision if mass present
29
What are the buzz words for duct ectasia
1. Cheesy thick white/green nipple
| 2. slit-like nipple
30
Define ductal carcinoma in-situ
Ductal carcinoma that has yet to invade the basement membrane
31
what are the risk factors for breast cancer (including ductal carcinoma in-situ
1. previous Hx (breast, ovarian Ca)
2. FHx (which may include mutations in BRCA 1 and 2 genes)
3. Irradiation to chest wall (for example in the treatment of Hodgkins lymphoma)
4. Increased exposure to oestrogen:
- early menarche <13 years
- Late menopause >51 years
- nulliparity
- Not breast-feeding
- HRT
- OCP
- obesity
32
What are the clinical features of ductal carcinoma in-situ
1. impalpable (no lump)
| 2. micro-calcification on imaging (mammography)
33
What is the management for ductal carcinoma in-situ
1. surgery (lumpectomy) + radiotherapy
34
What are the buzzwords for ductal carcinoma in-situ
1. Micro-calcification
| 2. Impalpable
35
What are the 2 types of invasive breast cancer
1. infiltrative ductal carcinoma (75%))
| 2. infiltrative lobular carcinoma
36
What are the clinical features of breast cancer
1. painless, immobile, irregular and hard lump
2. Axillary lymphadenopathy
3. Skin changes e.g. Peau d'orange, skin dimpling, nipple retraction, clear/bloody discharge from the nipple
37
What is the management of invasive breast cancer
Surgery
38
What is the investigation for invasive breast cancer
Triple assessment
1. Breast history + examination
2. Imaging: Ultrasound (<35 years old)
3. Histology: core biopsy
39
What are the surgery options for breast cancer
1. wide local excision (breast conserving)
| 2. modified radical mastectomy
40
If a tumour is oestrogen receptor (ER) +ve what drug can be administered
Tamoxifen (Oestrogen antagonist)
41
If a tumour is Her2 receptor +ve what drug can be administered
Trastuzumab (Herceptin)
42
What is Paget's disease of the breast
Presence of Paget's cells in the nipple
| Essentially it is the spread of cancer cells to the skin
43
Which types of cancers is paget's disease of the breast seen in
1. DCIS
| 2. Invasive breast carcinoma
44
What are the clinical features of Paget's disease of the breast
1. Eczematous lesion of the nipple
| 2. Itchy, erythematous, crusty scaly skin
45
What is the management of Paget's Disease of the Breast
Surgery
46
What is triple assessment
1. Clinical assessment
2. Imaging:
USS - age <35 y/o
Mammogram - age >35 y/o
3. Biopsy
Fine Needle Aspiration (FNA) - cytology (fluid)
Tru-Cut Core Biopsy - Histology (solid)
47
```
22 year old woman presents to clinic with a three-month history of a single lump in her right breast. Examination reveals a mobile, firm, smooth and non-tender lump of 2cm in the lower outer quadrant that is not attached to the overlying skin. No axillary lymph nodes are palpable. The most likely diagnosis is:
Acute Mastitis
Breast Abscess
Breast Cyst
Fibroadenoma
Periductal Mastitis
```
Fibroadenoma
48
```
A 54 year old patient who is febrile, presents with an irregular, firm mass in her left breast. The overlying skin appears red and is warm to touch. The most likely diagnosis is:
Acute Mastitis
Breast Abscess
Breast Cyst
Fibroadenoma
Periductal Mastitis
```
Breast Abscess
49
```
A 31 year old presents with an ill-defined, tender mass in her left breast, 2 weeks after giving birth. The affected segment is diffusely red and hot. Fine needle aspiration cytology (FNAC) of the mass shows neutrophils and inflammatory debris. The most likely diagnosis is:
Acute Mastitis
Breast Abscess
Breast Cyst
Fibroadenoma
Periductal Mastitis
```
Acute Mastitis
50
```
A 56 year old female presents with thick creamy discharge from the right nipple. USS shows dilated subareolar ducts. Cytology of discharge shows macrophages and debris but no epithelial cells. The most likely diagnosis is:
Acute Mastitis
Ductal carcinoma in-situ
Duct Ectasia
Invasive Breast Cancer
Paget’s Disease of the Breast
```
Duct Ectasia
51
```
A 55 year old presents with a firm, irregular, painless lump in her left breast. On examination you find an enlarged apical lymph node. The most likely diagnosis is:
Acute Mastitis
Ductal carcinoma in-situ
Duct Ectasia
Invasive Breast Cancer
Paget’s Disease of the Breast
```
Invasive Breast Cancer
52
```
A 48 year old woman presents with red, scaly lesions around the nipple of the right breast. The most likely diagnosis is:
Acute Mastitis
Ductal carcinoma in-situ
Duct Ectasia
Invasive Breast Cancer
Paget’s Disease of the Breast
```
Paget’s Disease of the Breast
53
```
A 25 year old woman is seen in breast clinic as she has noticed a small lump in her right breast. This is confirmed on examination and she is sent for further investigation. What is the next investigation she should have?
Core Biopsy
Fine Needle Aspiration
Mammography
None Needed – Send Home
Ultrasound
```
Ultrasound
54
What is fat necrosis and what are the risk factors
Post trauma of fatty breast tissue
Hx of trauma
e.g. Car accident, surgery, needle biopsy (iatrogenic)
55
What are the clinical features of fat necrosis
1. Painless, irregular hard lump
| 2. bruising or redness of overlying skin
56
What is the management for fat necrosis
1. analgesia + discharge
57
What is fibroadenosis/fibrocystic breast disease and what are the risk factors
Normal and physiological changes in breast tissue leading to fibrous tissue and cyst formation
risk factors:
due to hormonal chnages in women aged 30-50s
cyst rupture leads to fibrosis
58
What are the clinical features of fibroadenosis/fibrocystic breast disease
1. Cyclical - premenstrual breast nodularity
| 2. Painful, multiple lumps
59
What is the management for fibroadenosis/fibrocytic breast disease
Reassure and discharge
60
What is intraductal papilloma and what are the risk factors
Benign neoplasm growing within the ducts of the breast
Risk Factors include Peri-/post-menopausal women
61
What are the clinical features of intraductal papilloma
and what is the management
1. Bloody or Clear nipple discharge
2. Subareolar mass
Surgical excision of duct and papilloma
62
What is phyllodes tumour
Phyllodes = 'leaf-like'
Fibroepithelial tumour formed of periductal stromal cells
can be malignant or benign
63
What are the clinical features of a phyllodes tumour
1. Rapidly growing
2. Tear drop appearance of the breast
3. Slit-like-nipple
4. Warm shiny erythematous skin
64
What is the management for a phyllodes tumour
Aggressive treatment including wide excision
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