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   On pectoral fascia and musculature of    the chest wall   Over upper anterior rib cage 2nd or 3rd to    6th   Fat su...
   A – Ducts   B – Lobules   C – Lactiferous sinus   D – Nipple   E – Fat   F – Pectoralis major   G – Ribs and int...
Cooper’s ligament
   Axillary lymph nodes    defined by pectoralis    minor muscle    › Level 1 – lateral    › Level 2 – posterior    › Lev...
   Estrogen    - Development of the breast and      lactiferous ducts   Progesterone    - Together with estrogen causes ...
Inspection Overall inspection  - symmetry, size, shape, skin color,    venous pattern, lump, local dimpling Nipple  - ex...
Palpation Gentle palpation  - quadrant by quadrant Mass  - number, size, consistency and mobility Lymph node  - anterio...
 90% of the breast lump are found by  patients themselves. Encourage female have regular self  breast examination.
In Front a Mirror
In The Shower
Lying Down
   Mammography   Ultrasound   Magnetic Resonance (MR)   Computed tomography (CT)   Positron Emission Tomography (PET)
Mammographic screening is key to the early detection of breast cancer
   Fine needle aspiration    - Cytology Core biopsy  - Image guided  - Stereotactic Excisional biopsy  - Needle localiz...
   Abnormalities of Normal Development    and Involution Most benign disorders are related to  normal process of reprodu...
 These include conditions of well define  etiology Example: fat necrosis, breast abscess
 Cyst formation Fibrosis Hyperplasia of epithelium in the lining of  the ducts and acini may occur Papillomatosis
 Breast lump Mastalgia – cyclical and non cyclical Nipple discharge Infection
   Normal breast nodularity or cyclical    nodularity    - Upper quad and axillary tail    - Assessment is clinical, supp...
   Fibroadenoma    - 15-25 yrs    - Firm, smooth or lobulated and extremely mobile    - increase in size during pregnancy...
   Breast cysts    - 40-50 years    - smooth and tense and easily      palpable against the chest wall    - USG and needl...
   Galactocele    - Painless swelling appears in breast      during or after cessation of lactation    - Cyst filled with...
Galactocele
   Cyclical    - Related to menstrual cycle    - Duration of >1 week per cycle is significant      and called “pronounced...
   Non Cyclical Mastalgia    - True non cyclical mastalgia    - Chest wall pain
 Non Medical Measures  - Reassurance  - Breast support  - Dietary measures Medical Measures  - NSAIDS  - Evening primros...
   Discharge from single duct    - Blood stained      1. Intraductal carcinoma      2. Intraductal papilloma      3. Duct...
   Discharge from more than one duct    - Blood Stained      1. Carcinoma      2. Duct ectasia    - Grumous      1. Duct ...
Cause Hormonal imbalance Excessive estrogen production
Clinical present   Pain or lump, nipple discharge (15%)   Tense cyst no fluctuant   Cyst may appear rapidly and then ma...
   Diagnosis    - Pain or lump    - FNA   Management    - Hormonal therapy    - Mastectomy
 Dilation of ducts associated with  periductal inflammation Presented as nipple discharge, subareolar  mass, abscess, ma...
 Bacterial mastitis  - cellulitic stage  - abscess form Tuberculosis Actinomycosis Syphilis
   40-50 years old.   6%-8% malignant tendency.   Forming from the epithelial    linings of the main ducts.   Nodule a...
Types of Intraductal Papilloma Solitary intraductal papillomas – one lump,  usually near a nipple, causes nipple  dischar...
   Cause    - Lactic stasis    - Bacterial invasion   Clinical present    - Swelling pain  - Painful mass with reddish s...
   Thermo therapy    - 25% Magnesium sulfate   Antibiotic therapy    - Local and general administration   Drainage   P...
 After breast surgery or breast injury Bruised, injured, or dead fatty tissue Clinical features  - Hard lump  - Tender ...
THE END
Benign breast disease by Dr. Kong
Benign breast disease by Dr. Kong
Benign breast disease by Dr. Kong
Benign breast disease by Dr. Kong
Benign breast disease by Dr. Kong
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Benign breast disease by Dr. Kong

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Transcript of "Benign breast disease by Dr. Kong"

  1. 1.  On pectoral fascia and musculature of the chest wall Over upper anterior rib cage 2nd or 3rd to 6th Fat surrounding Internal mammary artery & lateral thoracic artery Axillary vein, internal mammary veins & intercostal veins
  2. 2.  A – Ducts B – Lobules C – Lactiferous sinus D – Nipple E – Fat F – Pectoralis major G – Ribs and intercostal muscles A – Duct cells B – Basement membrane C – Duct lumen
  3. 3. Cooper’s ligament
  4. 4.  Axillary lymph nodes defined by pectoralis minor muscle › Level 1 – lateral › Level 2 – posterior › Level 3 – medial
  5. 5.  Estrogen - Development of the breast and lactiferous ducts Progesterone - Together with estrogen causes lobular and alveolar growth Prolactin - Synergizes the effect of estrogen and progesterone
  6. 6. Inspection Overall inspection - symmetry, size, shape, skin color, venous pattern, lump, local dimpling Nipple - excoriation, inversion, discharge, edema and redness Skin - redness, edema, Peau d’orange
  7. 7. Palpation Gentle palpation - quadrant by quadrant Mass - number, size, consistency and mobility Lymph node - anterior, posterior, lateral, central and apical Character of the discharge - Milky, serous, or green-brown discharge - Bloody discharge
  8. 8.  90% of the breast lump are found by patients themselves. Encourage female have regular self breast examination.
