Pathology notes detailing common pathologies and pathophysiology. Note - these notes were made using online resources from Queen's University Belfast and unlike the other notes on this account cannot be recommended for other university medical school exams.
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Normal Breast Structure
Normal Structure
- Tissue: Contains Fat and Glandular tissue
- Glandular: Consists of ducts and lobules
- Lobules: Secretory fxn via epithelial cells
- Ducts: Intralobular; Extralobular; Lactiferous
Breast Pain and Discharge
Pain Presentation
- Cyclical: Most often cyclical mastalgia
- NB: Greatest pre-menstrually; Resolves by period
Discharge Presentation
- Ducts: Single or multiple ducts
- Clear: Physiological; Rarely prolactinoma
- Opaque: Implies infection; Esp. if lactate
- Single: Papillary lesion; Rarely malignant
- Multiple: Duct Ectasia
- Ectasia: ↑Age while reproductive; Smoking
- Blood: Intraductal Papilloma
- NB: May find malignancy within papilloma
Breast Lumps in General
History Taking Mammogram
- Duration: Increase or decrease in size noticed - Use: Useful as a screening tool
- Timing: Cyclical or constant - Angle: Cranio-caudal + Oblique angles
- Skin: Inflammation; Lump Tethering - Age: More effective in ↑ age due to ↑ fat
Clinical Exam - Calcification: Ductal carcinoma in situ
- Location: Benign lesions uncommon medially Ultrasound
- Size: Size encompasses advancement - Use: Not useful for screening; Visualises lump
- Consistency: Soft; Firm; Hard - Character: Can differentiate if Cystic or Solid
- Skin: Raise arms; Inspect axilla - Biopsy: Guides fine needle biopsy
, Benign Breast Lumps
Classifications
- Papilloma - Fibroepithelial
o Character: Lump; Nipple discharge o Benign: Fibroadenoma; Phyllodes tumour
o Benign: Epithelium covers a CT core in ducts o Malignancy: Phyllodes tumour may transform
o Pattern: Branches out from core - Fibroadenoma
- Simple Cysts o Prevalence: Very common condition
o Near Surface: Epidermal Inclusion cyst o Exam: Palpable in young
o Breast Parenchyma: Dilated duct or lobule o Treatment: Hormone responsive; Excision
- Fibrocystic o Transformation: May transform into
o Character: Asx; Lump, bump, or thickening Phyllodes
o Prevalence: Very common condition - Fat Necrosis
o Character: Painless lump; Calcifies
o Cause: 2o to trauma (surgery; biopsy; seat
belt)
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