Benign breast disorders
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  • Internal mammary arteyLateral thoracic arteryVEINSInternal mammry veinsAlong the lateral thoracic artey to axxilary veinLateral perforating branches to intercostal veinsAcromio thoracic artery
  • Subclavian trunk
  • Poland’s syndrome: amazia with absence of the sternal portion of the pectoralis major muscle
  • Accessory breast and nipples are usually due to persistence of the portions of the milk line which fail to disappear
  • This shows the condition is due to over sensitivity of breast tissue to oestrogen
  • Slight swelling in adolescent boys is normal; due to change in hormonal pattern
  • May have simply drawn the attention of the patient towards the lump
  • Infants’ nasopharynxharbours Staph……………..This theory of stasis is supported as mastitis is more commom in females with retracted nipples
  • Infants’ nasopharynxharbours Staph
  • Antibioma with its attendant pain, chronicity and ill health
  • Antibioma with its attendant pain, chronicity and ill health
  • Smoking has a relation with commensals
  • Failure to do so causes recurrence
  • H: isoniazid 5mg/kgR:Rifampicin 10S:streptomycin 10-30E: ethambutol 15-25Z: pyrazinamide 25-35
  • Resolution without any complication or recurrence
  • Aspirate has high potassium contentPh is higher
  • Danazol: antigonadotropin (200 to 400mg daily)Tamaxofine:anti-oestrogen (10 mg daily)Bromocriptine ; Prolactin lowering agentsMedroxyprogesterone: 10 mg dailyOrder of use
  • Post menopausal women not on HRT have chest pain
  • Breast has two components of connective tissueseparated by elastic lamina covering the ductules.(outside the lamina)Pericanalicular: more of ducts and fibrous tissueIntracanalicular: More of connective tissue
  • Mobility lessens with age due to fibrosis of the surrounding tissue
  • Suture the defect or place a drain when not sure of haemosta
  • Intraductal papillary carcinoma arise de novo
  • Intraductal papillary carcinoma arise de novo
  • Fibroadenosis and fibroadenoma seen in young girls
  • Fibroadenosis and fibroadenoma seen in young girls
  • Base on pectoralis muscle, apex on areolaIncision not more than 3/5th of the circumference

Benign breast disorders Benign breast disorders Presentation Transcript

  • BENIGN BREAST DISORDERS DR. MINHAJUDDIN KHURRAM
  • OUTLINE  Anatomy (in brief)  Investigations  Anamolies  Injury to breast  Infections  Benign breast disease  Benign Neoplasms  Breast cysts  Nipple
  • ANATOMY
  • ANATOMY
  • ANATOMY
  • ANATOMY
  • ANATOMY
  • INVESTIGATIONS  Mammography  Ultrasound  MRI  Needle biopsy/ cytology  Large-needle with vacuum system  Triple assessment
  • INVESTIGATIONS  Mammography  Direct radiograph  Exposure to low-voltage, high amperage Xrays  Exposure of 0.1 cGy (very low)  Sensitivity increases with age  Normal mammograph does not exclude carcinoma
  • INVESTIGATIONS  Ultrasound:  USG more useful in young women : as breast is more dense  Mammographs are difficult to interpret  Distinguish cysts from solid lesions  Locate impalpable lumps  Diagnosis of axillary pathology  USG guided aspiration and biopsy
  • INVESTIGATIONS  MRI  Distinguish scar from recurrence for women with previous surgeries  Becoming the standard when lobular ca is diagnosed  To assess the multicentricity and multifocality  Best imaging modality for women with implants  Less useful in axilla pathology  Biopsy possible but difficult than USG guided
  • INVESTIGATIONS  Needle biopsy / cytology  To obtain histology under local ansthesia  Spring loaded core needle biosy using 21G or 23G 10 ml syringe  Multiple passes with negative suction  Fixed or dried to view under microscope  Least invasive technique of obtaining a cell diagnosis  Receptor staining is possible  False negetives: cannot differentiate invasive carcinoma from in situ  Large-needle biopsy  Less sampling error  Using 8G or 11G  More helping in calcifications
  • INVESTIGATIONS  Triple Assessment  Clinical diagnosis  Imaging  Tissue diagnosis  Accuracy of 99.99%
  • ANAMOLIES  Amazia:  Athelia  Polymazia  Polythelia  Micro-mastia  Diffuse Hypertrophy  Gynacomastia
  • ANAMOLIES  Amazia:  Congenital absence of breast (unilateral/ bilateral)  More common in males  Poland’s syndrome*  Athelia  Congenital absence of nipple
  • ANAMOLIES  Polymazia  Accessory breast tissue  Along the “MILK LINE”  Axilla is the commonest site  Other sites: groin, thigh and buttocks*  They function during lactation  Treatment is excision  Polythelia  Multiple nipples along the “MILK LINE”
