BREAST

Common causes of breast symptoms     FIBROCYSTIC DISEASE   benign breast condition consisting of fibrous and  cystic cha...

Common causes of breast symptoms

 

 

FIBROCYSTIC DISEASE

 

1. benign breast condition consisting of fibrous and  cystic changes in breast
2. age 30-50 years
3. pain with multiple bilateral lumps
4. fluctuate in size and tenderness with menstrual cycle
5. if no dominant mass, observe to ensure no mass dominate
6. for a dominant mass, Fine Needle Aspiration
7. if > 40 years, mammography every 3 years
   

FIBROADENOMA

 

1. most common benign breast tumour in women
2. no malignant potential usually
3. age < 30 years
4. smooth, rubbery, discrete nodule, non-tender, mobile
5. usually excised to confirm diagnosis

 

FAT NECROSIS 

 

1. due to trauma (although positive history in only 50%) 
2. firm, ill-defined mass with skin or nipple retraction
3. +/- tenderness 
4. will regress on own but complete excisional biopsy the safest approach to rule out carcinoma

PAPILLOMA

 

1. solitary intraductal benign polyp
2. most common cause of bloody nipple discharge

DIFFERENTIAL DIAGNOSIS OF NIPPLE DISCHARGE

 

1. bloody - papilloma, papillary/intraductal carcinoma, Pagetís, fibrocystic change
2. serous - duct hyperplasia, pregnancy, BCP, menses, cancer
3. green/brown - mamIllary duct ectasia, fibrocystic change
4. purulent – abscess
5. milky - postlactation, BCP, prolactinoma
   

MASTITIS 

1. nursing mothers; sporadic or epidemic 
2. etiologic agent: S. aureus
3. unilateral localized pain, tenderness and erythema 
4. Sporadic: acinar and duct systems uninvolved, therefore, infant should continue being nursed 
5. Recurrent: due to regurgitation of milk back into ducts, therefore, discontinue nursing and suppress lactation 
6. Antibiotic therapy: if start delayed > 24 hours, increased risk of abscess requiring incision and drainage