Breast Disease Insights Quiz
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Questions and Answers

Which of the following is NOT a common symptom of breast disease?

  • Breast pain
  • Hair loss (correct)
  • Nipple discharge
  • Palpable mass
  • What is the most common cause of breast peau d'orange?

  • Mastitis
  • Breast cancer
  • Inflammatory breast cancer (correct)
  • Fibroadenoma
  • What is the term for milk production outside of lactation?

  • Supernumerary Nipples
  • Galactorrhea (correct)
  • Lactation
  • Mastitis
  • What is the significance of the embryonic milk line?

    <p>It indicates the location of potential breast tissue development. (A)</p> Signup and view all the answers

    Which of the following is NOT a characteristic that can be assessed during a clinical evaluation of a breast lump?

    <p>Color of the lump (D)</p> Signup and view all the answers

    Which of the following conditions is associated with smoking and vitamin A deficiency?

    <p>Periductal mastitis (C)</p> Signup and view all the answers

    Which condition is characterized by a poorly defined peri-areolar mass with thick green/brown nipple discharge?

    <p>Mammary duct ectasia (A)</p> Signup and view all the answers

    Which condition typically occurs in obese and post-menopausal women and may be caused by trauma?

    <p>Fat necrosis (D)</p> Signup and view all the answers

    Which condition is often associated with type I insulin-dependent diabetes and may have an autoimmune basis?

    <p>Lymphocytic mastitis (C)</p> Signup and view all the answers

    Which condition is characterized by a cystic dilatation of a duct during lactation, and may become infected with abscess formation?

    <p>Galactocoele (D)</p> Signup and view all the answers

    What is the most common cause of surgical procedures performed on the female breast?

    <p>Fibrocystic changes (A)</p> Signup and view all the answers

    What is the primary cause of fibrocystic changes?

    <p>Hormonal imbalance (C)</p> Signup and view all the answers

    Which of the following conditions is NOT associated with inflammation?

    <p>Fat necrosis (D)</p> Signup and view all the answers

    Which of the following is a reason why a lump may remain following a cyst aspiration?

    <p>The lump may contain a solid mass, not just fluid. (B), The cyst may be malignant and require further investigation. (D)</p> Signup and view all the answers

    In which scenario is a fine needle aspiration (FNA) the less preferred method?

    <p>When the lump is suspected to be both solid and cystic. (C)</p> Signup and view all the answers

    Which imaging method is used for guided biopsy?

    <p>Ultrasound (D)</p> Signup and view all the answers

    Why is mammography more challenging in younger women?

    <p>The breast tissue tends to be more dense, making it difficult to detect abnormalities. (B)</p> Signup and view all the answers

    Which of the following is NOT a mammographic sign of malignancy?

    <p>Smooth, well-defined areas of increased density. (D)</p> Signup and view all the answers

    Which diagnostic category is most likely to be followed with further investigation?

    <p>Lesion of uncertain malignant potential (C), Suspicious (D)</p> Signup and view all the answers

    What is the most common type of bacteria involved in acute mastitis?

    <p>Staphylococcus aureus (B)</p> Signup and view all the answers

    Which technique involves obtaining thin cores of tissue?

    <p>Needle Core Biopsy (E)</p> Signup and view all the answers

    A 25-year-old woman presents with a firm, rubbery, solitary lump in her breast. It is freely moveable and fluctuates in size with her menstrual cycle. Which of the following is the most likely diagnosis?

    <p>Fibroadenoma (A)</p> Signup and view all the answers

    Which of the following features is characteristic of apocrine metaplasia?

    <p>Replacement of normal glandular cells with cells resembling apocrine sweat glands (D)</p> Signup and view all the answers

    Which of the following is a true statement about fibrocystic disease?

    <p>It involves proliferative changes in breast tissue (D)</p> Signup and view all the answers

    A patient presents with a breast mass that is large, firm, and has a leaf-like appearance. Which of the following is the most likely diagnosis?

    <p>Phyllodes tumour (A)</p> Signup and view all the answers

    What is the relationship between progesterone and oestrogen in the context of breast tissue?