  • ANAMOLIES  Micromastia: due to hypo-functioning ovary (congenital defect); breasts are smaller  Diffuse Hypertrophy (Benign virginal hypertrophy)  Occurs sporadically in otherwise normal female  At puberty or first pregnancy  Enormous size (may reach upto knees when sitting)  Rarely unilateral  Pathophysiology unknown  Some response to anti-oestrogen drugs*  Plastic surgical repair is the only definitive treatment
  • ANAMOLIES  Gynacomastia  Breast-like swelling in males*  The breast is enlarged, not the nipple and areola  Unilateral/ bilateral  Mostly Physiological  Oestradiol excess  Testosterone deficiency
  • ANAMOLIES  Gynacomastia  Pathophysiology  Oestrogen excess: may result from an increase of oestradiol from  Testicular tumors  Leydig cell / Sartoli cell tumour  Choriocarcinoma  Embryonal carcinoma  Non testicular tumors  Adrenal cortical neoplasm  Lung carcinoma  Hepatocellular carcinoma  Endocrine disorders  Hyperthyroidism  Hypothyroidism  Liver cirhosis
  • ANAMOLIES  Gynacomastia  Pathophysiology  Androgen deficiency states  Aging  Kline-felter syndrome  Congenital anorchia  Heriditary defect in androgen biosynthesis  ACTH deficiency  Renal Failure  Secondary Testicular fauilure  Trauma  Orchitis  Crytochordism  Irridiation  Varicocoele
  • ANAMOLIES  Gynacomastia  Pathophysiology  Drugs  Oestrogen realted activity activity (Digitalis, Anabolic steroids)  Anti-testosterone ( cemitidine, phenytoin, spironolactone, diazepam)  Enhancing oestrogen activity (reserpine, theophylline, frusemide)  Pathology  Breast show fibro-fatty proliferation rather than acinar growth!!
  • ANAMOLIES  Gynacomastia  Clinical features  No complaints other than enlargement of breast  May be associated with slight pain  Breast tissue can be moved over the underlying muscle  Serious psychological consequences  Can be associated with various pathologies
  • ANAMOLIES  Gynacomastia  Treatment  Idiopathic gynacomastia resolves by itself so “wait and waitch”  Androgen deficiency: administer testosterone  Danazol, tamoxifene  No cause elicited: surgical excision by sub-areolar mastectomy  In case of suspected pathology: HPR should be sent for
  • INJURY TO BREAST  Haematoma:  Resolving haematoma gives impression of a lump  In the absence of an overlying bruise, diagnosis is difficult unless biopsied  Traumatic Fat Necrosis:  May be acute or chronic  Some sort of injury: Direct or Indirect  Diagnosis is confused with ca.  Prsents as a painless lump, firm and irregular  Some skin tethering  No retraction of nipple may be present)  No axillary lymph nodes  History of trauma*
  • INJURY TO BREAST  Traumatic Fat Necrosis:  Pathophysiology  Trauma  Focal necrosis of fat Inflammatory reaction  subsequent scarring to give rise to a focus of firmer consistency  Chronic cases mimic new lumps  Treatment:  Whenever in doubt excisional biopsy should be done
  • INFECTIONS  Acute Inflammatory Mastitis  Chronic Inflammatory Mastitis  Sub-areolar abscess  Duct ectesia / periductal mastitis  Mastitis of infants  Retromammary abscess  Tuberculosis  Syphilis  Mondor’s Disease
  • INFECTIONS  Acute Inflammatory Mastitis  Aetiology  Acute bacterial mastitis is very common: associated with lactation  Develepment of cracks and bruises in the nipple: ascending infection  Staph aureus infection, penicillin resistant if nosocomial*  Streptococcus cuases more toxic symptoms  Blockage of one or more of the lactiferous ducts with epithelial debris*  Retracted nipple*
  • INFECTIONS  Acute Inflammatory Mastitis  Clinical features  Acute mastitis  Redness, oedema, induration  Cellulitis  Abscess  Redness, oedema and induration are somewhat localized  Fluctuation is very difficult to elicit
  • INFECTIONS  Acute Inflammatory Mastitis  Treatment:  Cellulitis stage: breast support + local heat + analgesia + antibiotics  Feeding from the affected site can be continued if patient can manage  Absces stage: whenever pus has formed, it has to be let out  Antibiotics at this stage will lead to the formation of Antibioma*  Incision and drainage to be done*  Latest view: Repeated aspirations have the same result  Can be accomplished with USG guidance  No scar and patient can breast feed
  • INFECTIONS  Acute Inflammatory Mastitis  Treatment:  Incision and drainage: needed only if there is marked skin thinning  Radial incision in the most prominent part  Counter-incision if it is not the dependent part  Break all loculi  Pack loosely with gauze, drain may be kept  Give firm support.
