Clinical Medicine 216 - Breast Lumps and Nipple Discharge

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1

The breasts, or mammary glands, are present in?

Both males and females

2

The breast lies on top of the __________ ?

Pectoralis major muscle and serratus anterior muscle

3

The breast is located between the ________ and extends from the side of the ________.

2nd and 6th ribs; sternum to the midaxillary line

4

The superior lateral corner of breast tissue is called?

Axillary tail of Spence

5

The areola contains?

Montgomery's sebaceous glands

6

Montgomery's sebaceous glands secrete a protective lipid material during ________ .

Lactation

7

The breast is composed of __________ ?

Glandular ducts and lobules, connective tissue, and fat

8

__________ provides the background architecture of the breast.

Fibrous stroma

9

_________ are attached to both the fascia of the skin and the pectoralis major muscle.

Cooper's ligaments (suspensory ligamants)

10

Cancer around Cooper's ligaments may cause them to be contracted and can cause ________ of the overlying skin.

Dimpling

11

The relative proportion of glandular, fibrous, and fatty tissue varies depending on ________ ?

Age, cycle, pregnancy, location, and general nutritional state

12

Most breast cancers occur in the _________ because that is where most of the tissue is located.

Upper outer quadrant and subareola region

13

Genetic contribution to breast cancer involves specific BRCA 1 and BRAC 2 locations. Women with these mutations are at increased risk for __________ ?

Breast and ovarian cancer

14

Almost _________ of all breast cancers occur in the upper outer quadrant.

50%

15

Approximately _________ of breast cancer occurs in the subareola region.

18%

16

_________ of breast cancer occurs in the upper inner quadrant.

15%

17

_________ of breast cancer occurs in the lower outer quadrant.

11%

18

_________ of breast cancer occurs in the lower inner quadrant.

6%

19

Nearly half of the glandular tissue is located in the __________ .

Upper outer quadrant

20

Most breast cancer is thought to originate in the __________ ?

Terminal ductal lobular unit (TDLU)

21

Terminal ductal lobular unit (TDLU) comprises _________ ?

Lobules with intralobular terminal ducts and extralobular ducts

22

Each lobe of the breast contains ________ of terminal ductal units, which forms the functional secretory units of the breast.

Thousands

23

The _________ drain to the infraclavicular and sometimes to the medial substernal lymph nodes.

Lower inner quadrants

24

Most of the breast drains into the _________ ?

Lymphatics of the axilla

25

_________ serve to produce and secrete milk—the primary function of the breast mammary glands.

Lobes, lobules, and acini

26

During __________ , vertical epidermal ridges or milk-lines are present and curve down from the axilla to the groin bilaterally.

Embryonic development

27

________ are tubular connections between the lobes and nipples to allow milk to exit the breast

Ducts and lactiferous sinuses

28

Supernumerary nipples occur along the __________ . Supernumerary nipples and/or breasts with inverted nipples are congenital conditions that occur in about 10% of the population.

Milk-line

29

Supernumerary nipples and/or breasts with inverted nipples are congenital conditions that occur in about _________ of the population.

10%

30

Supernumerary nipples are sometimes mistaken for _________ .

Skin tags or moles

31

Neoplasms can still develop in _________ ?

Supernumerary breasts

32

Regardless of breast size, all women have approximately ________ lobules.

15 to 25

33

_________ major ducts exits the nipple.

6 to 10

34

The nipple and areola are _________ structures.

Separate

35

_________ are common within normal breasts, with oral contraceptives, and in benign breast (fibrocystic) disease.

Cyclic changes

36

__________ occurs with trauma, inflammation, infection, and benign breast disease.

Mastalgia

37

__________ is the secretion of breast milk in men, or in women who are not breastfeeding an infant

Galactorrhea

38

What are the 3 most common breast lumps?

Fibroadenomas, fibrocystic breast changes, and breast carcinoma

39

What is commonly found in young women and is a benign tumour composed of glandular (related to gland) and fibrous (containing fibers) tissues?

Fibroadenoma

40

Most of the benign and malignant pathologies of the breast arise in the __________?

Duct and lobular network

41

Most major venous pathways of the breast lead to the _________ (why lung metastases are common) or _________ (skeletal metastases).

Pulmonary capillary network; vertebral vein

42

Obstruction of the lymphatic system in the dermis of the skin is a serious sign of _________ of the breast. Later-stage presentation will give the skin an _________ ?