    <p>Progesterone counteracts the growth effects of oestrogen on breast tissue. (A)</p> Signup and view all the answers

    Which of the following conditions is associated with a moderate risk of breast cancer?

    <p>Proliferative breast disease with atypia (C)</p> Signup and view all the answers

    What is the most common presenting symptom of an intraductal papilloma?

    <p>Nipple discharge (B)</p> Signup and view all the answers

    Which of the following is NOT a characteristic feature of sclerosing lesions?

    <p>Typically present with a palpable mass (B)</p> Signup and view all the answers

    Which of the following is a common cause of gynecomastia?

    <p>Oestrogen excess (B)</p> Signup and view all the answers

    Which of the following is NOT a common drug implicated in gynecomastia?

    <p>Vitamin D (A)</p> Signup and view all the answers

    A patient presents with a palpable breast mass that is firm, mobile, and fluctuates in size with the menstrual cycle. Which of the following clinical features would be the MOST helpful in differentiating between a fibroadenoma and a cyst?

    <p>Size and shape of the mass (B)</p> Signup and view all the answers

    A 45-year-old woman presents with a palpable breast mass that is hard, fixed, and associated with a peau d'orange appearance of the skin. The most concerning differential diagnosis for this presentation is:

    <p>Inflammatory breast cancer (C)</p> Signup and view all the answers

    A patient presents with a tender, fluctuating breast mass that is associated with a greenish-brown nipple discharge. Which of the following is the MOST likely diagnosis?

    <p>Intraductal papilloma (C)</p> Signup and view all the answers

    Which of the following scenarios would MOST likely require a fine needle aspiration (FNA) rather than a core biopsy?

    <p>A soft, mobile mass with suspected cystic features (A)</p> Signup and view all the answers

    A 20-year-old male patient presents with unexplained breast enlargement. Which of the following is the LEAST likely cause of this condition?

    <p>Hypothyroidism (D)</p> Signup and view all the answers

    Which of the following conditions exhibits characteristics resembling carcinoma both clinically and on mammograms?

    <p>Mammary duct ectasia (D)</p> Signup and view all the answers

    A patient presents with a firm, rubbery, subareolar mass that is often bilateral and associated with Type I insulin-dependent diabetes. What condition is most likely present?

    <p>Lymphocytic mastitis (C)</p> Signup and view all the answers

    Which breast condition is primarily associated with smoking and vitamin A deficiency?

    <p>Periductal mastitis (D)</p> Signup and view all the answers

    Which of the following conditions is characterized by the presence of necrotic fat, calcification, and macrophages with giant cells on biopsy?

    <p>Fat necrosis (A)</p> Signup and view all the answers

    Which of the following breast conditions is NOT directly associated with inflammation?

    <p>Fat necrosis (D)</p> Signup and view all the answers

    A patient presents with a painful subareolar mass and an inverted nipple. Which of the following conditions is most likely present?

    <p>Periductal mastitis (B)</p> Signup and view all the answers

    Which of these conditions can result in a cystic dilatation of a duct, potentially leading to abscess formation if infected?

    <p>Galactocoele (A)</p> Signup and view all the answers

    What is the primary cause of fibrocystic changes in the breast?

    <p>Hormonal imbalance, specifically oestrogen dominance (D)</p> Signup and view all the answers

    What is the primary difference between phyllodes tumours and fibroadenomas?

    <p>Phyllodes tumours are typically larger and occur in older women, unlike fibroadenomas. (A)</p> Signup and view all the answers

    Which specific type of proliferative change in fibrocystic disease can share cytological features with in-situ carcinoma?

    <p>Epitheliosis with atypia. (B)</p> Signup and view all the answers

    Which of the following is NOT a morphological feature associated with fibrocystic disease?

    <p>Epithelial hyperplasia with atypia. (A)</p> Signup and view all the answers

    Which of the following best describes the role of progesterone in breast tissue?

    <p>Counterbalancing effect to oestrogen, regulating growth of uterine lining. (A)</p> Signup and view all the answers

    A patient presents with a serous or bloody nipple discharge. Which of the following is the most likely diagnosis?