  • INFECTIONS  Chronic Inflammatory Mastitis  Continuous antibiotic treatment  Improper drainage of the abscess  Too tight packing of the abscess cavity  Has thick fibrous cavity  May have sterile pus  May mimic carcinoma  Incision of the cavity wall and curettage of the walls
  • INFECTIONS  Sub-areolar abscess  Not a true mastitis  Results from an infected sebaceous gland of Montogomery of areola  Or follow a furuncle near the areola  Incision and drainage of pus OR excision of the sebaceous cyst
  • INFECTIONS  Sub-areolar abscess/ Periductal mastitis/ Duct ectesia/ Plasma cell mastitis  More common in smokers  Develops behind the nipple pointing towards the areola; avoiding the tough fibromuscular tissue of the areola  Dilatation of the larger peri-areolar ducts  Usually 6-8 ducts are involved, rest are normal  May be bilateral  Condition may mimic carcinoma with an indurated mass beneath the areola
  • INFECTIONS  Sub-areolar abscess/ Periductal mastitis/ Duct ectesia/ Plasma cell mastitis
  • INFECTIONS  Sub-areolar abscess/ Periductal mastitis/ Duct ectesia/ Plasma cell mastitis  Duct dilatation theories:  Hormonally induced muscular relaxation of duct wall  Inadequate absorption of secretions  Obstruction of duct with squamous debris (but how bilateral?)  Smoking  arteriopathy  periductal inflammation  damage to the duct wall  duct dilatation  stasis  infection or healing by fibrosis*.  Cessation of smoking prolongs the long term survival.
  • INFECTIONS  Sub-areolar abscess/ Periductal mastitis/ Duct ectesia/ Plasma cell mastitis  Clinical features  Mostly seen after menopause  Diffuse lump in the sub-areolar region  Differentiate with ca.  Nipple retraction (slit like)  Nipple discharge  Clasically it is thick and creamy / but may be greenish  Bloody discharge at times  Chronic milk fistula (on and off with abscess)  No adenopathy
  • INFECTIONS  Sub-areolar abscess/ Periductal mastitis/ Duct ectesia/ Plasma cell mastitis  Treatment:  Exclude malignancy by mammography  If unsure: excision of the mass  Antibiotics  Fistula; fistulectomy with excision of the involved duct  Recurrent plasma cell mastitis : Hadfield’s operation  Remove all the terminal ducts*
  • INFECTIONS  Mastitis of infants  Drop of colourless fluid can be expressed on the third day of life  Witch’s milk  Seen only in full-term infants  Cause: Stimulation by prolactin from the mother’s milk
  • INFECTIONS  Retromammary abscess:  This conditionis nothing to do with breasts  Infection arises from  Infected haematoma  Tuberculosis of the ribs  Osteomyletis of the ribs  Incision and drainage by Guillard Thomas incision  breast lifted and chest wall drained corrugated rubber drain kept dressing done.  Appropriate antibiotics
  • INFECTIONS  Tuberculosis of Breast  Usually secondary to:  Pulmonary tuberculosis  Chest wall tuberculosis  Cervical lymph node tuberculosis  Mediastenal tuberculous lymphadenitis  Blood borne  Clinical features:  Parous women mostly  Primary focus somewhere else in the body  Multiple chronic abscesses with bluish hue
  • INFECTIONS  Tuberculosis of Breast  Clinical features:  Cold abscess: no or very little signs of inflammation  Discharging sinuses, may be multiple  Anti-tubercular therapy  Mastectomy only with persistent residual infection