Inflammatory carcinoma; orange peel appearance called "peau d'orange"

43

Carcinoma invasion of __________ will cause dimpling of the skin.

Cooper's ligaments

44

The parenchyma is the __________ elements of a gland or organ.

Essential or functional

45

The parenchyma of the breast is composed of _________ ?

Ductal and glandular structures

46

The __________ is the framework of a gland or organ.

Stroma

47

On physical examination, the ________ may contribute to feeling granularity under the areola.

Lactiferous sinuses

48

________ is a benign condition of the breast, and it is a spectrum of a variety of morphologic changes in the terminal ductal lobular unit (TDLU).

Fibrocystic change

49

Some fibrocystic changes can result from _________ and can cause palpable masses and/or mammographic lesions.

Cellular proliferation (hyperplasia)

50

What is a benign proliferation of glandular acini within a lobule?

Adenosis

51

Adenosis may also be referred to as _________ when acini are deformed by sclerotic reaction.

Sclerosing adenosis

52

A subtype of adenosis is called _________ , in which there is dilatation of acini within the TDLU.

Blunt duct adenosis

53

Blunt duct adenosis can show calcifications within the _________ .

Acinar secretions

54

_________ is a change in which the cells of the TDLU resemble those of apocrine sweat glands; it is often associated with cysts of various sizes.

Apocrine metaplasia

55

__________ is a dilation of medium to large ducts lined by flattened cells and filled with secretions and amorphous debris, which can include some calcifications ("milk of calcium").

Duct ectasia (smaller) and cysts (larger)

56

Smaller dilated ducts are often referred to as _________ , particularly when associated with periductal inflammation.

Duct ectasia

57

________ is the replacement of the normal fatty stroma by increased fibrous tissue.

Fibrosis

58

_________ is a spectrum of complexity in the proliferation of benign cells lining the TDLU, both quantitatively and qualitatively.

Epithelial hyperplasia

59

________ contains only a few more cells beyond the normal 2-cell layer, and the cells do not have any significant nuclear changes.

Mild hyperplasia

60

________ contains many more cells than the usual 2-cell layer and is found in 20% of breast biopsies.

Moderate or florid hyperplasia

61

Atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH) are 2 forms of ________ that are referred to as "atypical" since they have many, but not all, of the histologic features of carcinoma in situ.

Epithelial hyperplasia

62

________ is associated with a significant risk for the development of invasive breast cancer.

Atypical ductal hyperplasia (ADH)

63

Since their risk for developing invasive cancer and histologic appearance are not significantly different, lobular carcinoma in situ and atypical lobular hyperplasia (ALH) are often referred to together as ________.

Lobular neoplasia

64

________ are frond- or finger-like hyperplastic epithelial growths with a fibrovascular core. Small calcifications can occur at the tip of the epithelial fronds. The epithelial hyperplasia may be of varying degrees.

Papillomas

65

Papillomas can occur in large or small ducts and can be solitary or multiple. When multiple and small, the term ________ is used and is considered to be part of the spectrum of fibrocystic change.

Papillomatosis

66

Papillomas may arise from _________ ?

Skin, mucous membranes, or glandular ducts

67

A _________ is a circumscribed, benign epithelial tumour projecting from the surrounding surface; more precisely, a benign epithelial neoplasm consisting of villous or arborescent outgrowths of fibrovascular stroma covered by neoplastic cells.

Papilloma

68

Fibroadenoma is a benign breast lesion, but is not part of ________ . Fibroadenoma represents a focal hyperplasia of the stroma and the epithelial component of the terminal ductal lobular unit (TDLU) and creates a distinctive round and well-circumscribed mass on physical exam or mammogram.

Fibrocystic change

69

The stromal hyperplasia often compresses and stretches the hyperplastic glands, creating the fibroadenoma's characteristic histologic pattern. With age, the stroma will become more sclerotic and may undergo dystrophic calcification, and the epithelial hyperplasia may decrease _________ ?

The fibroadenoma(s)

70

When a fibroadenoma contains cysts, sclerosing adenosis, epithelial calcifications, or papillary apocrine changes, it is referred to as a ________ , and there is a slightly increased risk in the development of breast cancer.

Complex fibroadenoma

71

________ is considered a precursor to invasive breast cancer because it is often noted in and around invasive cancers and because invasive cancer has been noted to develop when these lesions are incompletely excised.

