This document discusses benign breast disease. It defines various types of benign breast conditions including cysts, fibroadenomas, and proliferative breast disease without atypia. It describes the typical presentation, risk factors, evaluation, and management for each condition. The management often involves clinical examination, imaging such as ultrasound or mammogram, and biopsy when needed to rule out malignancy. Most benign breast diseases can be managed without surgery through techniques such as aspiration of cysts or short-term imaging follow up.
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Seminar presentation by student under supervision of endocrinology specialist from HRPZ. References as mentioned in the slides. Mostly from Malaysia CPG.
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Seminar presentation by student under supervision of endocrinology specialist from HRPZ. References as mentioned in the slides. Mostly from Malaysia CPG.
Benign ovarian masses include functional cysts and tumors; most are asymptomatic.Most functional cysts and benign tumors are asymptomatic. Sometimes they cause menstrual abnormalities. Hemorrhagic corpus luteum cysts may cause pain or signs of peritonitis, particularly when they rupture. Occasionally, severe abdominal pain results from adnexal torsion of a cyst or mass, usually > 4 cm. Treatment varies depending on the patient's reproductive status.
Ovarian tumors are abnormal growths on the ovaries, the female reproductive organs that produce eggs. Ovarian tumors can be noncancerous (benign) or cancerous (malignant). Many things can make you more likely to develop an ovarian tumor.
Breast Cancer Management & Surgical ConsiderationsRiaz Rahman
Clinical overview and surgical considerations for management of Primary Breast Cancer and other subtypes. Covers screening recommendations, mammography (including BIRADS score interpretation), pathophysiology, staging, prognosis, surgical management, breast anatomy, non-surgical management, follow-up considerations. Given at Jackson Park Medical Center on 1/30/2014. Includes references.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. Benign breast diseases are often under diagnosed.
Malignancy is not commonly associated with benign
disease
Management of BBD depends on accurate diagnosis
Most benign disease can be managed without
surgery.
5. Proliferative disease and absolute risk of
breast cancer development is 20% in 15 years
among patients with family history of first
degree relative, and 8% in those group which
do not have family history.
6. Developed by LE Hughes at Cardiff breast
clinic 1987
Replaces fibrocystic disease, fibroadenosis,
chronic mastitis, mastopathy etc.
Most benign breast diseases arise from normal
physiological process & range from normality to
mild abnormality (aberration) to severe abnormality
(disease).
7. Cyst formation
Retention cysts
Blue –domed cyst of Bloodgood (macrocysts)
Brodie’s tumor (microcysts)
Fibrosis
Epithelial proliferation
Adenosis (increase in no. of acinar units per lobule)
Epithelial Hyperplasia ( of cells) + Papilloma formation
papillamatosis
8.
9. Age ( years) normal process aberration
<25 Breast development
Stromal Juvenile hypertrophy
Lobular Fibroadenoma
25-40 yr Cyclical activity
Cyclical mastalgia
Cyclical nodularity
(diffuse or focal)
35- 55 yr Involution
Lobular Macrocyst
Stromal Sclerosing adenosis,
Radial scar, Complex
Sclerosing lesion
Ductal Duct ectasia
12. 90 % of condition that cause breast pain are benign.
Cyclical 2 weeks before menses and diminish with
onset of menses
Noncyclical more common in peri-menopausal than
in post menopausal lady .
It may be assoc with ANDI or referred pain from chest
wall.
Drugs - Antideprssants, Digoxin, Thiazide, Methyldopa
can cause it
About 5% of breast cancer exhibit pain at presentation.
13. MANAGEMENT OF ANDI
Exclude cancer
Reassure
Use pain chart If cyclical or non cyclical .
Also allows time for reassurance to become active
Adequate support Firm bra during the day and softer bra at night
Exclude caffeine
Vitamin E & B6 and Diuretics
Work for some although not very efficacious .
Reduction in symptoms in some cotrolled clinical
trials
Evening primrose oil (gammalinoleic acid)–
adequate dose (80mg tid )given over 3 months
Better effect in women over 40 yr old than in
younger women (will help >50% of these women)
For those with intractable pain
Antigonadotropin -Danazol ,100 -400mg tds
Prolactin inhibitor- Bromocriptine 2.5mg BD
Start at 100mg per day & increase (seldom used
theses days)
Antiestrogen- tamoxifen 10 – 20 mg/day
Luteinising hormone releasing hormone agonist
(LHRH)-(ovarian suppression) for refractory cases .
No role for ablative surgery.