    <p>Intraductal papilloma. (A)</p> Signup and view all the answers

    Which of the following conditions is characterized by extensive fibrosis and may mimic carcinoma on imaging and histology?

    <p>Radial scars/complex sclerosing lesions. (A)</p> Signup and view all the answers

    What is the clinical significance of proliferative disease with atypia in fibrocystic changes?

    <p>Indicates a moderate risk of breast cancer development. (C)</p> Signup and view all the answers

    Which of these conditions is NOT typically characterized by a solitary, well-defined, freely moveable breast mass?

    <p>Sclerosing lesion. (C)</p> Signup and view all the answers

    Which of the following is NOT a possible cause of gynecomastia?

    <p>Progesterone excess. (A)</p> Signup and view all the answers

    Which of the following is NOT a drug traditionally implicated in causing gynecomastia?

    <p>Fluoxetine. (B)</p> Signup and view all the answers

    Which of the following is NOT a clinical assessment technique typically utilized for evaluating a breast lump?

    <p>Colonoscopy (A)</p> Signup and view all the answers

    What is the rationale for performing a fine needle aspiration (FNA) cytology on a breast lump, despite it not being the preferred method?

    <p>FNA can be performed quickly, in an outpatient setting, and is cost-effective. (D)</p> Signup and view all the answers

    Which of the following scenarios would most likely necessitate an open biopsy of a breast lump?

    <p>Discrepancies or inconclusive findings between the clinical examination, radiology, and pathology results. (B)</p> Signup and view all the answers

    Which of the following mammographic signs is MOST suggestive of malignancy?

    <p>Small, irregular, clustered, linear or branching calcifications. (D)</p> Signup and view all the answers

    Which of the following is a valid reason why mammography is more challenging in younger women?

    <p>Younger women are more likely to have dense breast tissue. (D)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of 'lesion of uncertain malignant potential' in the diagnostic categories of FNA and core biopsy?

    <p>It is a clear indication of malignancy with minimal possibility of being benign. (A)</p> Signup and view all the answers

    In which scenario is a patient most likely to be referred for further clinical examination, mammography, and ultrasound after an initial mammogram?

    <p>The mammogram reveals an abnormality that requires further assessment. (B)</p> Signup and view all the answers

    In the context of breast cancer management, 'triple assessment' refers to which of the following?

    <p>Clinical examination, mammography, and pathology. (C)</p> Signup and view all the answers

    Flashcards

    Normal Anatomy of the Breast

    The structure and organization of breast tissues including lobules and ducts.

    Galactorrhoea

    Milk production outside of lactation, not caused by breast cancer, often due to hormonal issues.

    Supernumerary Nipples

    Extra nipples due to a congenital anomaly, sometimes linked to underlying breast tissue.

    Clinical Presentation of Breast Disease

    Common signs include breast pain, palpable mass, and nipple discharge.

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    Breast Lumps Assessment

    Evaluating lumps by characteristics like solidity, mobility, and number.

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    Triple Assessment

    A diagnostic approach including clinical, radiology, and pathology evaluations to assess breast lumps.

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    Mammographic Signs of Malignancy

    Indicators that may suggest breast cancer on a mammogram, including density changes and calcifications.

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    Fine Needle Aspiration (FNA)

    A diagnostic procedure that uses a thin needle to extract cells from a lump for analysis.

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    Needle Core Biopsy

    A biopsy method that removes small cores of tissue for examination, more interpretable than FNA.

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    Open Biopsy

    Surgical procedure to remove a lump for examination, typically when tests are inconclusive.

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    Inadequate Diagnostic Category

    Results from FNA or core biopsy that do not yield enough cells for a conclusive diagnosis.

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    Benign Diagnostic Category

    Results that indicate the lump is non-cancerous following biopsy assessments.

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    Mammogram Frequency in Ireland

    Women aged 50-69 in Ireland receive mammograms every two years for breast cancer screening.

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    Periductal Mastitis

    Inflammation of the ducts associated with smoking and vitamin A deficiency, causing pain and reversed nipples.

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    Mammary Duct Ectasia

    Condition with thick green/brown discharge and poorly defined mass, mimicking carcinoma.