Ductal carcinoma in situ (DCIS)

72

Histologically, ductal carcinoma in situ (DCIS) is characterized by a proliferation of neoplastic cells, which distend the terminal ductal lobular unit (TDLU) but do not breach the _________ .

Basement membranes

73

Of the ________ that subsequently develop, invasive ductal carcinoma is the most common type. However, it is not a single entity and the risk of progression to invasive carcinoma may vary considerably based on several pathologic features.

Invasive carcinomas

74

________ is usually an incidental finding in breast tissue removed for another indication and is frequently multifocal. This lesion rarely causes clinical findings such as a mass. On palpation it feels more like a platform of dense tissue and may be seen as calcifications on mammography.

Lobular carcinoma in situ (LCIS)

75

Lobular carcinoma in situ (LCIS) is characterized microscopically by the distention of at least half of the ________ by a very round uniform population of small cells, which may have clear cytoplasm or nuclear vacuoles.

Acini in a lobular unit

76

________ is characterized histologically by a monotonous population of small cells that frequently contain a cytoplasmic vacuole and that classically infiltrate in a single-file pattern. The stroma is densely sclerotic, giving this tumour a rock-hard feeling on palpation and making the cells difficult to remove by FNA.

Infiltrating lobular carcinoma

77

Infiltrating ductal carcinomas are the most common type of invasive breast cancer, accounting for _________ of cases, and is sometimes referred to as ductal carcinoma of no special type.

50% to 75%

78

In general, this form of breast cancer is composed of neoplastic cells that infiltrate the tissue in nests, sheets, cords, tubular structures, or as a combination of these patterns. The stroma is usually sclerotic, and the tumor may invade vascular spaces.

Infiltrating ductal carcinomas

79

The ________ of metastases in axillary lymph nodes is the most important predictor of disease-free and overall survival in breast cancer, due to it being an indicator of systemic rather than local disease.

Presence or absence

80

Patients with metastases in ________ lymph nodes have a worse prognosis than those who have fewer involved lymph nodes.

4 or more

81

This proto-oncogene encodes a transmembrane protein which functions as a cell-surface receptor which is involved with regulation of cell growth and proliferation. When mutated, it promotes neoplastic transformation. Mutations cause over-expression of the gene and is seen in approximately one third of breast cancers.

HER-2-Neu

82

HER-2-Neu ________ can be used as a predictive marker for a variety of adjuvant therapies

Tumor positivity

83

This tumour suppressor gene is located on chromosome 17 and is involved in the maintenance of normal cell growth by suppressing cell replication and possibly inducing apoptosis.

p53

84

_________ of p53 lead to over-expression with increased accumulation of the mutated gene product, which is detectable in the affected cells by immunocytochemical stains. Approximately one third of breast cancers demonstrate this change, but those that do are associated with high nuclear grade have a considerably worse prognosis.

Genetic alterations

85

_________ starts with a small crust on the nipple apex and then spreads to areola.

Paget's disease

86

A lump from an _________ is due to local hematoma or edema and resolves shortly.

Injury

87

Breast cancer occurring _________ menopause in family members increases risk for the patient.

Before

88

Risk factors for breast cancer that you cannot change:

Female gender, age >50, personal history of breast cancer, mutation of BRCA1 and BRCA2, first-degree relative with breast cancer (mother, sister, daughter), high breast tissue density, biopsy-confirmed atypical hyperplasia, high-dose radiation to chest, early menarche (<12 years) or late menopause (>55 years).

89

Lifestyle related risk factors for breast cancer:

Nulliparity (never had a child) or first child after age 30 years, recent oral contraceptive use, never breastfed a child, recent and long-term use of estrogen and progestin, alcoholic intake of more then 1 drink a day, obesity (especially after menopause) and high-fat diet, and physically inactive.

90

Recent nipple __________ signifies acquired disease.

Retraction

91

Maneuvers to screen for retraction or dimpling:

Arms raised, hands pressed at the hips, and patient bends forward

92

Lymph nodes around the breast will enlarge with any _________ ?

Local infection of the breast, arm, or hand; and with breast cancer metastases

93

Premenstrual engorgement is normal and is due to increasing _________?

Progesterone

94

During palpation, you may feel a transverse ridge of compressed tissue in the lower quadrant known as ________ , and it is especially noticeable in larger breasts.

Inframammary ridge

95

Edema of the breast exaggerates the _________ , giving a pigskin or orange peel look (peau d-orange).

