Benign breast disease

1. BENIGN BREAST
DISEASES

2. Anatomy
• Modified sweat gland – derived from the ectoderm
• Each breast consists of 15-20 lobules

3. • Breast extends from 2 – 6th rib
• Sternum to mid axillary line
• Lies in the superficial fascia, superficial to the pectoral fascia.
• Axillary tail of Spence - upper outer portion of the breast passes deep to the
deep fascia through the foramen of Langer.

4. Aberrations of Normal Development and
Involution of the Breast (ANDI)
• Breast in Females goes through various phases
• Early reproductive phase (Lobular development): 15 – 25 yrs
• Matured reproductive phase (Cyclical hormonal modification): 25 – 40 yrs
• Involution phase (Resorption of glandular structures): 40 – 55 yrs
• Presents as a spectrum of diseases at various stages of development

5. • Early reproductive age group:
• Fibroadenoma
• Giant
• Multiple
• Juvenile hypertrophy
• Mature reproductive age group:
• Caused due to cyclical hormonal effects
• Generalized enlargement
• Cyclical mastalgia with nodularity  Fibroadenosis or fibrocystic disease

6. • Involution age group
• Lobular involution: Microcysts, fibrosis, adenosis, apocrine metaplasia
Macrocysts, cystic disease of breast, sclerosing adenosis
Ductal involution: Nipple discharge, periductal mastitis, bacterial infection,
nonlactational breast abscess, mammary duct fistula

7. Fibroadenoma
• Benign, encapsulated tumor occurring in younger patients 15- 25 yrs
• Presently considered as hyperplasia of single lobule.
• Most common lesion in patients < 30 yrs old
• Shows similar hormonal activity as normal breast tissue.
• Juvenile fibroadenoma:
• Adolescent girls with rapid growth (Epithelial & Stromal hyperplasia)
• May clinically mimic phyllodes tumor

8. • Giant Fibroadenoma:
• Size > 5 cm
• Multiple fibroadenoma
• Clinical features:
• Painless, smooth, nontender, well localized swelling
• Moves freely within the breast tissue
• No node enlargement

9. • Investigation: ???
• Treatment:

10. Fibrocystic disease of
breast/Fibrocystadenosis/ Mammary
dysplasia/ Cyclical mastalgia with nodularity
• Estrogen dependent condition.
• Most common breast condition
• Exaggerated response of breast stroma and epithelium to Hormones
and growth factors
• Stages
• Stromal proliferation
• Adenosis
• Cyst formation.

11. • Clinical features:
• Bilateral, painful, diffuse, granular, swelling
• Better palpated with the fingers than palm.
• Commonly in upper outer quadrant.
• Pain and tenderness >> just prior to menstruation
• Subsides during pregnancy, lactation and post menopause.
• Occasionally serous discharge may be present

12. • Treatment:
• Conservative management
• Oil of evening primrose – Linolenic acid + Linoleic acid
• Danazol – Interferes with FSH and LH  decreases Est and Pro
• Bromocriptin – Lowers Prolactin
• Tamoxifen – Antiestrogenic drug.
• Vit E and B6
• NSAIDs
• Severe cases not subsiding with Medical management  Subcutaneous
mastectomy or Cyst excision.

13. Sclerosing Adenosis
• 30 – 50 yrs of age
• Patient presents with mastalgia & Lump
• Palpation – Smooth, relatively mobile mass.
• Patho – Proliferative terminal ductules & acini, with proliferation of
stroma often with deposition of Ca.
• Treatment:??

14. PhyllodesTumor:
• Spectrum of disease.
• Benign  Malignant
• Arises from the stromal element of the breast
• Microscopy:
• Contains cystic spaces with leaf like projections hence the name.
• Cells chow hyper cellularity and pleomorphism.

15. • Clinical Features:
• Premenopausal women,
• Usually unilateral, Rapid growth
• Smooth bossellated, overlying skin necrosis may be present
• Skin may be stretched, shiny, dilated veins + over the lesion.
• Recurrence is common.
• Investigation:???
• Treatment:???