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    Fat Necrosis

    A mass following trauma, appearing in obese and post-menopausal women, showing necrosis on biopsy.

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    Lymphocytic Mastitis

    Palpable subareolar mass, often seen in type I diabetes, possibly autoimmune.

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    Granulomatous Mastitis

    Involves inflammation, idiopathic or linked to systemic diseases like sarcoidosis.

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    Galactocoele

    Cystic dilatation of ducts during lactation, potentially leading to infection.

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    Fibrocystic Changes

    Common breast disorder with symptoms in 10% of women, linked to hormonal imbalance.

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    Oestrogen Dominance

    Imbalance with more oestrogen than progesterone, leading to various breast issues.

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    Oestrogen Role

    Promotes growth and proliferation of breast tissue.

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    Progesterone Insufficiency

    Insufficient progesterone disrupts uterine lining growth.

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    Fibrocystic Disease Symptoms

    May be asymptomatic; causes nodularity and discomfort.

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    Apocrine Metaplasia

    Normal glandular cells are replaced by apocrine-like cells.

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    Fibroadenoma

    Most common benign breast tumor, often moveable and solitary.

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    Phyllodes Tumor

    Larger tumors resembling fibroadenomas; may be benign or malignant.

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    Benign Epithelial Changes

    Non-proliferative changes have no increased breast cancer risk.

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    Intraductal Papilloma

    Benign growth in duct, presents with nipple discharge.

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    Gynecomastia

    Enlargement of male breast, often due to hormonal imbalance.

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    Sclerosing Lesions

    Extensive fibrosis/sclerosis may mimic carcinoma.

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    Terminal Ductal Lobular Unit

    The functional unit of the breast, involved in milk production and secretory processes.

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    Mastalgia

    Breast pain that can result from various benign conditions or hormonal changes.

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    Peau d'Orange

    Skin appearance resembling orange peel; often signifies underlying breast condition.

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    Palpable Mass Characteristics

    Assessment of breast masses based on their solidity, mobility, and whether they're single or multiple.

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    Nipple Discharge Causes

    Common causes include infections, intraductal papillomas, and hormonal imbalances.

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    Persistent asymmetrical nodularity

    A lump that is not symmetric and does not resolve over time.

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    Densities in Mammography

    Areas on a mammogram that appear different in thickness compared to surrounding tissue, indicating possible malignancy.

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    Fine Needle Aspiration (FNA) cytology

    A quick procedure that uses a thin needle to extract cells for examination, typically in an outpatient setting.

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    Architectural distortion

    An abnormality in the structure of breast tissue seen on imaging, which may suggest malignancy.

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    Suspicious Diagnostic Category

    Results indicating uncertainty regarding a lump's malignancy after biopsy.

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    Chronic Inflammation

    Long-lasting inflammation that can mimic breast cancer, includes conditions like periductal mastitis.

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    Fibrocystic Disease

    A breast condition characterized by cysts, nodularity, and discomfort, often linked to hormonal changes.

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    Proliferative Changes

    Changes that involve increased cell growth in the breast tissue, can be with or without atypia.

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    Sclerosing Adenosis

    Extensive fibrosis and adenosis that may mimic carcinoma on imaging and histology.

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    Clinical Significance of Proliferative Disease

    Proliferative disease with atypia has a moderate breast cancer risk, while without atypia has mild risk.

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    Nipple Discharge

    Fluid that can be serous or bloody, associated with several conditions like intraductal papilloma and fibrocystic changes.

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    Study Notes

    Benign Breast Diseases

    • Course: Pathology
    • Class: Year 2
    • Lecturer: Professor Paul Murray
    • Date: February 2024

    Learning Objectives

    • Describe normal breast anatomy
    • Describe breast histology and physiology
    • Describe clinical assessment of a breast lump
    • Explain mastitis
    • List and discuss benign breast lumps

    Anatomy of the Female Breast

    • The breast is composed of lobules, ducts, and fatty tissue.
    • Terminal Ductal Lobular Units (TDLUs) are the functional units.
    • Lobules contain acini (small sacs) which are epithelial structures.
    • Ducts transport milk to the nipple.
    • Structures like the areola and nipple are also present.