Hair follicles

96

_________ is a benign growth of male breast tissue, and feels like a smooth, firm, movable disk, which occurs normally in puberty, and it can be unilateral or bilateral and is temporary. Can also occur with the use of anabolic steroids, some medication, and some disease states.

Gynecomastia

97

In women who are not lactating, nipple discharge is most frequently caused by?

Intraductal papilloma, duct ectasia, or cancer

98

One section of the breast surface in a lactating woman appearing red and tender may indicate _________ ?

A plugged duct

99

Nipple retraction looks flattened and broader, like an underlying crater. A recent retraction suggests cancer, which causes fibrosis of the whole duct system and pulls in the nipple. But it may also occur with ________ ?

Benign lesions such as ectasia of the ducts

100

As cancer advances you may see:

Firm or hard irregular axillary nodes; skin dimpling; nipple retraction, elevation, and discharge

101

_________ is usually a solitary, unilateral, non-tender mass, with a single focus in one area, although it can be interspersed with other nodules. Borders are irregular and poorly delineated, and grows constantly.

Breast cancer

102

A fibroadenoma is a __________ , that is usually a solitary non-tender mass that is solid, firm, rubbery, and elastic. It is round, oval, or lobulated in shape, and clearly demarcated. It is also freely movable, slippery, and usually presents with no axillary lymphadenopathy.

Benign tumour

103

Ectasia is

The distension or dilation of a duct, vessel, or hollow viscus

104

_________ is the term used to describe discharge that contains both blood and a clear yellow liquid known as blood serum.

Serosanguineous

105

__________ is a rare complication of generalizes infection (e.g., mastitis) if untreated.

Breast abscess

106

_________ is uncommon, and is the inflammation of breast tissue, which could result in abscess formation. Area is red, swollen, tender, very hot, and hard. Patient may also have a fever and chills.

Mastitis

107

Breast lumps found _________ in identical quadrants of the breast are more likely to be _________ .

Bilaterally; benign

108

The Canadian Task Force on Preventive Health Care does not recommend _________ for women ages 40 to 74 who do not have a higher risk of breast cancer. Studies show that self-examinations do not save women's lives, and that they can lead to unneeded tests, such as biopsies.

Breast self-examinations

109

Clinical Breast Exam: A normal finding in palpating axillary lymph nodes is _________ ?

1 or more soft, small (<1cm), non-tender nodes

110

Clinical Breast Exam: An abnormal finding in palpating axillary lymph nodes is _________ ?

1 or more enlarged (>1cm), hard, tender nodes

111

Clinical Breast Exam: Normal findings with the patient in the 4 seated positions?

Breast contours remain symmetric throughout movements, nipples point forward

112

Clinical Breast Exam: Abnormal findings with the patient in the 4 seated positions?

Asymmetry between breasts (possible skin dimpling), deviation of nipple direction

113

Clinical Breast Exam: Normal findings of inspection of colour, size & symmetry, couture of breasts, characteristic of nipples.

Symmetric and smooth contours of breast, no erythema or nipple erosion

114

Clinical Breast Exam: An abnormal findings of breast inspection?

Thickening of skin causing prominent pores to be visible

115

Clinical Breast Exam: _________ of palpation are clavicle superiorly, the mid sternum medially, the mid-axillary line laterally, and the infra-mammary fold inferiorly.

Breast boundaries

116

Clinical Breast Exam: Palpation: Feeling for consistency of tissues, tenderness, nodules (location, size, shape, consistency, elimination, tenderness, mobility). ________ charting is used to document location, as well as, charting the distance from the nipple.

Clock-face or 4 quadrant

117

Clinical Breast Exam: Normal findings of palpation:

Soft/cystic, regular borders, mobile mass

118

Clinical Breast Exam: Abnormal findings of palpation:

Hard, irregular borders, fixed mass

119

Clinical Breast Exam: Areolar palpation looks for:

Elasticity of tissues and discharge (colour, quantity, consistency, origin, laterality)

120

What are the most concerning symptoms with breast changes?

Fever, erythema skin changes, non-milky nipple discharge, increased in mass size over time

121

Cyclic mastalgia is related to the ________ and is bilateral with diffuse, heavy or sore sensation.

Menstrual cycle

122

Non-cyclic mastalgia is related to ________ and is often unilateral with a sharp, burning sensation.

Fibroadenoma, cyst, or infection

123

Mastalgia is often present with cyclical and non-cyclical breast changes. Non-cyclical breast changes are seen with ________ ?

