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859-3 Benign Breast Disease
BBD
60
Health Care
Graduate
03/09/2012

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Cards

Term
Is breast cancer usually painful?
Definition
No, as a rul breast cancer ins't painful, lole symptom in BRCA less than 10% of the time
Term
what is mastalgia
Definition
breast pain, can be cyclic or non-cyclic, anxiety causing
Term
what are fibrocystic changes
Definition
an imbalance between estrogen and progesterone produces excessive ductal stimulation, proliferation and stromal edema
Term
what are some things that cause breast tenderness
Definition
menstrual cycle, pregnancy, caffeine and sodium, nicotine, HRT, trauma, muscular pain
Term
are fibrocystic changes painful/tender
Definition
yes, due to hormonal stimulation and or estrogen excess
Term
bilateral, not localized mastalgia is likely cyclic or non-cyclic
Definition
cyclic
Term
when in the cycle does cyclic mastalgia occur/resolve
Definition
luteal phase, improves with menses
Term
is mastalgia over 40, constant and no relationship to menses likely cyclic or non-cyclic
Definition
non-cyclic
Term
which mastalgia is more worrisome, cyclic or non-cyclic
Definition
non-cyclic
Term
what other systems do you want to r/o for cause of pain if a patient over 40 presents with non-cyclic pain
Definition
cardiac/respiratory (SOB, palpitations)
Term
What are some dietary changes/supplements a patient with mastalgia for a CC could try
Definition
elliminate caffine (or cut in half), soy products, vitamin E, magnesium, evening primrose oil, decrease fat
Term
If a patient is on OCPs and has mastalgia for a CC, what could you do to manage hormones?
Definition
Try a OCP with less estrogen
Term
What pharmacologic management could you try for a patient with mastalgia after trauma?
Definition
NSAID
Term
What could a differential diagnosis be for a patient with mastalgia in pregnancy
Definition
costalcondritis
Term
What are some non-pharmacologic measures for mastalgia
Definition
Supportive bra (no underwire), reassurance that only 1 in 10 pain with breast cancer, encourage pt to stop touching breasts for 30 days
Term
what is a pharmacologic treatment for mastalgia
Definition
Danazol- lots of SE's
Term
what is physiologic nipple discharge?
Definition
nonmalignant pathology
Term
what is pathologic nipple discharge
Definition
malignancy
Term
what is galactorrhea
Definition
milky discharge
Term
What is it important to rule out with nipple discharge (esp. if serosangunous)
Definition
malignancy
Term
if discharge is milky, with stimulation, bilateral, multiple ducts, is it likely malignant or benign?
Definition
benign
Term
what tests do you want to order with a woman with galactorrhea?
Definition
HCG, prolactin, TSH
Term
What can cause galactorrhea besides pregnancy
Definition
medications, thyroid, stress, pituitary tumor
Term
what do you want to do on PE for CC of nipple discharge
Definition
try to recreate it in office
Term
What tests do you run for serosangunous discharge?
Definition
hemoccult or cytology, but data does not support this, instead send to specialist for needle biopsy of duct
Term
What test do you order if prolactin is elvated
Definition
MRI
Term
What is an intraductal papilloma
Definition
serosanguineous or watery discharge, small benign tumor in duct
Term
what is a galactocele
Definition
milk filled cyst, masses on lactating patient
Term
what is Duct Ectasia
Definition
dilatation and inflammation, common short term problem
Term
What are differentials of nipple discharge
Definition
intraductal papilloma, galactocele, duct ectasia
Term
If PE for nipple discharge reveals a benign cause, how do you treat?
Definition
avoid breast stimulation X 30 days
Term
What is a medication that can be used for nipple discharge (with a referral)
Definition
bromocriptine- lots of SE's
Term
What percent of all breast masses are benign?
Definition
90%
Term
Must you always rule out breast CA in a mass?
Definition
yes, a breast lump is assumed to be cancer until proven otherwise in postmenopausal women
Term
What is the most common breast mass?
Definition
fibroadenoma
Term
What is a fibroadenoma
Definition
Hormonally caused overgrowth of stromal and epithelial cells in ducts
Term
What is the treatment for a fibroadenoma
Definition
measure q 6 months, biopsy and mark them if they change
Term
Are fibroadenomas usually single or multiple? unilateral or bilateral?
Definition
signle, unilateral
Term
What lump can be rapid during pregnancy?
Definition
fibroadenoma (d/t estrogen)
Term
WWhat type of mass is typically firm, well-delineated, freely-mobile, non-tender to slightly tender?
Definition
Fibroadenoma
Term
What test do you order for a breast lump if the patient is >35?
Definition
diagnostic mammogram (not screening)
Term
What test do you order for < 35 yo with a breast lump
Definition
US
Term
What do you do for follow up after radiology?
Definition
Go over rsults in person and in 3-6 months feel lump again for changes
Term
What is pagets disease?
Definition
rare form of nipple cancer, rapid growth, poor prognosis
Term
what is peau D'orange?
Definition
orange peel skin- dimpled texture, swollen, inflammatory breast
Term
What type of breast mass feels discrete, tender, mobile, may fluctuate with the menstrual cycle
Definition
cyst, cyst fluid and inflammation found on sampling
Term
What breast mass is discrete, soft, non-tender, may or may not be mobile?
Definition
lipoma, fatty tissue found on tissue sampling
Term
What type of breast mass is ill defined, firm, non-tender, non-mobile
Definition
fat necrosis, necrotic fat with inflammation found on sampling
Term
What type of breast mass is discrete, firm, round, mobile, findings similar to a fibroadenoma but mass is usually larger, may observe stretching of skin due to rapid tumor growth
Definition
phyllodes tumor- stromal hypercellularity with glandular and ductal elements found on sampling
Term
what breast lump is discrete, non-tender, non-mobile, may be non-plapable with incidental diagnosis on imaging studies
Definition
hamartoma, glandular tissue, fat, and fibrous connective tissue found on sampling
Term
what type of breast mass is discrete, firm and sometimes tender
Definition
galactocele, fat globules found on sampling
Term
What type of breast tissue sampling procedure is used for a palpable breast mass or thickening to differentiate solid and cystic mass, tissue for cytologic evaluation is aspirated
Definition
fine-needle aspiration biopsy
Term
What type of breast tissue sampling procedure is used for a calcification or density seen on mammogram, uses a large bore needle to obtain cores of tissue for histologic examation and uses sterotatic mammography for targeting
Definition
stereotactic core needle biopsy
Term
What type of breast tissue sampling procedure is used for solid lesions seen on US, uses large bore needle, obtains core of tissues for hisologic exam
Definition
ultrasound guided core needle biopsy
Term
What type of breast tissue sampling procedure is used for lesions visible only with MRI, uses IV contrast
Definition
MRI guided needle biopsy
Term
What type of breast tissue sampling procedure is used for density or calcification seen on mammogram that cannot be effectively assessed with a core biopsy and uses a wire to localize occult mammographic abnormality
Definition
needle localized breast biopsy
Term
What type of breast tissue sampling procedure is used for palpable breast mass, thickening, or skin change if needle biopsy is not feesable, is a surgical procedure, mass is removed with a surrounding margin of normal tissue
Definition
excisional breast biopsy
Term
What breast imaging is best for detecting calcifications, densities and architectural distortion but cannot show if a density is solid or cystic
Definition
mammogram
Term
what breast imaging is best for detecting solid or cystic masses but cannot show calcifications
Definition
ultrasound
Term
what breast imaging is best at detecting tissues with an increased blood flow such as tumors but is limited due to expense and high rate of false-positives
Definition
MRI
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