    Terminal Ductal Lobular Unit (TDLU)

    • A diagram shows the TDLU, emphasizing components like the extralobular terminal duct, lobule, intralobular terminal duct, ductule, and lobular stroma.

    Breast Histology

    • Microscopic images of breast tissue show ductal and lobular structures.
    • Components including acini and the surrounding stroma are visible.
    • The acinus has a basement membrane, myoepithelial cells, luminal epithelial cells, and a lumen with eosinophilic secretions.

    Galactorrhoea

    • Milk production outside of lactation.
    • Not a symptom of breast cancer.
    • Caused by nipple stimulation or prolactinoma.
    • Certain drugs can induce galactorrhoea.

    Supernumerary Nipples/Breasts

    • Common congenital anomaly.
    • May be associated with underlying breast tissue which can have normal characteristics.
    • Breast adenomas and cancers can arise in the tissue underlying supernumerary nipples.
    • Related to the embryonic milk line.

    Clinical Presentation of Breast Disease

    • Common presentations: Breast pain (mastalgia), palpable mass, nipple discharge, or mammographic abnormality.
    • Other presentations: Skin changes (e.g., peau d'orange), nipple retraction.
    • Peau d'orange is often associated with inflammatory breast cancer.

    Breast Lump

    • Assessment for lumps include: describing the lump, age, symptoms, consistency (solid/cystic, smooth/irregular), mobility (mobile/fixed), and if single/multiple or related to the menstrual cycle.
    • Special situations to recognize include: new lumps, persistent asymmetrical nodularity, unresolved inflammation, lumps remaining after cyst aspiration, or a family history of breast cancer.

    Clinical Assessment

    • History and physical examination of the area, including the axilla.
    • Examination includes inspection and palpation.
    • Imaging like ultrasound can outline mass lesions, be a useful technique in younger patients, and can include guided biopsy.
    • Mammography important in females over a certain age.
    • MRI (magnetic resonance imaging) high sensitivity, however, low specificity.

    Triple Assessment

    • A combination of clinical, radiological, and pathological findings.
    • If benign, the lump may be monitored without intervention.
    • Intra-operative confirmation of carcinoma by frozen section is exceptional.

    Ireland's Mammogram Guidelines

    • Yearly mammograms for women aged 50-69 in Ireland.
    • Referrals for further clinical assessment, mammography, and ultrasound follow detected abnormalities.
    • Only some women need biopsy/pathology diagnosis.

    Mammographic Signs of Malignancy

    • Signs include densities, calcifications (small, irregular, clustered, linear, or branching), architectural distortion, and asymmetry.

    Pathological Diagnosis

    • Fine Needle Aspiration (FNA): A common method for cytology, but not the preferred choice for all situations. It's quick, inexpensive, performed in the outpatient clinic, and doesn't require anasthesia. However, it's operator dependent and some expertise is required.
    • Needle Core Biopsy: Provides thicker tissue cores, is slower than FNA, easier to interpret, and is more commonly used.
    • Open Biopsy: Used if uncertainty remains after the triple assessment. May involve intra-operative frozen section.

    Diagnostic Categories (FNA and Core Biopsy)

    • Inadequate: Insufficient material or tissue for diagnosis.
    • Benign: No sign of cancer.
    • Lesion of uncertain malignant potential: Uncertain or inconclusive findings.
    • Suspicious: Possible signs of cancer but not definitive.
    • Malignant: Cancerous tissue found.

    Inflammatory Conditions

    • Acute mastitis: Often occurs after cracked nipples in lactating periods, allowing bacteria to invade breast tissue. It involves fever, erythema, pain, and purulent nipple discharge. Treated with antibiotics, rarely surgery.
    • Chronic inflammation: Can sometimes mimic malignancy due to scarring, examples include: Periductal mastitis, Mammary duct ectasia, Fat necrosis, Granulomatous mastitis, and Lymphocytic mastitis.

    Periductal Mastitis

    • Associated with smoking and vitamin A deficiency.
    • Keratin production plugs ducts leading to inflammation.
    • The condition is characterized by a painful subareolar mass and nipple inversion/retraction.
    • Surgical excision of the affected duct is usually sufficient.