Mastitis, cellulitis, other infections, and trauma

124

Mastalgia is often present with cyclical and non-cyclical breast changes. Cyclical breast changes are seen with _________ ?

Fibrocystic disease and copper ligament stretching

125

Unilateral nipple discharge is seen with _______ ?

Papilloma, duct ectasia/abscess/infection, and breast cancer

126

Bilateral nipple discharge is seen with _______ ?

Medications, lactation, pituitary adenoma, and hypothyroidism

127

Intraductal papilloma is a benign epithelial tumour, may have a palpable mass in the areolar region with spontaneous, unilateral, bloody nipple discharge. What is the management?

Imaging then excision of affected duct

128

What is termed as an obstruction of a sub-areolar duct with inspissation (thickening) of normal secretions, which leads to duct dilation, inflammation, and fibrosis? May present with a palpable mass, local pain, possible retraction, and spontaneous, unilateral, gray-green nipple discharge.

Duct ectasia

129

Galactorrhea (not associated with childbirth) may present with bilateral, milky discharge. Galactorrhea can also be due to medications and endocrine disruptions (hypothyroidism, pituitary adenoma). What is the management?

Labs (PRL, hCG, TSH) and microscopy of discharge

130

What is a rare and very aggressive disease in which cancer cells block lymph vessels in the skin of the breast? Presents with marked edema, erythema, dimpling (peau d-orange), and is less painful than mastitis.

Inflammatory breast cancer

131

What is the management for inflammatory breast cancer?

Imaging and tissue sampling

132

What is an uncommon disease of the nipple and areola, where malignant cells migrate to the surface of the breast? It is associated with underlying ductal carcinoma.

Paget's disease of the breast

133

Paget's disease present with?

Scaling, tender to palpation, and erosion of the nipple

134

A female breast mass can be a non-dominate mass that ________ through the cycle, or a dominant mass that _______ throughout the cycle.

Fluctuates; persists

135

Management of non-dominate breast masses:

Imaging (ultrasound, mammogram)

136

Management of dominate breast masses:

Imaging and fine needle aspiration (FNA)

137

BI-RADS stands for:

Breast Imaging Reporting and Data System

138

________ is the recording of body temperature distribution using the infrared radiation emitted by the surface of that body at wavelengths between 0.8 μm and 1.0 μm. Despite being non-invasive, it has low sensitivity.

Infrared thermography

139

Fibrocystic changes is a mammary disease complex with underlying endocrine disturbances resulting in 3 abnormalities ________. it is bilateral, granular to nodular masses, with possible mastalgia.

Cyst formation, fibrosis, and adenosis

140

________ are bilateral, granular to nodular masses, with possible mastalgia.

Fibrocystic changes

141

Management of fibrocystic breast changes?

Ultrasound (cystic lesion) & fine needle aspiration (FNA) (yields fluid)

142

Management of fibroadenoma?

Ultrasound (cystic lesion) & fine needle aspiration (FNA)(yields no fluid) are not diagnostic - requires core or excisional biopsy

143

Fibroadenoma is an overgrowth of ________ within the lobule of the breast. These masses are smooth, rubbery, discrete, non-tender, and are a mobile nodule.

Periductal stromal connective tissue

144

What is a benign, non-suppurative inflammatory process of adipose tissue (often due to trauma or surgery), which can present as peri- or sub-areolar mass, and possible skin changes (scar)?

Fat necrosis of the breast

145

What is the management of fat necrosis of the breast tissue?

Mammogram: “oil cysts”, can appear similar to malignancies, ultrasound (variable: hypoechoic mass with well defined borders), and fine needle aspiration (FNA) (milky, emulsified fat)

146

Invasive breast cancer may be _______.

Ductal, lobular, or other type

147

Breast cancer subtypes:

ER+, PR+, HER2-Neu +, and tripple negative breast cancer (TNBC)

148

Malignant carcinoma, also known as breast cancer, is a painless, unilateral, dominant (non-cyclic) mass. It is fixed and hard. It may have associated skin changes like dimpling or nipple retraction in advanced stages. What is the management?

Imaging and fine needle aspiration (FNA) or core-needle biopsy, with possible surgery, chemotherapy, and/or radiation

149

What is the most common type of in-situ breast carcinoma? It is often non-palpable and found on screening mammogram, and is a precursor to invasive ductal carcinoma.