  • INFECTIONS  Syphilis:  All three stages can be seen in breast  Primary: Primary chancre seen on the nipple  Secondary: Mucous patches in the sub-mammary folds; with diffuse mastitis  Diffuse Syphilitic Mastitis)  Tertiary: Gumma (very rare)
  • INFECTIONS  Mondor’s disease  Superficial thrombophlebitis of the superficial veins  No known cause  Not encountered in arm  Clinical feature:  Thrombosed sub-cutaneous chord, usually attached to the skin  May be painful and tender  When arm is raised; a groove alongside the vein is seen  Treatment: Rest to the arm and firm support to the breast*  D/D: lymphatic permeation of occult malignancy to be ruled out
  • BENIGN BREAST DISEASE (ANDI)  Concept:  Breast in in dynamic change throughout reproductive life  Super-imposed by menstrual cycles and pregnancies  Concept of ANDI was first given by L.E. Hughes et.al of Cardiff University (1987)  This concept recognizes conditions as being within a spectrum from normal to mild abnormalities to disease process.
  • BENIGN BREAST DISEASE (ANDI)
  • BENIGN BREAST DISEASE (ANDI)  Pathology:  The disease consists centrally of four features:  Cyst formation  Fibrosis  Hyperplasia  Papillomatosis
  • BENIGN BREAST DISEASE (ANDI)  Pathology:  Cyst formation: Two types of cysts are found  Simple cysts: Formed due to passive diffusion of plasma through simple membrane to cause cyst  Aspirate from simple cysts are similar to plasma in Na:K ratio  These are single and do not recur with no risk of malignancy  Complex cysts: Lined by apocrine epithelium cahractereised by large columnar cells like those in sweat glands  These cysts arise from a single lobule.*  The solitary draining duct is blocked and cysts become very large  Multiple cysts: but all may not be palpable
  • BENIGN BREAST DISEASE (ANDI)  Pathology:  Complex cysts:  Complex cysts tend to recur  May be associated with malignancy  Classic diffuse cystic disease :Schimmelbusch’s Disease  One large cyst becomes tense and blue domed: “Blue-domed cyst of Bloodgood”  Cysts usually contain greyish green desquamated cells  Cysts may contain blood due to haemorrhage
  • BENIGN BREAST DISEASE (ANDI)  Pathology:  Fibrosis: Fat and elastic tissue is replaced by white fibrous tissue  Interstitium is infiltrated with chronic inflammatore cells  This fibrous tissue compresses the ducts and distorts the acinar patterns.  Hyperplasia: Hyperplasia of epithelium of ducts and acini  Hyperplasia of both glandular and connective tissue  Ductal lumen may get full of cells  Can be a pre-malignant condition if epitheliosis is more  Papillomatosis: Hyperplasia may be extensive enough to cause papillomatous growth within the ducts
  • BENIGN BREAST DISEASE (ANDI)  Clinical feature:  A benign discrete lump in the breast is commonly a cyst or fibroadenoma  Lumpiness : described by patient as heaviness in the upper outer quadrant  Mastalgia:  Cyclical mastalgia with nodularity (fibrocystic disease)  Non-cyclical mastalgia
  • BENIGN BREAST DISEASE (ANDI)  Fibrocystic disease / Cyclical mastalgia with nodularity /Fibroadenosis  Aetiology: It is an Aberration in normal involution (ANI) of breast  Hyper-oestrogenism  Increased estrogen OR  Decreased progesterone  Exessive caffeine  Inadequate essential fatty acids  Pathology:  Cyst formation  Fibrosis  Hyperplasia  Papillomatosis
