2. the ‘team’ Syamamol P.S Syam G. Thomas Mathai. Thushara U.B VarkeyS.Kulangara VarshaVijayan. Vidyakrishna Vidya S. Tobin Dominic
3. “ The breast from their prominence, the colour of their skin, and the red colour of the nipples, by which they are surmounted, add great beauty to the female form”
4. APPROACH Embryology-congenital lesions , anatomy & physiology of breast Classification Investigations Case scenario1-lump Case scenario 2-mastalgia Case scenario 3-nipple discharge Case scenario 4-BBD in pregnancy & lactation Case scenario 5-BBD in males
12. Congenital Nipple Inversion failure of nipple to evert during development. May be unilateral. Spontaneously corrected during growth of pregnancy or by simple traction.
18. The ANDI (Aberrations of Normal Development and Involution ) Breast –physiologically dynamic structure unifying concept of symptoms, signs, histology and physiology Benign disorders are related to the normal processes of reproductive life. spectrum ranges from normal to aberration to sometimes disease. classification is not comprehensive
19. ETIOLOGY Endocrine Disturbance of hypothalamic pituitary gonadal steroid axis Altered prolactin profile Non endocrine Methylxanthines Stress catecholamines High saturated fat diet Iodine deficiency
20. Normal Benign disorder Benign disease Early reproductive years Nipple eversion Nipple inversion Subareoalar abscess, duct fistula Lobular development FibroadenomaGiiantfibroadenoma Stromal development Adolescent Gigantomastia Hypertrophy Later reproductive years Cyclical Hormonal changes nodularity Mastalgia, incapaciating . mastalgia Pregnancy Lactation Epithelial hyperplasia pregnancy Bloody nipple discharge Galactocele Involution Duct involution dialation Duct ectasia Periductal mastitis Sclerosis Lobular involution Nipple retraction Macrocysts,sclerosing lesions Epithelial turnover Epithelial hyperplasia epi hyperplasia atypia
21. PATHOLOGICAL CLASSIFICATION NONPROLIFERATIVE LESIONS Cysts and apocrine metaplasia Duct ectasia Mild ductal epithelial hyperplasia Calcifications Fibroadenoma II. PROLIFERATIVE BREAST DISORDERS WITHOUT ATYPIA Sclerosingadenosis Radial and complexingsclerosing lesions Moderate and florid ductal epithelial hyperplasia Intraductalpapilloma III. ATYPICAL PROLIFERATIVE LESIONS Atypical lobular hyperplasia(ALH) Atypical ductal hyperplasia(ADH)
76. DUCTOSCOPE A fiber optic scope less than a millimeter thick is inserted into the milk duct at the nipple and threaded deep into the breast through the duct. An imaging system displays the output of the scope on a computer monitor. Samples of epithelial cells can be collected onto microscope slides for further analysis.
77.
78.
79.
80. If fluid is not produced, the lavage is not performed.DUCTAL FLUID COLLECTION
81.
82. One or two small dilators to help open the duct.
94. Case scenario 1 25 year old female patient presented with a lump in the breast.She gives a history of slow growing lump not associated with any pain or discharge from nipple & is very much anxious.
97. Fibroadenomas Second most common tumor of breast ANDI Represent a hyperplastic or proliferative process in a single lobule Etiology is unknown, thought to be due to hormonal influence Risk of malignant transformation is rare Resulting carcinoma is often a lobular carcinoma Mimic malignancy in pregnancy,HRT
98. types Simple/solitary/small(2-3 cm) Multiple(>5) Juvenile-in young women between the ages of 10 -18. Giant(>5cm)-rapidly growing,more common in afro-caribbean population Complex -contain other histological changes such as sclerosingadenosis, duct epithelial Hyperplasia, epithelial calcification. Associated with slightly increased risk of cancer
99. Clinical features Between the ages of 15-25 years & size of 2-3cm Painless lump- capsulated,smooth, firm, well defined, nontender, BREAST MOUSE Confused with phyllodes Microscope- intracanalicularpericanalicular
101. Treatment-conservative Surgery Very large/increasing in size Suspicious cytology Surgery is desirable Extracapsularexcision with a 1cm rim of normal tissue Newer techniques-laser ablation &cryoablation
111. Traumatic Fat Necrosis Clinical features - Pain & lump in the breast Lump is hard - extensive fibrosis caused by tissue reaction D.D : Carcinoma breast Mammography findings - density lesion; can have calcifications; may mimic carcinoma breast Treatment - excision of the lump
113. Introduction Definition – non integrated involution of breast tissue Age group – 30-50 Multiple and bilateral Can mimic malignancy Confirmed by USG and aspiration
116. Case scenario2 28 year old lady presenting with complaints of pain in both her breast for the past 6 years & increases just prior to menstruation, no pain during her pregnancy and lactation.
165. Pathology Size: usually less than 0.5 cm, may be as large as 5cm Site: lactiferous duct within 4 to 5 cm from nipple orifice Gross: Pinkish tan friable ,attached to the wall by a stalk
177. TREATMENT Flucloxacillin or co-amoxiclav Support of the breast,local heat,& analgesics Incision & drainage Now recommended is repeated aspiration under antibiotics continue breast feeding close follow up Antibioma if I&D not done DD-inflammatory carcinoma of breast
178. OPERATIVE DRAINAGE OF A BREAST ABSCESS Local anaesthesia Radial or circumareolar incision drainage Septa is disrupted & wound is packed
179. MONDOR’S DISEASE Thromboplebitis of superficial veins of the breast & chest wall Aetiology not known C/F – thrombosed subcutaneous cord DD – breast cancer Treatment – antiinflamatory medication warm compresses & support restriction of movement symptoms persist - excision
194. BENIGN BREAST LUMPS IN MALES Gynaecomastia Fibroadenoma Phyllodestumour Epidermal inclusion cysts Sub cutaneousleiomyoma Sub areolar abscess Intra mammary lymph node
201. TREATMENT Depends on the cause -androgen deficiency -medications -endocrine defects medicines -surgery
202. Were you attentive?? ANDI Gold standard for imaging breast with implants Giant fibroadenoma? Carcinoma simulating mastitis Difference between male & female breast Commonest benign breast disease Popcorn calcification in mammogram?
