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Benign Breast Disease - Coggle Diagram

- - - - Affects lobular component of breast; usually in ages 15-25; Typically: firm, well-circumscribed, <3cm in size
      - Age-based management:
        -Women<20: no investigations, reassure patient, surgery when >4cm
        -Women 20-25 years old: ultrasound to confirm, reassure patient, surgery if >4cm
        -Women 25-30 years old: US and core biopsy, if abdnormal (fixed, rapidly growing, skin changes) offer excision, follow up 6/12 for 1 year if not excised, most patients get surgery
        -Women >30 years old: core biopsy, only US if <40; mammogram +/- US if >40; recommend excision, follow up 6/12 for 2 years if not excised, all patients can get surgery
      - Indications for surgical excision (4): PADS:
        -Giant fibroadenomas>5cm in size
        -Women over 30
        -Diagnostic uncertainty on clinical, radiological or pathological grounds
        -Patient request.
      - US features of fibroadenoma: ovoid smooth solid mass (hypoechoic), narrower in anteroposterior diameter than transverse diameter, even, low-level internal echoes.
    - - Associated with significant trauma = bruising of breast = lump/lumps develop weeks to months later; may be skin changes.
      - Full triple assessment: 1. Clinical Exam: hard and irregular mass with some tethering to a number of small, tiny nodules just under skin. Similar to malignant lump. 2. Investigations: Imaging (US/mammogram) 3. Single biopsy with fat necrosis not reassuring as fat necrosis can be found on clinically normal breast tissue. Correleate biopsy result with imaging and exam. Doubt=excise lump. Usually slowly decreases in size over several months.
    - - Simple cysts usually in 40s/50s.
      - Pathophysiology: With age, glandular and supporting connective tissue involutes and is partly replaced by fatty tissue. Breast cysts develop when there is blockage of terminal breast ducts due to: 1. Fibrosis (fibrocystic change) 2. Inflammation. Blockage=distends lobule and fills up with fluid. Cysts drain if obstruction resolves, becomes large/palpable if not.
      - Investigation and management: 1. Aspiration/biopsy 2. mammogram + US.
        US: dark anechoic structure with bright posterior acoustic enhancement.
        Aspiration: confirm diagnosis= straw colored fluid with mass disappearing after drained, any residual masses=biopsy. Blood-stained aspirate=papillary cystic carcinoma=US guided biopsy of solid component + cytology (but has high false negative rate). Cysts may recur so treat same every time to exclude malignancy.
      - Clinical presentation: mobile, well-circumscribed; size ranges from 1-5cm; tender when large/tense. Not malignant if simple (no solid component/debris in fluid). Blood in aspirate=papillary cystic carcinoma.
    - - Obstruction of lactiferous duct=becomes distended with milk=milk containing retention cyst that occurs in women who are lactating.
      - Painless lump in lactating women. Diagnosis=aspiration of milky contents. Secondary infection=oral antibiotics + aspiration to dryness. Women>30y/o=US to ensure cyst collapsed and no other lesions.
    - - INvestogations/management: US + mammography. Diagnosis on FNA =shows fatty tissue that must be interpreted with clinical and radiological findings.
      - Soft, smooth breast lumps in any part of breast.
      - Certain diagnosis=no surgical intervention
- - - - • Allergic response to contact allergen
        
        • May present during lactation
        
        • Often bilateral
        
        • Irritation and itching
        
        • Acute inflammation, weeping vesicles or blisters
        
        • Chronic problems with dry, thickened areas
        
        • Nipple is usually preserved
        
        • No palpable underlying breast lump
        
        • Hx: Atopic eczema, personal/fam Hx of hay fever/asthma
    - - • Avoid aggravating cause if identified
        
        • Moisturisers
        
        • Topical corticosteroid cream or ointment
        
        • Oral antihistamine if itching is troublesome
        
        • Patch testing if allergen suspected
        
        • Mammogram and punch biopsy if older patient and/or if unresponsive to treatment.