  9. 9. In Front a Mirror
  10. 10. In The Shower
  11. 11. Lying Down
  12. 12.  Mammography Ultrasound Magnetic Resonance (MR) Computed tomography (CT) Positron Emission Tomography (PET)
  13. 13. Mammographic screening is key to the early detection of breast cancer
  14. 14.  Fine needle aspiration - Cytology Core biopsy - Image guided - Stereotactic Excisional biopsy - Needle localization
  15. 15.  Abnormalities of Normal Development and Involution Most benign disorders are related to normal process of reproductive life There is a spectrum that ranges from normal to aberration and occasionally to disease
  16. 16.  These include conditions of well define etiology Example: fat necrosis, breast abscess
  17. 17.  Cyst formation Fibrosis Hyperplasia of epithelium in the lining of the ducts and acini may occur Papillomatosis
  18. 18.  Breast lump Mastalgia – cyclical and non cyclical Nipple discharge Infection
  19. 19.  Normal breast nodularity or cyclical nodularity - Upper quad and axillary tail - Assessment is clinical, supplemented by USG cytology or core needle histology - Excisional biopsy if doubt persists
  20. 20.  Fibroadenoma - 15-25 yrs - Firm, smooth or lobulated and extremely mobile - increase in size during pregnancy and involutes after parturition - 5cm is giant fibroadenoma - Estrogen may play an important role in its pathogenesis - If age<25 conservative. - Excision is done, if age>25, size increases, giant fibroadenoma and positive family h/o of carcinoma
  21. 21.  Breast cysts - 40-50 years - smooth and tense and easily palpable against the chest wall - USG and needle aspiration confirms - Excisional biopsy is done if residual mass is present or blood stained fluid is present
  22. 22.  Galactocele - Painless swelling appears in breast during or after cessation of lactation - Cyst filled with milky material and has same character as other cysts - Mainly found towards areola - Repeated aspiration
  23. 23. Galactocele
  24. 24.  Cyclical - Related to menstrual cycle - Duration of >1 week per cycle is significant and called “pronounced” symptoms - Etiology 1. Hyperprolactenemia 2. Increase level of estrogen after ovulation 3. Abnormality of prostaglandin secondary to deficient essential fatty acid intake in diet
  25. 25.  Non Cyclical Mastalgia - True non cyclical mastalgia - Chest wall pain
  26. 26.  Non Medical Measures - Reassurance - Breast support - Dietary measures Medical Measures - NSAIDS - Evening primrose oil - Danazol - Tamoxifen Surgical measures - subcutaneous mastectomy – the last resort
  27. 27.  Discharge from single duct - Blood stained 1. Intraductal carcinoma 2. Intraductal papilloma 3. Duct ectasia - Serous 1. Fibrocystic disease 2. Duct ectasia 3. Carcinoma
  28. 28.  Discharge from more than one duct - Blood Stained 1. Carcinoma 2. Duct ectasia - Grumous 1. Duct ectasia - Purulent 1. Infection - Serous 1. Duct ectasia 2. Fibrocystic disease 3. Carcinoma
  29. 29. Cause Hormonal imbalance Excessive estrogen production
  30. 30. Clinical present Pain or lump, nipple discharge (15%) Tense cyst no fluctuant Cyst may appear rapidly and then maintain their size or shrink after next menstraual flow Most painful in pre-menstraual period
  31. 31.  Diagnosis - Pain or lump - FNA Management - Hormonal therapy - Mastectomy
  32. 32.  Dilation of ducts associated with periductal inflammation Presented as nipple discharge, subareolar mass, abscess, mammary fistula and/or nipple retraction To rule out malignancy if lump or nipple retraction - if suspicion remain excisional biopsy - excision of all major ducts
  33. 33.  Bacterial mastitis - cellulitic stage - abscess form Tuberculosis Actinomycosis Syphilis
  34. 34.  40-50 years old. 6%-8% malignant tendency. Forming from the epithelial linings of the main ducts. Nodule at the areola margin. Pressure reproduces the bloody discharge.
  35. 35. Types of Intraductal Papilloma Solitary intraductal papillomas – one lump, usually near a nipple, causes nipple discharge Multiple papillomas – groups of lumps, farther away from a nipple, usually doesnt cause discharge, and cant be feltTreatment Surgical excision (involved duct or radical resection if it is proved malignant by frozen section)
  36. 36.  Cause - Lactic stasis - Bacterial invasion Clinical present - Swelling pain - Painful mass with reddish skin General features: Chill, fever, ipsilateral LN enlargement, bacteriaemia Abscess formation
  37. 37.  Thermo therapy - 25% Magnesium sulfate Antibiotic therapy - Local and general administration Drainage Prevention
  38. 38.  After breast surgery or breast injury Bruised, injured, or dead fatty tissue Clinical features - Hard lump - Tender or painful - drainage from nipple - nipple will pull inward Triple assessment Management - NSAIDS - Vacuum-assisted core needle or lumpectomy
  39. 39. THE END
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