Psychiatrist consultation +/-
Not licensed for this indication but
occasionally very helpful.
To deprive the breast epithelium of estrogenic
drive.
14. Exclude extra mammary causes such as chest wall
pain, musculoskeletal pain,(eg-Bornholm
mayalgia),costocondritis(2nd rib/cartilage joint –
Tietze’s syndromes)
Mondor’s disease , abdominal and pleural disease.
Common in post menapausal women who are not on
HRT ,& the neck and shoulder are common sights of
referred pain.
Rx may be NSAID or by injection with local
anaesthetic on a trigger spot.
15.
16. Duct normally contain 2 layer of epithelial cell.
when number of layers increases we call it as
ductal hyperplasia (mild if 3 or 4)
Can be with or without atypia
Atypical hyperplasia may be dutal or lobular
20. Painless, freely mobile,
rubbery hard swelling in the
breast smooth , bosselated
surface.
Age group -15- 25 years
It is hyperplasia of a single
lobule. (neoplasm from
single cell)
21. 1/3rd gets smaller or disappear over two years
Less than 5% increase in size
No need for excision below 30 years
INDICATIONS FOR SURGERY
a lump more than 3-4 cm size
Above 30 years
Suspicious cytology
Patient desire
Multiple fibroadenoma associated with Maffucci
syndrome, cowden syndrom, carney complex
should be excised.
22. Image guided core biopsy
VAB/VAM – Vacuum assisted biopsy – Vacuum assisted
mammotomy system.( 7-8 G needle)
Local anaesthesia and small incision.
Large core radiofrequency biopsy system( BLES –
Breast lesion excision system). – 6-8 mm skin insicion.
10 – 20 mm lesion can be removed.
Radiological excision of fibroadenoma. Lesions up to
2.5 to 3 cm size can be removed. ( 7-8 G needle).
23. Can do under local anaethesia
USG guidance for 3D probe placement within
center of lesion . Once the probe is in place, the
fibroadenoma is frozen.usually two freeze/thaw
cycles are performed .cryo ablation continues until a
frozen ball encompasses all of the tumor area
25. Most common benign tumor of breast and typically
occur in women younger than 30 yr
Arises from the breast lobules (not from single cell)–
comprised of stromal and epithelial cells.
Firm rubbery masses with a well circumscribed border
Usually single tumor
15% multiple tumor
10% B/L tumor
>5 cm tumor called as giant fibroadenoma
Fibroadenoma had no risk for breast cancer
26. Stromal element define their classification and
behaviour
Simple fibroadenoma- stroma of low cellularity and
regular cytology
Phyllodes – stroma with marked cellularity and
atypia. May or maynot from fibroadenoma
27. Tubular adenoma- fibroadenoma with
fibroconnective stroma containing glandular tissue
When entire lesion consist of gland with very little
stroma intervening this is termed as tubular
adenoma
Lactating adenoma- same but in pregnant lady
28. Criteria for excision-
Size >2-3 cm
Symptomatic tumor
Diagnosis doubt- vascularity, irregular border , on
USG
Increase in size documented by USG
No need of additional surrounding breast tissue as
non infiltrative lesion
Tripple test negative go for cryoablation
percutaneously
30. Factor that dictate the choice of management are
Size (most important),should be <4cm.
Patients preferrence
Proximity of lesion to skin
Shape of lesion
Should sonographically visible
31. The lesion must be sonographically visible
Diagnosis of fibroadenoma must be confirmed
histologically
Lesion should be less than 4cm in largest diameter
Cotraindication-
Core Bx diagnosis of suggestive of Cystosarcoma
phyllodes or other malignancy
Poor visualisation of lesion by Ultrasound
Core Bx diagnosis to be discordant with findings on
imaging or physical examination.
32. It is the most frequent female breast disease
1/3rd of women aged 30-50 yr have cysts in their breast
Most common in 3rd decade and sharp diminishes after
menopause
Due to non-integrated involution of stroma and epithelium ,
often multiple and bilateral and can mimic malignancy.
Cystic disease caused by dilation of duct & acini to form cyst
,proliferation & metaplasia of ducts &acini (adenosis)
resulting in obstruction of the terminal ductal lobular unit
Diagnosis confirm by aspiration &/or USG.
Cyst >3mm can be visualized by USG & are potentially
palpable on breast examination.
33. SIMPLE CYST-
Round or oval shape
Anechoic with posterior enchancement
Relative mobility in the surrounding tissue
Cyst with above finding includes in BIRAD-2
USG has 98% accuracy for diagnosis simple cyst
35. often with septation with in the cyst ,homogeneous low
level internal echoes & brightly echogenic foci.