Ductal carcinoma in-situ (DCIS)

150

Most common types of breast cancer is ________ (70% - 85%)?

Invasive breast cancer

151

Invasive ductal carcinoma is the most common type of invasive breast cancer (79%), while _______ is the second (10%).

Invasive lobular carcinoma

152

T: Tumour size; N: regional lymph Nodes involvement; M: Metastasis has occurred.

TNM staging of solid tumours

153

BRCA management with hormone therapy (SERM: Tamoxifen, AI: Femara) can causes these common concerns:

Hot flushes and osteoporosis

154

BRCA management with chemotherapy can causes these common concerns:

Hair loss, nausea, fatigue, and infection

155

BRCA management with radiation can causes these common concerns:

Fatigue, anemia, lymphedema (arm), skin irritation, pneumonitis, and heart damage

156

Serious causes of skin alteration and thickening of the breast are ________ ?

Inflammatory breast cancer and breast abscess

157

__________ can cause benign causes of skin alteration and thickening of the breast.

Mastitis

158

A serious cause of bloody nipple discharge is seen in ________ ?

Breast cancer

159

Benign causes of bloody nipple discharge is ________ ?

Papilloma and physiologic conditions

160

Discharge is considered pathological if it is:

Spontaneous, unilateral, bloody, serous, clear, or associated with a mass

161

With mastitis you must rule out ________ ?

Inflammatory carcinoma

162

Inflammatory breast cancer usually has a _________ , and often by the time of diagnosis 1/3 of the breast is involved.

Rapid onset

163

Intraductal papilloma are:

Wart like growths in ductules attached by a stalk

164

The most common cause of an inflamed breast in non-lactating women is _______ ?

Inflammatory breast cancer

165

Mastitis associated with breastfeeding, a subareolar abscess, and inflammatory breast cancer can present with ________ ?

Purulent discharge

166

Ductal ectasia and papillomatosis can produce _________ ?

Greenish or brownish discharge

167

A bloody nipple discharge can occur with __________ ?

Benign or cancerous conditions

168

_________ involvement is more suspicious for intraductal papilloma or cancer. Whereas, _________ discharges usually are caused by hyperprolactinemia or duct ectasia.

Single-duct; multiple-duct

169

_________ is usually helpful in differentiating solid from cystic lesions and is often the first step in evaluation of a cyst, or a mass, in the women with firm, dense, breast tissue.

Ultrasonography

170

________ involves both breasts, which are enlarged and dense. While ________ usually involves one lobe or a quadrant of a breast.

Engorgement (congestive mastitis); infectious mastitis

171

Prominent vessels, plus tender cordlike veins suggests _______ ?

Thrombophlebitis of the superficial veins of the breast

172

Paget's disease begins as a _________ area on the nipple and progresses to a deep ________ behind the nipple well.

Scaling eczematoid; lump

173

Fluctuation of breast masses are of a ________ .

Bouncy consistency

174

_________ is used primarily to evaluate abnormal areas that are seen on a mammogram, to assess breast implants for leaks or ruptures, and to assess breast abnormalities not seen on mammography or ultrasound.

Magnetic Resonance imaging

175

__________ should be suspected when prolactin serum levels are high.

Hyperprolactinemia

176

Thyroid function test is used to rule out _________ as a cause of hyperprolactinemia.

Hypothyroidism

177

_________ vary in size during menstruation, but ________ do not.

Cysts; fibroadenomas

178

Breast abscess can be caused by _________ ?

Staph aureus or streptococcal infections, and can be associated with duct ectasia

179

_________ is a fatty tumour of the breast, with borders that are smooth and well defined. The mass has a fluctuant consistency and is usually non-tender and mobile.

Lipoma

180

_________ is an uncommon breast finding, but should be considered, especially in immunocompromised patients. In the early stages, it can appear as a solitary, firm, irregular, non-tender mass.

Tuberculosis

181

An acute abscess typically follows _________ . It is exquisitely tender on palpation and very warm to the touch. The breast is erythematous and swollen, usually involves 1/4 of the breast tissue, and the mass has a fluctuant consistency.

Lactational mastitis

182

Inflammatory breast cancer does not usually present with a _______ , but it is often present with an abscess.

Fever

183

The breast is _________ sensitive tissue, and responsive to the changes of monthly cycling and aging.

Hormonally

184

After menopause, there is _________ of glandular tissue, and a notable __________ in the number of lobules.