  • BENIGN BREAST DISEASE (ANDI)  Fibrocystic disease / Cyclical mastalgia with nodularity /Fibroadenosis  Clinical feature:  Cyclical mastalgia: breast pain has a definitive relation to the menstrual cycle  40% of the patients present with cyclical mastalgia in breast clinic  Discomfort lasts for a varying period of time (for months) then disappears, to relapse again after years  Pain is mostly located in the upper-outer quadrant  May radiate to axilla, chest wall or side of the arms  No mammographic findings
  • BENIGN BREAST DISEASE (ANDI)  Fibrocystic disease / Cyclical mastalgia with nodularity /Fibroadenosis  Clinical feature:  Lumps or lumpiness: The next mode of presentation  Upper-outer quadrant  Just before menstruation both lump and pain increase with tenderness  On examination:  Nodular lesion with lumps, lumps are inseparable  Best palpated between thumb and fingers  Easily movable lumps, not adherent  No axillary lymph nodes enlarged  No retraction of nipple
  • BENIGN BREAST DISEASE (ANDI)  Fibrocystic disease / Cyclical mastalgia with nodularity /Fibroadenosis  Management of cyclical mastalgia  Breast pain monthly diary  Re-assurance  Breast support  Evening primrose oil  Danazol  Bromocriptine  Tamoxifene  MedroxyProgesterone  Oral contraceptives  Avoid conception for three months when using bromocriptine and danazol
  • BENIGN BREAST DISEASE (ANDI)  Fibrocystic disease / Cyclical mastalgia with nodularity /Fibroadenosis  Management of lumpy breast  In case of no discrete lump (supported by mammography)  Reassurance  Ask the patient to come in different phase of cycle*  In case of lumps  Mammography and USG to exclude other conditions  Biopsy from a single or multiple lumps
  • BENIGN BREAST DISEASE (ANDI)  Fibrocystic disease / Cyclical mastalgia with nodularity /Fibroadenosis  Management of lumpy breast  Surgical management:  Indications:  Intolerable pain  Lump inspite of best conservative management  Presence of concomitant malignancy cannot be excluded  Older patients causing anxiety  Excision biopsy by circumareolar incision  If not possible then sub-mammary of Gaillard Thomas  In case of failure then radial or curved incision over Langer’s line
  • BENIGN BREAST DISEASE (ANDI)  Sclerosing adenosis:  It is an AND of normal breast  Characterised by terminal duct and myo-epithelial proliferation  Distorted glandular proliferation: loss of normal lobular architecture  May be multifocal  May calcify: mimics carcinoma  Causes mastalgia :perineural invasion causing “trigger spot zones”  Causes mastalgia rather than lump  Lump: smooth relative mobile mass  Treatment: Reassurance and management of mastalgia
  • NON-CYCLICAL MASTALGIA  Cyclical nodularity:  Mass rather than pain, being the chief complaint  Teenagers mostly affected /premenopausal women may sometimes be affected  A large and uncomfortable swelling develops in the upper outer quadrant  Vague discomfort may be associated  Examination: Diffuse nodular swelling with tenderness  Management:  Reassurance: may resolve by next cycle  Mammography  Aspiration cytology in older women
  • NON-CYCLICAL MASTALGIA  No co-relation with the menstrual history  More commonly seen in peri-menopausal women  Less understood  Mostly felt in the medial quadrant of breasts  Described as “burning” or “dragging”  Sometimes well localized at “trigger spot zones”  May be associated with Periductal mastitis  50% doesn’t arise from breast.
