A 28-year-old woman presented with a 6-year history of bilateral breast pain that increases before menstruation and resolves during pregnancy and lactation. This cyclical pattern of breast pain is consistent with cyclical mastalgia, which is caused by hormonal fluctuations. Cyclical mastalgia is typically treated with over-the-counter NSAIDs or supplements like evening primrose oil, with reassurance that the condition is benign in nature. Further imaging would only be pursued if the breast pain was non-cyclical or accompanied by other concerning findings on physical exam.
Carcinoma of breast is the second common killer disease in women after carcinoma of cervix in developing countries like India whereas it is the number one killer in western world. It can also run in families associated with BRCA1 & BRCA2 genes. Early diagnosis is almost curative and that is why they are doing mass screening like mammogram to pick up this cancer early.
Carcinoma of breast is the second common killer disease in women after carcinoma of cervix in developing countries like India whereas it is the number one killer in western world. It can also run in families associated with BRCA1 & BRCA2 genes. Early diagnosis is almost curative and that is why they are doing mass screening like mammogram to pick up this cancer early.
Management of breast lumps with awareness to breast carcinoma إyusor (1)home
this power point deal with breast lumps benign and malignant one .. it is talk about how to deal with patient have alump in here breast in detail from history to risk fectors .. investigation and management and also deal with awareness to breast cancer .. hope to be useful .. enjoy:)
Paget's disease of the breast is an extremely challenging problem. It not only poses a diagnostic dilemma but a therapeutic as well. The paper describes the diagnostic and therapeutic challenges.
Management of breast lumps with awareness to breast carcinoma إyusor (1)home
this power point deal with breast lumps benign and malignant one .. it is talk about how to deal with patient have alump in here breast in detail from history to risk fectors .. investigation and management and also deal with awareness to breast cancer .. hope to be useful .. enjoy:)
Paget's disease of the breast is an extremely challenging problem. It not only poses a diagnostic dilemma but a therapeutic as well. The paper describes the diagnostic and therapeutic challenges.
http://cancer-treatment-madurai.com Breast cancer is a type of cancer that starts in the tissues of the breast. Dr.S.G.Balamurugan is one of the best cancer doctor in India, offers low cost breast cancer diagnosis, breast cancer treatments and breast cancer care at Guru Cancer Hospital, Madurai.
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
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
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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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
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.
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Anatomy
Modified sweat gland between the superficial and deep
layers of the chest wall
Cooper’s Ligament Fibrous band of tissue
l
3. Hormonal Effects
Estrogen
Development of the breast and
lactiferous ducts
Progesterone
Secretory acinar tissue – lobules
Prolactin
Synergizes the effect of estrogen and
progesterone
9. Examination of LNS
Sitting posture
Pulp of the fingers
Axillary group of LNs
Pectoral group
Brachial group
Subscapular group
Central group
Apical group
Supraclavicular nodes
12. Question
22 yo female presents with a new right breast
mass. Complains of mild tenderness. No other
complaints. On physical exam, there is a 1 cm
nodule at the 2:00 position. Your diagnostic test
of choice is….
Mammogram
Ultrasound
Excisional biopsy
Incisional biopsy
15. BREAST SONOGRAPHY
Not a screening tool
Palpable vs cystic
Mammographic detected lesion
Indications
If Mammography is uncertain
To differentiate solid from cystic lesion
If asymmetric density
Visualise lesions near chest wall.
Interventional procedures.
Evaluate site of lumpectomy.
Lesion at periphery of breast.
Evaluating after surgical augmentation.
