Breast Disorders

Regarding Breast lumps and disorders select an option from the list below for the given scenarios:

A. Lipoma
B. Paget's disease of the breast
C. Breast cancer
D. Sebaceous cysts
E. Fibroadenoma
F. Fibroadenosis
G. Duct papilloma
H. Breast abscess
I. Fat necrosis
J. Mammary duct ectasia

1. A 72-year-old woman complains of 'eczema' on her left nipple. On examination the areola is erythematous and thickened.

Answer:  Paget's disease of the breast

2. A 26-year-old woman has noticed a discrete, non-tender lump which is highly mobile on examination.

Answer: Fibroadenoma

3. A 35-year-old woman complains of 'lumpy' breasts. Her symptoms are worse in the premenstrual period.

Answer:  Fibroadenosis

Discussion:

Breast Disorders: A few common disorders and features of lumps is described below:

1. Fibroadenoma: Common in women under the age of 30 years Often described as 'breast mice' due as they are discrete, non-tender, highly mobile lumps.

2. Fibroadenosis (fibrocystic disease, benign mammary dysplasia): Most common in middle-aged women 'Lumpy' breasts which may be painful. Symptoms may worsen prior to menstruation.

3. Breast cancer: Characteristically a hard, irregular lump. There may be associated nipple inversion or skin tethering.

4. Paget's disease of the breast: intraductal carcinoma associated with a reddening and thickening (may resemble eczematous changes) of the skin/areola.

5. Mammary duct ectasia: Dilatation of the large breast ducts Most common around the menopause May present with a tender lump around the areola +/- a green nipple discharge If ruptures may cause local inflammation, sometimes referred to as 'plasma cell mastitis'

6. Duct papilloma: Local areas of epithelial proliferation in large mammary ducts Hyperplastic lesions rather than malignant or premalignant. May present with blood stained discharge.

7. Fat necrosis: More common in obese women with large breasts May follow trivial or unnoticed trauma Initial inflammatory response, the lesion is typical firm and round but may develop into a hard, irregular breast lump Rare and may mimic breast cancer so further investigation is always warranted.

8. Breast abscess: More common in lactating women Red, hot tender swelling.

9. Lipomas and sebaceous cysts may also develop around the breast tissue.