This document presents 5 cases of benign breast conditions: 1. A 20-year-old female with a 3-month history of a left breast lump, which was diagnosed as fibroadenoma. 2. A 26-year-old breastfeeding female with 2 months of right breast pain and 3 weeks of swelling, diagnosed with mastitis. 3. A 33-year-old female with a 2-year history of cyclical left breast pain, diagnosed with mastalgia. 4. A 38-year-old female with a 3-month history of bloody discharge from her right nipple, diagnosed with an intraductal papilloma. 5. A 48-year

1. BENIGN BREAST CONDITIONS
Supervisor: Dr. Ndegwa
Melody Kioko

2. CASE 1
• YM
• 20 year old female
• Thika
• Student
• CC- breast lump on left breast -3months
• HPI
• She was well untill 3mo ago when she noticed a lump on her left breast on self
examination. It was of gradual onset, and has since increased in size. there are no
changes in the nipple, or discharge. there are no overlying skin changes, no
temperature variation, no associated pain, no cyclical changes on the lump, no history
of trauma to the breast, no hotness of body.

3. • no noted weight loss
• menarche was at 15 years
• reports maternal history of breast cancer (mother had breast cancer)
• is nulliparous, on implanon
• does not smoke cigarettes or take alcohol
• is worried it could be cancer since her mother had cancer before
• PMSHx
• No history of previous surgery, blood transfussion or hospital admission.
• FSHx
• Is single, NHIF beneficiary
• NKFDA

4. • ROS
• CNS- no headaches, no vision chsnges, no LOC
• CVS- no palpitations
• RS- no chest pain, no cough
• GIT- no change in bowel habits, no N/V
• GUT- no dysuria, urgency, hematuria
• Summary
• YM, 20y/o female who presented with 3mo hX of a painless left breast lump, and
has a family hX of breast cancer.
• On Examination,
• she was in fair general condition, not in obvious respiratory distress.
• has no pallor, no cyanosis, no jaundice, not dehydrated and in good nutritional
status.
• vitals; BP-107/72mmhg, PR-67bpm, RR-17bpm, SPO2-97%

5. • Breast exam
• inspection
• breast are bilaterally symmetrical, no scars, no overlying skin changes,
no skin color changes,
• nipples; are everted, no ulceration, no discharge.
• palpation
• RT: no mass, warm skin (no temp variation), no palpable axillary LNs
• LT: warm skin (no temp variation), single lump on upper inner
quadrant, at 11o’clock
• is 3cm*3cm, mobile, well circumscribed with regular margins, non
tender, firm, non fluctuant, not tethered to the skin,
• no palpable axillary LNs

6. • Impression- Fibroadenoma
• Differentials
 Phylloides tumor
 Fibrocystic breast disease
 Breast carcinoma
• Investigations
• imaging: breast ultrasound
• FNAc
• Labs: CBC, LFT, UEC,
• Management
• Excisional biopsy
• Reassurance of the patient & advice on BSE

7. CASE 2
• GW
• 26 year old female
• Kiandutu
• Business lady
• CC
• Right breast pain- 2 months
• Right breast swelling -3weeks
• HPI
• She was well untill 2months ago when she started to experience pain on her Rt
breast. the pain was of gradual onset, dull in character, non radiating, had no
diurnal variation, no excercabting factors, relieved by painkillers.
• It was associated with swelling of the same breast that she incidentally noticed 2
weeks ago while taking a bath. it gradually increased in size, the skin over the
breast was warmer to touch than the rest of the body,and the entire breast was
generally painful.
• no changes on the nipple, she has lactational amenorrhea, is breastfeeding a
6months old baby, who is her second born. she is para 2+0

8. • Has hotness of body
• No history of trauma to the breast
• No noted weight loss
• No history of radiation
• Menarche was at 15 years
• Reports maternal history of breast cancer (her sister had breast cancer-
she passed on)
• Is not on oral contraceptives
• Does not smoke cigarettes or take alcohol
• PMSHx
• No history of previous surgery, blood transfussion or hospital admission.
• FSHx
• No hX of diabetes, HTN in the family
• Is married, not a NHIF beneficiary
• NKFDA