16. Ultrasound
Benign
Pure and intensely
hyperechoic
Elliptical shape (wider
than tall)
Lobulated
Complete tine capsule
Malignant
Hypoechoic, spiculated
Taller than wide
Duct extension
microlobulation
17. Features of malignant lesion on
Sonomammography
STAVROS CRITERIA
Spiculation
Hypoechoic
Irregular margins
Posterior shadowing
Depth :width ratio <1
Microlobulation
19. Mammography views
Screening tool
Age of 40
Estimated reduction in mortality 15-25%
10% false positive rate
Densities & calcifications
Mediolateral oblique Craniocaudal
20. Mammography evaluation
Mass lesion
Density
Asymmetry
Malignant
Calcification
Benign
calcification
Well circumcribed –benign
Spiculated-malignant 95%
Low density benign ,high-malignant
Asymmetric involution in bbd.HRT
Trauma ,Intraductal CA
Fine ,numerous CA,only sign in early
noninvasive CA
Scattered ,round circumscribed
Ductectasia- needlelike
Arterial -parallel line
Fibroadenoma –popcorn
Microcystic disease-teacup
Fat necrosis-oilcyst calcification
21. Breast Imaging Reporting And
Data System BI-RADS
BI-RADS
Classification
Features
0 Need additional imaging
1 Negative – routine in 1 yr
2 Benign finding – routine in 1 yr
3 Probably benign, 6mo follow-up
4 Suspicious abnormality, biopsy
recommended
5 Highly suggestive of malignancy;
appropriate action should be taken
22. Calcification
Macrocalcifications
Large white dots
Almost always noncancerous and require no
further follow-up.
Microcalcifications
Very fine white specks
Usually noncancerous but can sometimes be a sign
of cancer.
Size, shape and pattern
23.
24.
25.
26. BREAST MRI
To distinguish scar from
recurrence
Gold standard for
imaging breast with
implants
Detection of vertebral
body metastasis &
musculoskeletal
pathology
Visualisation of axilla
27. BREAST MRI
Indications
Radiologically dense breasts when
mammography fails.
If Axillary node +ve and breast
normal after mammo and sonography.
To rule out multifocality
multicentricity before BCS.
To assess induction chemotherapy.
Followup after BCS.
•Contrast enhanced more sensitive
28. MRI
High risk patients
Personal history of breast ca
LCIS, atypia
1st degree relative with breast cancer
Very dense breast
High sensitivity (95-100%)
10-20% will have a biopsy
31. FINE NEEDLE ASPIRATION
CYTOLOGY
Uses 21gauge needle & 10 ml
syringe
Multiple passes through lump
without releasing negative
pressure
Aspirate is smeared onto slide
& fixed
Differentiates solid & cystic
lesions
32. FNA
Fast, inexpensive
96% accuracy
Institution dependent
Unable to differentiate
b/w in situ vs CA
33. CORE NEEDLE BIOPSY
If fnac is inconclusive
Advantages
significant core of tissue obtained
can distinguish invasive from intra ductal
carcinoma
Grading of tumor
To know ER/PR and Her 2 status
Disadvantage
seeding of malignant cells along needle tract
38. When core needle biopsy is inconclusive
Whole tumour is removed preferably
if <4 cm in size
INCISION BIOPSY
Removal of small portion of
tumour
> 4cm in size
EXCISION BIOPSY
40. OPEN BIOPSY(EXCISIONAL BIOPSY)
Most accurate and the Best Diagnostic
Procedure for a Suspicious Breast Lesion.
Complete excision with a rim of normal tissue
Plan the incision in such a way that
subsequent radical surgery can easily include
the scar.
Follow Langer’s line
41.
42. MAMMOTOME
Used for taking
stereotactic biopsy from
mammographically
detected breast lesions that
are not clinically palpable.
45. 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.
46. DUCTOSCPOY
INDICATIONS
Patients with pathologic nipple
discharge
Patients who are at high-risk for
developing cancer but have normal
breast on examination and imaging
studies.
47.
48. DUCTAL FLUID COLLECTION
After application of a numbing cream, a small clear
cap with a syringe attached is placed over the
nipple. This device (the nipple aspirator) is similar
to a small breast pump and is used to see if fluid
will come out of the nipple.
•To encourage fluid production,women are
instructed in breast massage and heat packs
may be used on the breasts.
•If fluid is not produced, the lavage is not performed.
49. If fluid is obtained with the nipple
aspirator,then the lavage procedure is
started.
One or two small dilators to help open the
duct.
Then the ductal lavage catheter is inserted
and a small amount of lidocaine, as
anesthetic may be injected through the
catheter for comfort.
50. Saline, is injected through the
catheter into the duct and the breast
massaged to bring ductal cells into the
chamber of the catheter.
