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15 Cards in this Set
- Front
- Back
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What is meant by "fibrocystic changes"?
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Histologically, fibrocystic changes consist of fibrosis, cysts, and a variable amount of ductal hyperplasia.
On exam, fibrocystic changes are felt as a DIFFUSE, rubbery, dense texture with NO real predominant mass. Symptomatic fibrocystic changes are present in 30-50% of women during their reproductive life. |
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Do fibrocystic changes confer an increased cancer risk?
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In and of themselves, no. However, they do make the breast more difficult to examine, so in a roundabout kind of way they might.
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Describe how "fibrocystic changes" typically present on palpation.
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Fibrocystic changes are typically experiences as a DIFFUSE, rubbery, dense texture with no real predominant mass.
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What is a fibroadenoma?
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A fibroadenoma is exactly what it sounds like: a benign tumour composed of fibrous and glandular tissue.
They are usually present as a predominant mass in a woman with some amount of fibrocystic changes. They typically have smooth, well-defined borders and are highly mobile. |
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How can you differentiate between a cyst and a fibroadenoma?
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Ultrasound (cysts are fluid-filled, fibroadenomas solid)
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What is a phyllodes tumour?
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Phyllodes tumours, also called cystosarcoma phylloides, are fast-growing tumours originating from the stromal cells of the breast.
They are rare, constituting 1% of all breast neoplasms. |
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A patient presents with a breast mass. What are some benign causes of breast masses?
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Breast cyst
Fibroadenoma Fibrocystic changes Phyllodes tumour Inframammary lymph nodes Fat necrosis secondary to trauma Breast abscess |
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How are malignant breast masses further subdivided?
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Malignant breast masses are divided into those derived from epithelial tissue (ductal) and those derived from the breast stroma.
They can also be divided based on whether or not they have invaded beyond the basement membrane ("invasive") or not ("in situ"). |
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True or false: most malignant masses are painful.
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False.
Only 11% of women diagnosed with breast cancer initially presented with a painful mass. Most breast cancers are not initially painful. |
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What do cyclical fluctuations in size of mass or symptoms such as pain suggest?
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Cyclical fluctuations in pain or mass-size are associated with benign causes of breast masses.
Cyclical fluctuations, then, suggest breast cyst, fibroadenoma, or fibrocystic changes rather than breast cancer. |
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Describe how you would take the history of presenting illness for a breast mass.
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Location:
-Where is the mass? Quality: -Is the mass painful? -Is it mobile? -How large is it? Timing: -Onset: when and how was it discovered? -Pattern: cyclical fluctuations in pain or size with menstruation? Progression: -Has the mass changed in size over time? One more: -History of trauma to the breast? Risk factors: 1) Family history of breast CA 2) Personal history of endometrial or ovarian cancer 3) Postmenopausal 4) Estrogen intake 5) Age at menarche |
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Name 5 risk factors for breast cancer that should be asked about during a breast mass history.
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1) Family history of breast CA (especially in a premenstrual breast)
2) Intake of estrogens (contraceptives, hormone replacement) 3) Age (pre vs. postmenopausal) 4) Age at menarche (early menarche = increased risk) 5) Prior history of endometrial or ovarian cancer |
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You are palpating the breast and find a mass with smooth borders that is quite mobile.
Is this mass benign or malignant-appearing? |
Benign
Malignant masses typically have irregular borders and are immobile. |
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Finding a mass at what location on breast exam confers a higher risk for the mass being malignant?
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Axillary mass most worrying
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You find a breast mass. What features of the mass make you think it's not likely malignant? What features are more suggestive of malignancy?
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***IMPORTANT: there is huge overlap. The following are only suggestions towards one truth or the other.
Low risk masses (likely benign) Location: variable Size: variable Shape: round but variable Consistency: soft but variable Delimination: smooth, well-defined borders Tenderness: variable Mobility: can be mobile Moderate to high risk masses (potentially malignant) Location: axillary most worrying, but can be anywhere Size: variable Shape: irregularly-shaped Consistency: hard Delimination: poorly circumscribed Tenderness: variable Mobility: fixed |
