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Questions and Answers
Which of the following is NOT a common symptom of breast disease?
Which of the following is NOT a common symptom of breast disease?
What is the most common cause of breast peau d'orange?
What is the most common cause of breast peau d'orange?
What is the term for milk production outside of lactation?
What is the term for milk production outside of lactation?
What is the significance of the embryonic milk line?
What is the significance of the embryonic milk line?
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Which of the following is NOT a characteristic that can be assessed during a clinical evaluation of a breast lump?
Which of the following is NOT a characteristic that can be assessed during a clinical evaluation of a breast lump?
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Which of the following conditions is associated with smoking and vitamin A deficiency?
Which of the following conditions is associated with smoking and vitamin A deficiency?
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Which condition is characterized by a poorly defined peri-areolar mass with thick green/brown nipple discharge?
Which condition is characterized by a poorly defined peri-areolar mass with thick green/brown nipple discharge?
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Which condition typically occurs in obese and post-menopausal women and may be caused by trauma?
Which condition typically occurs in obese and post-menopausal women and may be caused by trauma?
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Which condition is often associated with type I insulin-dependent diabetes and may have an autoimmune basis?
Which condition is often associated with type I insulin-dependent diabetes and may have an autoimmune basis?
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Which condition is characterized by a cystic dilatation of a duct during lactation, and may become infected with abscess formation?
Which condition is characterized by a cystic dilatation of a duct during lactation, and may become infected with abscess formation?
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What is the most common cause of surgical procedures performed on the female breast?
What is the most common cause of surgical procedures performed on the female breast?
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What is the primary cause of fibrocystic changes?
What is the primary cause of fibrocystic changes?
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Which of the following conditions is NOT associated with inflammation?
Which of the following conditions is NOT associated with inflammation?
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Which of the following is a reason why a lump may remain following a cyst aspiration?
Which of the following is a reason why a lump may remain following a cyst aspiration?
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In which scenario is a fine needle aspiration (FNA) the less preferred method?
In which scenario is a fine needle aspiration (FNA) the less preferred method?
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Which imaging method is used for guided biopsy?
Which imaging method is used for guided biopsy?
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Why is mammography more challenging in younger women?
Why is mammography more challenging in younger women?
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Which of the following is NOT a mammographic sign of malignancy?
Which of the following is NOT a mammographic sign of malignancy?
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Which diagnostic category is most likely to be followed with further investigation?
Which diagnostic category is most likely to be followed with further investigation?
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What is the most common type of bacteria involved in acute mastitis?
What is the most common type of bacteria involved in acute mastitis?
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Which technique involves obtaining thin cores of tissue?
Which technique involves obtaining thin cores of tissue?
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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?
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?
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Which of the following features is characteristic of apocrine metaplasia?
Which of the following features is characteristic of apocrine metaplasia?
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Which of the following is a true statement about fibrocystic disease?
Which of the following is a true statement about fibrocystic disease?
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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?
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?
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What is the relationship between progesterone and oestrogen in the context of breast tissue?
What is the relationship between progesterone and oestrogen in the context of breast tissue?
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Which of the following conditions is associated with a moderate risk of breast cancer?
Which of the following conditions is associated with a moderate risk of breast cancer?
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What is the most common presenting symptom of an intraductal papilloma?
What is the most common presenting symptom of an intraductal papilloma?
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Which of the following is NOT a characteristic feature of sclerosing lesions?
Which of the following is NOT a characteristic feature of sclerosing lesions?
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Which of the following is a common cause of gynecomastia?
Which of the following is a common cause of gynecomastia?
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Which of the following is NOT a common drug implicated in gynecomastia?
Which of the following is NOT a common drug implicated in gynecomastia?
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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?
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?
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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:
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:
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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?
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?
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Which of the following scenarios would MOST likely require a fine needle aspiration (FNA) rather than a core biopsy?
Which of the following scenarios would MOST likely require a fine needle aspiration (FNA) rather than a core biopsy?
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A 20-year-old male patient presents with unexplained breast enlargement. Which of the following is the LEAST likely cause of this condition?
A 20-year-old male patient presents with unexplained breast enlargement. Which of the following is the LEAST likely cause of this condition?
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Which of the following conditions exhibits characteristics resembling carcinoma both clinically and on mammograms?
Which of the following conditions exhibits characteristics resembling carcinoma both clinically and on mammograms?
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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?
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?
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Which breast condition is primarily associated with smoking and vitamin A deficiency?
Which breast condition is primarily associated with smoking and vitamin A deficiency?
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Which of the following conditions is characterized by the presence of necrotic fat, calcification, and macrophages with giant cells on biopsy?
Which of the following conditions is characterized by the presence of necrotic fat, calcification, and macrophages with giant cells on biopsy?
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Which of the following breast conditions is NOT directly associated with inflammation?
Which of the following breast conditions is NOT directly associated with inflammation?
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A patient presents with a painful subareolar mass and an inverted nipple. Which of the following conditions is most likely present?
A patient presents with a painful subareolar mass and an inverted nipple. Which of the following conditions is most likely present?
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Which of these conditions can result in a cystic dilatation of a duct, potentially leading to abscess formation if infected?
Which of these conditions can result in a cystic dilatation of a duct, potentially leading to abscess formation if infected?
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What is the primary cause of fibrocystic changes in the breast?
What is the primary cause of fibrocystic changes in the breast?
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What is the primary difference between phyllodes tumours and fibroadenomas?
What is the primary difference between phyllodes tumours and fibroadenomas?
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Which specific type of proliferative change in fibrocystic disease can share cytological features with in-situ carcinoma?
Which specific type of proliferative change in fibrocystic disease can share cytological features with in-situ carcinoma?
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Which of the following is NOT a morphological feature associated with fibrocystic disease?