9. • ROS
• CNS- no headaches, no vision chsnges, no LOC
• CVS- no palpitations
• RS- no chest pain, no cough
• GIT- no change in bowel habits, no N/V
• GUT- no dysuria, urgency, hematuria
• Summary
• GW, 26y/o female who presented with 2mo hX of Right breast pain and
Right breast swelling for 2weeks, hotness of body, is breastfeeding and
has a family hX of breast cancer.
• On Examination,
• she was in fair general condition, not in obvious respiratory distress.
• has no pallor, no cyanosis, no jaundice, not dehydrated and in good
nutritional status.
• vitals; BP-127/78mmhg, PR-69bpm, RR-18bpm, SPO2-98%

10. • Breast exam
• inspection
• breast are bilaterally symmetrical, no scars, no ulceration,
no overlying skin changes, no skin color changes,
• nipples; are everted, no accessory nipples seen, no
ulceration, discharge- milk.
• palpation
• LT: no mass, warm skin (no temp variation), no palpable
axillary LNs
• RT: warm skin (warmer), tender
• breast is tender and swollen
• 1 palpable axillary LN, 1*1 cm, is tender

11. • Impression- Mastitis
• Differentials
 Breast abscess
 galactocele
 Inflammatory breast carcinoma
 Paget’s disease of the breast
• Investigations
• imaging: breast ultrasound
• FNAc
• aspiration; pus sent for culture and sensitivity
• Labs: RBS, CBC, LFT, UEC,

12. • Management
• Antibiotics- flucloxacillin or coamoxiclav.
• Analgesia
• Continue breastfeeding or pump frequently
• Use warm water on affected area before breastfeeding and apply
ice compress after breastfeeding to relief pain
• Drink fluids and get enough rest
• Reassurance of the patient & advice on BSE

13. CASE 3
• JM, 33y/o lady
• CC: pain on the left breast -2years
• HPI
• she was well untill 2 years ago when when se developed Lt breast pain within
the second month of breastfeeding her 4th born. was of gradual onset, dull in
character, sometimes radiates to the Lt shoulder, relieved by painkillers, is
cyclical, worse during premenstrual days and resolves postmenses
• no H/o smoking or use of alcohol, tauma, DM, any malignancy in the family.
• Exam
• Is in fair general condition, BP-98/57mmHg, PR-62, Temp-36.50C
• Breast (Rt & Lt)
• Inspection: bilaterally symmetrical, no skin or nipple changes, no nipple discharge
• Palpation: tender Lt breast, no temp variation, no masses, no palpable LNs.

14. • Dx- Mastalgia
• Mx- Analgesics

15. CASE 4
• WW, 38 y/o lady
• CC: bloody discharge from right nipple- 3months
• associated with pain
• her mother died of breast CA at age 69
• mamography 6mo ago did not show any abnormalities
• Examination;
• expression of of a small amount of serosanguinous fluid from right nipple,
• no palpable breast masses
• no palpable axillary lymphnodes
• investigation
• U/S- single dilated duct Rt

16. • Intraductal papilloma
• Mx
• excision of a duct as a wedge
resection
• microdochectomy

17. CASE 5
• JK, 48 y/o lady
• CC- left breast mass- 4 weeks
• Summary
• the mass has progressively increased in size during this period. Is painless, no
familial history of breast CA, not on OCP/HRT, premenopausal, with regular
menses, no H/O wt loss, no H/O trauma, no H/O use of alcohol or smoking.
• Examination
• In fair general condition. Vitals; within normal range
• Breast; inspection- no skin or nipple changes.
• palpation- large dense breasts, 6cm, non tender, multinodular mass upper
outer quadrant
• no palpable axillary or cervical LNs
• investigations done:
• mammography; polylbulated mass
• Biopsy taken

18. • phyllodes tumor