  • NON-CYCLICAL MASTALGIA  Management:  Exclude extra mammary causes like chest pain*  Non- steroidal analgesics  Injection with local ansthetics in the trigger spots  Surgical excision of trigger spot zone (NOT WIDELY ACCEPTED)
  • BENIGN NEOPLASMS  Fibroadenoma  Phyllodes tumour  Duct papilloma  Papillary cystadenoma
  • BENIGN NEOPLASMS  Fibroadenoma  The most common tumour female breast  It is composed of both glandular and fibrous tissue  Aetiology: It is AND  May be seen along with Fibroadenosis (ANI)  Pathology  Increased sensitivity to oestrogen  More common in blacks  Mostly spherical; may be multinodular  They typically stop growing after 2 to 3 cm size  May harbor lobular carcinoma in situ
  • BENIGN NEOPLASMS  Fibroadenoma  Types:  The Pericanalicular (hard fibroadenoma): it is firmer, smaller and moves well within the breast tissue “BREAST MOUSE”  The Intracanalicular (Soft fibroadenoma): is relatively less firm, grows larger with profuse connective tissue “INTRADUCTAL MYXOMA”  Both variants can co-exist
  • BENIGN NEOPLASMS  Fibroadenoma  Clinical features  The pericanalicular occurs in younger females (15 to 30 yrs)  The intracanalicular affects older age group (30 to 50 yrs)  Painless, slow growing solitary lump (pain when associated fibroadenosis)  Mostly seen in the lower part of the breast  Multiple may be present; 10% cases  Intracanalicular can grow large causing pain due to stretching skin  No discharge per nipple
  • BENIGN NEOPLASMS
  • BENIGN NEOPLASMS  Fibroadenoma  On examination:  No visible swelling ( large intracanaliclar may be visible)  Freely mobile; more in young girls*  Firm consistency  No axillary lymph nodes  Treatment:  Present trend: women under 25 yrs of age, routine excision is avoided  The fibroadenoma grows upto 3 cm in 5 yrs  Thereafter gradually become smaller
  • BENIGN NEOPLASMS  Fibroadenoma  Treatment:  In case of suspected pathology: excision biopsy is the treatment of choice  Enucleation of the pericanacular variety  Excision of the intracanalicular variety  Peri-areolar or Sub mammary incision (Gaillard Thomas’s incision)  If not possible then radial or curved incision over Langer’s lines
  • BENIGN NEOPLASMS  Giant fibro-adenoma  Grows more than 5 cm in size  Bimodal age of presentation (at puberty and peri-menopause)  More common in blacks  Epithelial hyperplasia and atypia  Characterised by rapid growth  Differentiate from phyllodes tumour, Benign virginal hypertrophy  On examination:  Enlarged breast  Displaced nipples  Stretched and shiny skin  Dilated veins  Skin necrosis may occur  Treatment: Enucleation
  • BENIGN NEOPLASMS  Phyllodes Tumour  Also called Cystosarcoma Phyllodes, Serocystic Disease Of Brodie or Benign Cystosarcoma  Mostly seen in premenopausal women (40yrs age)  Show a wide range of histology  From an almost benign condition resembling fibroadenoma  To the ones with high mitotic index  Tumour has irregular projections: cause for recurrences  Clinical features:  Presents as massive tumour  Unevenly bosselated surface
  • BENIGN NEOPLASMS  Phyllodes Tumour  Clinical features:  Pressure necrosis of overlying skin  Or warm, red, shiny skin with dilated veins  Normal nipple  Firm consistency  Smooth margins  Not fixed: the stretched skin can be picked up  No axillary lymph node involvement  Known for local recurrence
  • BENIGN NEOPLASMS
  • BENIGN NEOPLASMS  Phyllodes Tumour  Treatment:  Younger women (Benign end of spectrum): Simple enucleation  Older patients (Malignant end of the spectrum) :Wide excision with 1 cm margin or more  Recurrences: mastectomy with recostruction
  • BENIGN NEOPLASMS  Duct Papilloma  Benign tumour, usually small  Arising from ther lining epithelium of lactiferous duct  It may too small for clinical palpation, but may obstruct a duct for cyst formation  Not a pre-cancerous condition*  Usually single and unilateral  Papillonama has a stalk  Papilloma vs papillomatosis (epithelial hyperplasia without a stalk)
  • BENIGN NEOPLASMS  Duct Papilloma  Clinical features  Age 30 to 50 yrs  Bloody discharge: commonest presentation  Small and soft lump palpable beneath the areola or nipple; often difficult  Discharge from the affected duct on pressing the lump  May present with a cystic swelling; due to impalpable lump blocking the duct  No lymph nodes are affected
