Benign breast disease by Dr. Kong

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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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