An empty syringe attached to the
catheter is used to collect the cells from
the catheter chamber.
The cells are then placed in a
preservative and sent to the cyto -
pathologist where they are processed
and read much like a Pap smear.
54. BREAST IMAGING EMERGING
TECHNOLOGIES
Digital mammography
Use of FDG-PET
Breast scintimammography
(nuclear medicine breast imaging- Miraluma
Tc-99m sestamibi compound)
Computerised thermal imaging(CTI)
Computerised tomographic
lasermammography (CTLM)
56. TUMOR MARKERS IN BBD
Expression of P53 in immunohistochemical
staining identifies the sub group with maligant
potential
Overexpresson of HER-2 in benign
proliferative lesion predicts increased risk
57. 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.
59. 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
60. 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
sclerosing adenosis, duct epithelial Hyperplasia,
epithelial calcification.
Associated with slightly increased risk of cancer
61. 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-
intracanalicular pericanalicular
63. Treatment
conservative
Surgery
Very large/increasing in size
Suspicious cytology
Surgery is desirable
Extracapsular excision with a 1cm rim of
normal tissue
Newer techniques-laser ablation
&cryoablation
66. Phyllodes Tumor
Proliferation of connective tissue with ductal
elements
Whorled and cellular stroma
Firm, lobulated
2 to 40 cm in size
10% malignant
Treatment
Wide excision
67. Histopathology
Proliferation of intralobular stroma
Fusiform fibroblast
3 types:-
benign
borderline
malignant
(cellularity,atypia,mitoses &invasion by edges)
68. Phylloides vs Fibroadenoma
Phyllodes Fibroadenoma
Age Older(40-50y) Younger
Duration Rapid growth Slower
progression
Recurrence Common Less common
Size Large ,bosselated Smaller
Mammogram Round density with
smooth borders
Same
Ultrasound Cystic spaces +/- Same
Cytology More cellular,
malignant type
Same as low grade
phyllodes
71. 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
72. Breast cyst
Definition – non integrated involution of breast tissue
Age group – 30-50
Multiple and bilateral
Can mimic malignancy
Confirmed by USG and
aspiration
74. No routine followup
No residual mass
No cyst recurrence
Surgical biopsy
Residual mass
Cyst recurrence (X3)
Non blood stained aspirate
FNAC/Surgical biopsy
Blood stained aspirate
Fine needle aspiration
Cyst
(Clinical diagnosis)
Routine followup
75. 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.
86. 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
87. What is fibroadenosis?
ANDI
Age group :30-50 years
Aberration in normal cyclical hormonal effects
Cyclcial mastalgia with nodularity
bloodgood’s bluedomed cyst
88. Fibrocystic Disease
Clinical, mammographic and histologic
findings
Exaggerated response from hormones and
growth factors
Cyclical pain
Nodularity – upper outer quadrants
89. Fibro-cystic Disease of the Breast
synonyms
Fibrocystic changes
Cystic Mastopathy
Chronic cystic disease
Mazoplasia
Cooper’s disease
Fibroadenomatosis
Reclus’s disease
90. Fibrocystic Disease
Risk Factors
Dense breast
Sclerosing adenosis
Atypical ductal, papillary, or lobular hyperplasia
103. Discharge from more than one duct
blood stained : duct ectasia
black/green : duct ectasia
purulent : infection
Serous : fibrocystic disease
duct ectasia
Milk : lactation
hypothyroidism
pituitary tumours
drugs
104. Approach to a patient
CLINICAL EXAMINATION
Nature of discharge
Mass present or not
Unilateral or bilateral
Single or multiple duct
Spontaneous/expressed
Relation to menstruation
Pre/post menopausal
Taking ocp/estrogen
118. INTRA DUCTAL PAPILLOMA
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
128. AETIOLOGY
Staph aureus – penicillin resistant if hospital acquired
Streptococus
Ascending infection from a sore and cracked nipple
129.
130. 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
131. OPERATIVE DRAINAGE OF A
BREASTABSCESS
Local anaesthesia
Radial or circumareolar incision
drainage
Septa is disrupted & wound is packed
132. 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