Benign Breast Disease July 12, 2007

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Benign Breast Disease July 12, 2007

  1. 1. Benign Breast Disease July 12, 2007 Maggie Gordon, R2
  2. 2. Benign Breast Disease Breast Anatomy
  3. 3.  A – ducts  B – lobules  C – lactiferous sinus  D – nipple  E – fat  F – pectoralis major  G – ribs and intercostal muscles  A – duct cells  B – basement membrane  C – duct lumen
  4. 4. Benign Breast Disease By Diagnosis
  5. 5. Risk Factors  Estrogen replacement  Genetic changes  Acquired  Congenital, including BRCA1, BRCA2  Protective  Anti-estrogens, e.g. Tamoxifen
  6. 6. Fibrocystic Change  Normal variant  60% of pre-menopausal women  ↑ cysts or fibrous tissue in otherwise normal breast  Types  Hyperplasia – 20’s  Adenosis – 30’s  Cystic disease – 30’s-40’s
  7. 7. Fibrocystic Disease  Fibrocystic change w/  severe pain  nipple discharge  excessive lumpiness → suspicion of cancer  Cause = blockage / dilation of ducts
  8. 8. Duct Ectasia  Distension of ducts  Contain crystalline material  Can develop localized infection  May leave nodule after resolution
  9. 9. Solitary Papillomas  Arise from cyst  Present with sanguinous / sero-sanguinous discharge
  10. 10. Fibroadenoma  Benign solid tumours  Present as well-defined, mobile masses  ↑ with estrogen, pregnancy  2-23% prevalence in adolescents to mid-20’s
  11. 11. Others  Superficial thrombophlebitis of the thoracoepigastric vein (Mondor's disease)  Mastitis, breast abscess, granuloma  Galactocele  Fat necrosis (panniculitis)  Hamartoma  Lipoma  Neurofibroma  Squamous, apocrine metaplasia  Tubular adenoma  Sarcoidosis  Diabetic mastopathy
  12. 12. Benign Breast Disease By Symptoms
  13. 13. Breast Pain  Normal cyclic breast pain  Fibrocystic change  Fibrocystic disease, when severe  Mastitis  Large, pendulous breasts  Cooper’s ligaments stretching  Occasionally  Masses, including malignancy  Duct ectasia  Hidradenitis suppurativa
  14. 14. Nipple Discharge  Spontaneous, bloody, unilateral: malignancy  Provoked, non-bloody, bilateral: benign  Milky  Post-partum  ↓ thyroid  Pituitary tumour → prolactin  Meds  OCP  TCA’s
  15. 15. Nipple Discharge  Sticky  Cystic changes  Duct ectasia
  16. 16. Breast Mass  Mostly fibroadenoma  ≥90% palpable breast masses 20’s to early 50’s are benign Must exclude malignancy
  17. 17. Benign Breast Disease Investigation
  18. 18. History
  19. 19. Physical Exam
  20. 20. Palpation of Mass  “Classic” findings in malignancy  Single lesion  Hard  Immovable  Irregular border  Skin dimpling over lesion  Size ≥2cm
  21. 21. Imaging  Mammography  ≥35y.o.  Ultrasound  <35y.o.  Dense breasts May be omitted in women who have lactational nipple discharge or cyclic breast pain as long as there is no breast mass
  22. 22. Biopsy  Essentially any solid mass
  23. 23. Benign Breast Disease Treatment
  24. 24. Fibrocystic Change  Reassurance  Support with appropriate bra  Acetaminophen, NSAID’s  Cysts can be aspirated  May help  ↓ fat, caffeine, nicotine  Vit E, evening primrose oil  Tamoxifen, danazol  ↓ medical estrogen
  25. 25. Simple Fibroadenoma  Several options  Follow with US  Core bx, then nothing further  Surgical excision not recommended  Up-and-coming: US-guided cryoablation
  26. 26. Cyst  Aspiration  Bloody fluid → cytology  Non-bloody fluid → garbage  Follow-up US  No recurrence → no further intervention  Recurrence → surgical consult

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