Thick walls ,thick internal septations, mixture of cystic
& solid components are at high risk of malignancy, &
should undergo biopsy
Cysts are often asymptomatic
Symptomatic cyst with pain ,or larger cyst USG guided
aspiration to be done
Aspirated fluid clear yellow, green can be
discarded. If bloody or floating debris sent for
cytology
36. Complex cyst with negative cytology can be
managed with 6 months follow up imaging studies
if asymptomatic.
Cyst not completely collapsed after aspiration or
with asymmetric wall thickening should undergo an
image guided biopsy of cyst wall or local excision
for histological diagnosis to exclude
cystadenocarcinoma. (0.1%)
Any lesion with atypical cellularity noted in the
aspirate should also excised..
37. More than 35 yrs do mammogram prior to needle aspiration.
Aspirate the cyst to dryness with 21 gauge needle.
No need for fluid cytology unless blood stained.
After aspiration examine the patient for residual mass.
If there is a residual lump do FNAC from that.
30 % of cysts will recur and require reaspiration.
Review patient 3 to 6 weeks after aspiration to check for
refilling.
38. If the cysts refil more than twice
If the fluid is blood stained
If there is residual lump.
Did not disappear completely after aspiration
Recures in 6 weeks
39. ANDI
Lymph cysts
Hydatid cyst
Galactocele
Intracystic papilliferous ca
Colloid degeneration of ca.
Papillary cystadenoma
Hematoma
Chronic abscess.
40. Cysts of the
breast
Ductal system Neoplastic
ANID
Macro
cysts
Micro
cysts
Stroma
Duct
papilloma
Papillary
cystadenoma
Benign
Degeneration
of carcinoma
Degeneration
of sarcoma
Intracystic
carcinoma
Serous
Lymphatic
Blood
Inflammatory
TB cold abscess
Chronic abscess
Hyadatid
Galactocele
Skin cysts
Malignant
Sebaceous
Dermoid
41.
42. A galactocele is a milk-filled cyst that is round ,well circumscribed, &
easily movable within the breast.
Occurs after the cessation of lactation.
Can occur up to 6-10 months after breastfeeding has ceased
Pathogenesis is unknown, but is thought that inspissated milk within duct
is responsible
Solitary subareolar cyst
Dates from lactation
Contains milk
Needle Aspiration produce sterile thick creamy material that may tinged
dark green or brown
Can calcify
Can greatly increase in size
Treatment is needle aspiration, and surgery reserved for those cyst that
cannot be aspirated and become infected.
43. Most nipple contain 5-9 ductal orifices
Affect the duct in retroareolar region
Defined as nonspecific dilatation of one or more
duct typically >2mm in diameter
Dut ectasia may be palpable and may assoc with
nipple discharge
Exact reason unknown- often assoc with periductal
inflammation
46. Histology
Same features as LCIS
Not suffieciently developed
Qualitative and quantitative
factors distinguish from
LCIS (< 50 to 75% of one
lobule)
47. Identified
Coincidentally in biopsy for proliferative lesion causing
mass or mammographic abnormality
On needle biopsy of calcifications of associated sclerosing
adenosis or benign calcs (rarely forms calcifications)
It is not mammographically detectable
Associated Risk
ALH is considered a pre-malignant lesion
It is associated with an increased risk of BILATERAL
breast cancer 4.5-5 X more than average risk
48. Histology
Fills some but not all
criteria of DCIS
About 2 mm
Distinct cell borders,
increased nuc/cyto ratio,
nuclear enlargement,
irregular chromatin or
nucleoli
Changes associated with
proliferation.
49. Identified
Incidentally on biopsy for benign lesion
On stereotactic biopsy of mammographic abnormality (usually
indeterminant calcs)
Associated Risk
ADH is considered a pre-malignant lesion
It is associated with an increased risk of BILATERAL breast
cancer 4.5-5 X more than average risk
EX: Dupont and Page: 3303 patients 2.2% NP dev Ca
4.3% with PDWA and 12.9% with atypia in 17 years
American J Epidemiol 1987; 1225: 769-779
50. The percentage of women with a 10-year Gail risk > 4
developing breast cancer within 3 years:
Without atypical cells: 4%
With atypical cells: 15%
The increase in breast cancer risk from atypical cells is
independent of the Gail risk.
Fabian CJ, Kimler BF, et al. J Natl Cancer Inst. 2000;92:1217-27