![]() Gynaecomastia presents in a male patient with an enlarging, painful breast lump. Cysts are easily identified on ultrasound. Patients present with a painful lump, which grows rapidly in the luteal phase of their cycle and tends to shrink on menstruation. Older patients have to rule out occult malignancy phyllodes tumour.Ĭysts are common in perimenopausal women, although they can occur at any age in women on hormonal contraceptives or HRT. Young patients (less than 25 years) with clearly benign clinical and imaging findings are usually spared a core biopsy. Symptomatic patients are referred to the breast clinic for triple assessment (history and examination, ultrasound and/or bilateral mammography and biopsy).įibroadenomas appear as a well-defined, smooth, oval-shaped lump, distinctly mobile and easily identified on ultrasound. This can be caused by latent hyperprolactinaemia, drugs or a hypersecreting pituitary tumour, or may be idiopathic.įat necrosis occurs after breast trauma and may present with a palpable lump. Galactorrhoea is a physiological cause, presenting as bilateral, white, milky, multiduct discharge. It presents as a creamy or brown serous discharge. It is the most common cause of unilateral, spontaneous, single duct bloody nipple discharge.ĭuct ectasia is another condition involving age-related dilation and shortening of the terminal ducts. ![]() Smoking leads to accumulation of toxic metabolites and overgrowth of aerobic and anaerobic Gram- negative bacteria, 3 leading to ductal inflammation and abscess.ĭuctal causes include intraduct papilloma, a stalk-like epithelial lesion that grows in large ducts within 5cm of the nipple. Periductal mastitis, a common non-lactational infection, is associated with younger women and smoking. 2 Inadequate ductal drainage leads to colonisation, infection and progression to an abscess. Staphylococcus aureus enters the duct through the nipple skin break and thrives in that culture media. Lactational mastitis can occur in 5% of puerperal women. Other common pathological causes include undiagnosed hyperprolactinaemia, liver failure, alcohol excess, obesity and malignancy (testes and lung). Gynaecomastia can also be physiological and present spontaneously in a trimodal age pattern neonates, pubertal and senescence. In older patients, it involves cardiovascular and prostate drugs, and in younger patients, cannabis, anabolic steroids, anti-ulcer drugs and antidepressants. The most common cause is secondary to drugs. It is usually caused by a relative increase in the estrogen to androgens ratio in the circulation or breast tissue. Gynaecomastia is hyperplasia of the male breast stromal and ductal tissue. In fibrocystic disease, the overgrowth of glandular and connective tissue tends to block ducts, causing lobules to widen and fill with fluid. They are more common in women from the age of 35 years up to the menopause. Referred breast pain from the chest wall is often musculoskeletal or neurological in origin.Ĭysts are fluid-filled, distended, involuted lobules. Recent evidence suggests that latent stress-induced hyperprolactinaemia can cause mastalgia. True mastalgia is more common in women taking hormonal contraceptives (oral, implant, injection or intrauterine) or menopausal HRT.Ĭombined estrogen-progestogen HRT preparations are known to cause more severe mastalgia than estrogen-only preparations. Causes of mastalgia should be differentiated (see table 1). ![]() Mastalgia, which is also known as mastodynia or mammalgia, refers to breast pain. They are larger than fibroadenomas and tend to occur in an older age group (15-20 years later). The latter are sarcomas which rapidly enlarge and have variable degrees of malignant potential. They are highly mobile, because of the encapsulation and pliability of young breast tissue.Ĭlinically, fibroadenomas are difficult to differentiate from phyllodes tumours, which is a distinct pathology. As well as excluding breast cancer and providing reassurance, patients expect a tailored approach to their benign condition.įibroadenomas arise from breast lobules and are composed of fibrous and epithelial tissue. 1.5 CPD Credits Click here to reflect on this article and add notes to your CPD organiser on MIMS Learning Section 1: Epidemiology and aetiologyĪbout 90% of patients referred to breast units are diagnosed with a benign condition.
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