16. Mastalgia:
• 45% of women present with mastalgia
• Predisposing conditions: ?? HRT, Caffeine, tobacco, large pendulous
breast
• Types:
• Cyclical (65%)
• Non cyclical (30 %)
• Chest wall pain (5%)

17. • Cyclical:
• Related to Menstrual cycle
• B/l diffuse pain with heavy feeling
• Patho  Similar to ANDI
• Hence treatment similar to ANDI
• Non cyclical:
• Rule out other causes of breast pain
• Periductal mastitis, cervical root pain, malignancy,Teitz syndrome
• U/l C/c, burning or dragging in nature.
• Occurs in both pre and post menopausal age group

18. Traumatic fat necrosis:
• Caused d/t trauma
• PATHOGENESIS:
• Capillary ooze  triglyceride in fat to dissociate into fatty acid  Combines
with Ca  Saponification Inflammatory reaction  Swelling
• CLINICAL FEATURES:
• Painless swelling
• Hard, irregular and adherent to breasts tissue.
• INVESTIGATIONS:???
• TREATMENT:???

19. Galactocele:
• It is a retention cyst.
• Occurs in Lactating women and up to 10 months after lactation.
• The lactiferous duct gets blocked and large amount of milk gets
collected.
• Contents are milk and epithelial debris.
• CLINICAL FEATURES:
• Large, soft, fluctuant swelling usually in the lower quadrant.
• Untreated  gets precipitated and calcified and mimics cancer.
• Usually gets infected  Abscess

20. • Investigation:???
• Treatment:???

21. Mastitis:
• Types
• Sub areolar
• Intra mammary, a) Lactational abscess b) Non-lactational abscess
• Retro mammary
• Sub areolar:
• Infection developing d/t cracks in the nipple, infected Montgomerie glands
or a furuncle
• Can be caused by duct ectasia
• CLINICAL FINDINGS: Red, inflamed areola, tender, nipple retraction may be
present.
• TREATMENT: ???

22. Intra mammary mastitis
• Usually up to 6 months of feeding
• Predisposing factors:
• Cracked nipple
• Retracted nipple
• Improper cleaning
• Inadequate suckling by the baby  stasis
• Infection from the mouth of the baby
Most common organism  Staph. Aureus

23. • CLINICAL FEATURES:
• Fever with chills and rigors
• Throbbing pain, severe tenderness
• Redness, local rise in temperature, induration
• Purulent discharge from the nipple.
• Entire breast may be involved and may end up having fluctuation +ve.
• Treatment: ???

24. Retro mammary abscess:
• D/tTuberculosis of the internal mammary nodes, ribs, empyema
necessitans, hematoma
• Breast tissue per say is normal.
• Investigations:???
Treatment:???

25. Antibioma:
• If intra mammary mastitis  Poorly treated with repeated with Abx
and/or inadequate drainage.
• Collection persists  Surrounding inflammation settles with thick
fibrous septum formation  Antibioma
• CLINICAL FEATURES: H/o Mastitis Rxed with Abx
• Lump, hard, non tender, smooth, fixed to surrounding breast tissue.
• INCESTIGATIONS AND MAMAGEMENT:

26. Duct Ectasia:
• It is dilatation of lactiferous ducts d/t relaxation of the myoepithelial
cells of the duct wall + Periductal mastitis.
• Hormones  Duct wall relaxation + Ineffective reabsorption of
secretions  Desquamation of epithelium in to the duct
• CLINICAL FEATURES:
• Greenish discharge or creamy discharge
• Indurated mass under the areola
• Retraction of the nipple at a later stage ( ??? )
• Eventually  Abscess  Fistula
• May be bilateral and multifocal
• Investigation and treatment: ???

27. Galactorrhoea
• Primary:
• Stress and other factors.
• Physiological during puberty or menopause.
• Secondary:
• Dopamine receptor blockers like haloperidol, methyl dopa, chlorpromazine,
metoclopramide
• Prolactin secreting pituitary tumors.
• Hypothyroidism
• Ectopic prolactin secreting tumors (like Bronchogenic Ca)
• CRF
• INVESTIGATION ANDTREATMENT

28. Duct Papilloma
• Epithelium lined papillae occurring in the lactiferous ducts.
• It is the most common cause of bloody discharge from the nipple.
• Usually < 1cm in size, fell as a mound in the retroareolar region.
• INVESTIGATION AND MANAGEMENT:

29. ThankYou…