    Mammary Duct Ectasia

    • Occurs predominantly in fifth and sixth decades.
    • Presents with nipple discharge (thick, green or brown).
    • Mimics carcinoma clinically and radiologically.
    • Inflamed and dilated subareolar ducts with secretions are hallmark. Surrounding stromal tissue and cells may be affected.

    Fat Necrosis

    • Usually follows trauma (including surgical biopsies).
    • Common in obese and post menopausal women.
    • On mammography, may appear as a mass or calcification.
    • Biopsy shows necrotic fat, calcification, and macrophages.

    Other Conditions

    • Lymphocytic mastitis: Often linked to diabetes type 1 or autoimmune disorders, causing a palpable mass, usually in the subareolar region and may be bilateral.
    • Granulomatous mastitis: Idiopathic or can be associated with certain systemic diseases such as sarcoidosis.

    Galactocoele

    • Cysts formed from duct dilatation during lactation.
    • Obstruction of the duct is a common cause.
    • May become infected, leading to acute mastitis and abscesses.

    Fibrocystic Changes

    • Common in women aged 20-40.
    • Caused by an imbalance between estrogen and progesterone.
    • Often asymptomatic but can cause discomfort.
    • Commonly presents with palpable nodules, which may be firm, rubbery, or cystic.
    • Fibrocystic changes result from morphological changes affecting the glandular and stromal components of the breast. These include cysts, apocrine metaplasia, fibrosis of the stroma, and adenosis.

    Fibrocystic Disease Clinical Features

    • May be asymptomatic.
    • Discomfort (cyclical)
    • Nodularity
    • A discrete, palpable lump (firm, rubbery).
    • Cysts may be tense or fluctuant.
    • Nipple discharge.

    Fibrocystic Disease Morphological Changes

    • Cysts (ductal dilatation)
    • Apocrine metaplasia
    • Stromal fibrosis
    • Adenosis (increase in acini per lobule).

    Proliferative Fibrocystic Changes

    • Epitheliosis: Epithelial hyperplasia (more than 2 cell layers), possibly with or without atypia.
    • Sclerosing lesions: Extensive fibrosis. Can mimic carcinoma radiologically and histologically. May be part of fibrocystic change or may form discrete lesions. May include radial scars or complex sclerosing lesions.
    • Intraductal papilloma: Benign papillary growth. Common in premenopausal women. Characterized by fibrovascular projections with epithelial and myoepithelial lining. Often presents with bloody or serous nipple discharge. Can recur if inadequately removed.

    Fibroadenoma

    • Most common benign tumor in the female breast.
    • Usually during puberty and before age 30.
    • Typically presents as a solitary, well-defined, and freely movable mass.
    • A combined proliferation component of epithelium and connective tissue is common.
    • Fibrous stroma compresses glands.
    • Affected by estrogen and progesterone, and thus size may fluctuate with a menstrual cycle.

    Phyllodes Tumor

    • Often larger than fibroadenomas, and appears after age 45.
    • Resembles fibroadenoma but can grow larger, sometimes becoming giant fibroadenomas.
    • Characteristics include "leaf-like" clefts and slits.
    • Primarily involves stroma.
    • Can be benign or malignant. Malignant variants have increased stromal cellularity, pleomorphism, mitotic rate, and infiltrative growth patterns. Can metastasize in 15% of cases.

    Clinical Significance of Benign Epithelial Changes

    • Non-proliferative changes: No increased risk of breast cancer.
    • Proliferative disease without atypia: Mild risk.
    • Proliferative disease with atypia: Moderate risk.

    Gynecomastia

    • Enlargement of the male breast.
    • Usually unilateral.
    • Causes include estrogen excess (liver disease, cirrhosis, certain drugs, puberty, testicular tumors), certain drugs (spironolactone, chlorpromazine, cimetidine, androgens, marijuana and heroin), and prolactin excess (pituitary/hypothalamus disorders).

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    Test your knowledge on the symptoms and conditions related to breast disease. This quiz covers various aspects of breast health, including clinical evaluations and common causes of breast-related issues. Ideal for medical students or health professionals looking to refresh their understanding.

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