Atrophy; decrease

185

Both the nipple and the areola are supplied with __________ to express milk from the ductal system during breast-feeding.

Smooth muscle that contracts

186

__________ of the area, including the breast examination, makes the nipple smaller, firmer, and more erect, whereas the areola puckers and wrinkles. These smooth muscle reflexes are normal and should not be mistaken for signs of breast disease.

Tactile stimulation

187

The adult breast may be soft, but it often feels granular, nodular, or lumpy. This uneven texture is normal and may be termed __________ . It is often bilateral.

Physiologic nodularity

188

The normal 'nodularity' may _________ before menses, a time when breasts often enlarge and become tender or even painful.

Increase

189

The male breast consists chiefly of a __________ . These overlie a thin disc of undeveloped breast tissue consisting primarily of ducts.

Small nipple and areola

190

Lacking _________ stimulation, the ductal branching and development of lobules of male breasts are minimal.

Estrogen and progesterone

191

A _________ of breast tissue, 2 cm or more in diameter, has been described in roughly one of three adult men.

Firm button

192

Not all the lymphatics of the breast drain into the axilla. Malignant cells from breast cancer may spread directly to the ________ nodes or into the _________ of lymph nodes within the chest.

Infraclavicular; internal mammary chain

193

Self-examination is best done when estrogen stimulation is lowest, approximately _________ of menses.

5 to 7 days after onset

194

Physiologic hypersecretion of breast discharge is seen with _________ .

Pregnancy, lactation, chest wall stimulation, sleep, and stress

195

Common lesions in the female breast at the age of 15 to 25 are _________ ; at the age of 25-50 are _________ ; and over 50 _________ .

Fibroadenoma; cysts, fibrocystic changes, and cancer; caner until proven otherwise

196

In pregnancy and lactating women, common lesions are:

Lactating adenomas, cysts, mastitis, and cancer

197

Male breast cancer constitutes 1% of breast cancer cases, peaking in frequency around age ________ .

71

198

Risk factors for male breast cancer are:

BRCA2 mutations, obesity, family history of male or female breast cancer, testicular disorders, and work exposure to high temperatures and exhaust emission

199

To examine the _________ portion of the breast, ask the patient to roll onto the ________ , placing her hand on her ________ but keeping the _________ pressed against the bed or examining table.

Lateral; opposite hip; forehead; shoulders

200

To examine the ________ portion of the breast, ask the patient to lie with her ________ flat against the bed or examining table, placing her hand at her ________ and lifting up her _________ until it is even with her shoulder.

Medial; shoulders; neck; elbow

201

Examination of the male breast may be brief but is important. If the breast appears enlarged, distinguish between the _________ enlargement of obesity and the _________ enlargement, called gynecomastia.

Soft fatty; firm disc of glandular

202

Inspection of the skin axilla should look for rash, infection, and unusual pigmentation. Deeply pigmented, velvety axillary skin suggests _________—one form is associated with internal malignancy.

Acanthosis nigricans

203

Mastitis is most common in lactating women, however, it can also occur in nonlactating women as a result of _________ .

Generalized dermatitis occurring from an insect bite, sunburn, or allergic reactions

204

Cyclic mastalgia occurs _________ and is associated with the menstrual cycle. _________ pain is not cyclic.

Premenopausally; postmenopausal

205

Cyclic mastalgia is usually described as _________ , and most likely caused by hormonal changes that affect the breast tissue, resulting in edema and increased nodularity. Noncyclic mastalgia is usually described as _________ .

Heaviness; sharp and burning

206

Noncyclic mastalgia is commonly ________ to the presence of a fibroadenoma or cyst, and can be relieved by the treatment of the underlying breast lesion.

Secondary

207

Gynecomastia can occur as a result of:

Medications (such as corticosteroids), hormonal medications, diazepam, and illicit drugs (such as marijuana).

208

Pregnancy is the most common cause of generalized breast tenderness in females of reproductive age. Test urine or blood for _________ to rule out pregnancy.

Human chorionic gonadotropin (β-hCG)

209

What is mastitis?

Inflammation of a mammary gland, usually caused by an infection

210

What is an adenoma?

A benign epithelial tumour having a glandular origin and structure.

211

What is fibrosis?

The formation of excessive fibrous tissue, as in a reparative or reactive process

212

What is adenosis?

A disease of a gland, especially one marked by the abnormal formation or enlargement of glandular tissue