Which of the following is NOT a morphological feature associated with fibrocystic disease?
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Which of the following best describes the role of progesterone in breast tissue?
Which of the following best describes the role of progesterone in breast tissue?
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A patient presents with a serous or bloody nipple discharge. Which of the following is the most likely diagnosis?
A patient presents with a serous or bloody nipple discharge. Which of the following is the most likely diagnosis?
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Which of the following conditions is characterized by extensive fibrosis and may mimic carcinoma on imaging and histology?
Which of the following conditions is characterized by extensive fibrosis and may mimic carcinoma on imaging and histology?
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What is the clinical significance of proliferative disease with atypia in fibrocystic changes?
What is the clinical significance of proliferative disease with atypia in fibrocystic changes?
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Which of these conditions is NOT typically characterized by a solitary, well-defined, freely moveable breast mass?
Which of these conditions is NOT typically characterized by a solitary, well-defined, freely moveable breast mass?
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Which of the following is NOT a possible cause of gynecomastia?
Which of the following is NOT a possible cause of gynecomastia?
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Which of the following is NOT a drug traditionally implicated in causing gynecomastia?
Which of the following is NOT a drug traditionally implicated in causing gynecomastia?
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Which of the following is NOT a clinical assessment technique typically utilized for evaluating a breast lump?
Which of the following is NOT a clinical assessment technique typically utilized for evaluating a breast lump?
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What is the rationale for performing a fine needle aspiration (FNA) cytology on a breast lump, despite it not being the preferred method?
What is the rationale for performing a fine needle aspiration (FNA) cytology on a breast lump, despite it not being the preferred method?
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Which of the following scenarios would most likely necessitate an open biopsy of a breast lump?
Which of the following scenarios would most likely necessitate an open biopsy of a breast lump?
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Which of the following mammographic signs is MOST suggestive of malignancy?
Which of the following mammographic signs is MOST suggestive of malignancy?
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Which of the following is a valid reason why mammography is more challenging in younger women?
Which of the following is a valid reason why mammography is more challenging in younger women?
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Which of the following is NOT a characteristic of 'lesion of uncertain malignant potential' in the diagnostic categories of FNA and core biopsy?
Which of the following is NOT a characteristic of 'lesion of uncertain malignant potential' in the diagnostic categories of FNA and core biopsy?
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In which scenario is a patient most likely to be referred for further clinical examination, mammography, and ultrasound after an initial mammogram?
In which scenario is a patient most likely to be referred for further clinical examination, mammography, and ultrasound after an initial mammogram?
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In the context of breast cancer management, 'triple assessment' refers to which of the following?
In the context of breast cancer management, 'triple assessment' refers to which of the following?
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Flashcards
Normal Anatomy of the Breast
Normal Anatomy of the Breast
The structure and organization of breast tissues including lobules and ducts.
Galactorrhoea
Galactorrhoea
Milk production outside of lactation, not caused by breast cancer, often due to hormonal issues.
Supernumerary Nipples
Supernumerary Nipples
Extra nipples due to a congenital anomaly, sometimes linked to underlying breast tissue.
Clinical Presentation of Breast Disease
Clinical Presentation of Breast Disease
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Breast Lumps Assessment
Breast Lumps Assessment
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Triple Assessment
Triple Assessment
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Mammographic Signs of Malignancy
Mammographic Signs of Malignancy
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Fine Needle Aspiration (FNA)
Fine Needle Aspiration (FNA)
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Needle Core Biopsy
Needle Core Biopsy
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Open Biopsy
Open Biopsy
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Inadequate Diagnostic Category
Inadequate Diagnostic Category
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Benign Diagnostic Category
Benign Diagnostic Category
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Mammogram Frequency in Ireland
Mammogram Frequency in Ireland
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Periductal Mastitis
Periductal Mastitis
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Mammary Duct Ectasia
Mammary Duct Ectasia
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Fat Necrosis
Fat Necrosis
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Lymphocytic Mastitis
Lymphocytic Mastitis
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Granulomatous Mastitis
Granulomatous Mastitis
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Galactocoele
Galactocoele
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Fibrocystic Changes
Fibrocystic Changes
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Oestrogen Dominance
Oestrogen Dominance
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Oestrogen Role
Oestrogen Role
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Progesterone Insufficiency
Progesterone Insufficiency
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Fibrocystic Disease Symptoms
Fibrocystic Disease Symptoms
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Apocrine Metaplasia
Apocrine Metaplasia
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Fibroadenoma
Fibroadenoma
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Phyllodes Tumor
Phyllodes Tumor
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Benign Epithelial Changes
Benign Epithelial Changes
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Intraductal Papilloma
Intraductal Papilloma
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Gynecomastia
Gynecomastia
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Sclerosing Lesions
Sclerosing Lesions
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Terminal Ductal Lobular Unit
Terminal Ductal Lobular Unit
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Mastalgia
Mastalgia
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Peau d'Orange
Peau d'Orange
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Palpable Mass Characteristics
Palpable Mass Characteristics
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Nipple Discharge Causes
Nipple Discharge Causes
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Persistent asymmetrical nodularity
Persistent asymmetrical nodularity
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Densities in Mammography
Densities in Mammography
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Fine Needle Aspiration (FNA) cytology
Fine Needle Aspiration (FNA) cytology
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Architectural distortion
Architectural distortion
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Suspicious Diagnostic Category
Suspicious Diagnostic Category
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Chronic Inflammation
Chronic Inflammation
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Fibrocystic Disease
Fibrocystic Disease
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Proliferative Changes
Proliferative Changes
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Sclerosing Adenosis
Sclerosing Adenosis
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Clinical Significance of Proliferative Disease
Clinical Significance of Proliferative Disease
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Nipple Discharge
Nipple Discharge
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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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Description
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.