  • BENIGN NEOPLASMS  Duct Papilloma  Treatment:  Complete excision of the affected duct Microdochectomy  Wedge resecteion  If not palpable then gently probe the affected duct  Carry on the resection with 1mm distance from the probe  Papilloma is mostly situated 4-5 cm away from the nipple
  • BENIGN NEOPLASMS  Papillary cystadenoma:  Swellings or lumps are composed of cysts  Into these cysts papillomatous processes extend  Cysts are almost filled with these papillomatous processes  Swelling feels soft: not cystic  Management  Excision and biopsy  Benign condition
  • BREAST CYSTS  Type I Classification  A FROM THE DUCTS:  Fibroadenosis  Blue domed cyst of Bloodgood  Galactocoele  Serocystic disease of Brodie  Papillary cystadenoma  Intradeuctal papillary carcinoma
  • BREAST CYSTS  Type I Classification  B FROM THE STROMA  Blood Cyst (encapsulation of haematoma)  Lymphatic cyst  Hydatid cyst  Colloid Degeneration of carcinoma
  • BREAST CYSTS  Type II Classification  A FROM MAMMARY DYSPLASIA  Fibroadenosis  Cyclical nodularity  Bluedomed cyst of Bloodgood  Sclerosing adenosis  B RETENTION CYSTS  Galactocoele
  • BREAST CYSTS  Type II Classification  C FROM TUMOURS  Benign  Papillary cystadenoma  Serocystic disease of Brodie  Malignant  Intracystic papillary carcinoma  Colloid or mucinous carcinoma  Medullary carcinoma  D MISC  Lymphatic cyst  Hydatid cyst  Blood cyst
  • BREAST CYSTS  Clinical presentation  Mostly seen in the last decade of reproductive life*  Usually single in presentation, or just single cyst is palpable  Relation to menstruation  Sudden appearance (subclinical state)  Mammography  Aspiration of cyst (for confirmation of diagnosis)  Treatment:  Aspirate when in doubt  Blood, mass after aspiration or recurrence: malignancy  No blood; no mass after aspiration : Benign nature (Mostly Fibroadenosis)  Follow up after 2 months
  • BREAST CYSTS  Treatment:  Diagnosis in Doubt / multiple cyst: excision and biopsy  Theoritically: Patients with breast cysts are at increased risk of malignancy
  • BREAST CYSTS  Galactocoele:  Accumulation of milk and amorphous epithelial debris  Blockage of main duct  Presents as sub-areolar cyst  Presents in patients who have just cased breast feeding  Management:  Excision of the affected duct
  • NIPPLE  Nipple retraction  Discharge per nipple  Cracked nipple
  • NIPPLE  Nipple retraction  Causes:  Benign horizontal inversion  Duct ectesia  Carcinoma  Post surgical  Types:  Slit-like: Duct ectesia  Circumferential: Carcinoma /Post surgical  May cause retention of secretions
  • NIPPLE  Nipple retraction  Treatment:  Spontaneous resolution during pregnancy or lactation  Mechanical suction device  Simple cosmetic surgery  Ducts will have to be divided
  • NIPPLE  Discahrge per Nipple:  A. Discharge from the surface  Paget’s disease  Skin diseases (eczema, psoriasis)  Rare cuases (chancre)  B. Discharge from a single duct  Blood stained  Intraduct papilloma  Intraduct carcinoma  Duct ectesia  Serous (any-colour)  Fibrocystic disease  Duct ectesia  Carcinoma
  • NIPPLE  Discahrge per Nipple:  C. Discharge from more than one duct  Blood- satined  Carcinoma  Ectesia  Fibrocystic disease  Black or green  Duct ectesia  Purulent  Infection  Serous  Fibrocystic disease  Duct ectesia
  • NIPPLE  Discahrge per Nipple:  Management: Mammography in those more than 35 yrs of age  Microdochectomy: Probe and remove a single duct upto 5cm  Hadfield operation: Cone excision of the major ducts*  Patient will not be able to breastfeed  Underlying pathology to be dealt with
  • NIPPLE  Other conditions:  Cracked nipple: fore-runner of acute mastitis  Breast feeding should be rested for 48 hrs  Milk to be evacuated with a breast pump  Resume feeding as soon as possible  Papilloma of nipple:  Same features as cutaneous papilloma  Excision with tiny disc of skin  Eczema:  Usually associated with eczema elsewhere in the body  0.5% hydrocortisone
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