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BENIGN BREAST DISCEASE

BREAST SYMPTOMS
LUMP
PAIN
DISCHARGE
SKIN CHANGES
LUMP IN THE BREAST
CANCER
FIBROADENOMA
FIBROADENOSIS
MASTITES
MULTIPLE INTRADUCTAL
PAPPILOMATOSIS
RARE TUMORS
FIBRO ADENOMA
55% REMAIN SAME

35% RESOLVE

10% INCREASE IN SIZE

CANCEROUS TRANSFORMATION EXTREAMLY


RARE
TYPICAL FIBROADENOMA
ASYMPTOMATC

TEENS AND TWENTIES

PALPATION IS DIAGNOSTIC
SLIPPERY WELL DEFINED EDGES, ROUND OR OVAL , 1 ~3 cms.
SIZE , SMOOTH AND FIRM SURFACE. . AXILLA FREE .

MAYBE MULTIPLE
D.D.

JUVENILE PAPILAMATOSIS

CORE BIOPSY
NO INTERFERANCE

AGE LESS THAN 30

SIZE LESS THAN 3 cms.

BIOPSY CLEAR
SURGICAL INTERVENTION
AGE GREATER THAN 30
SIZE GREATER THAN 3cms
BIOPSY NON CONFIRMATORY
GROWTH DISTORTING THE BREAST
PATIENT’S DESIRE
SURGICAL TREATMENT

ENUCLEATION THROUGH A
COSMETIC INCISION
ATYPICAL FIBROADENOMA’S

GIANT FIBROADENOMA
GREATER THAN 5 cms.
M AMMOGRAM, F.N.A.C
Proceed surgery
ATYPICAL FIBROADENOMA’S
TUBULAR ADENOMA
SOFT

Mammogram shows diagnotic punctate


calcification

Treatment Enuc leation


ATYPICAL FIBROADENOMA’S
PREGNANCY / LACTATIONAL
ADENOMA
SOFT
U.S. and f.n.a.c
REASSUARANCE
ATYPICAL FIBROADENOMA’S
OLDER LADIES , ie age > 40

Tripple assessment

phylloides tumor
PHYLLOIDES TUMOR
Connective tissue elements are
more cellular

Sometimes atypical
PHYLLOIDES SARCOMA
PHYLLOIDES TUMOR
TEND TO GROW FAST

VASCULR ; SO, WARM & HAS DIALATED


VEINS
STRETCHED SHINY SKIN
ULCERATION
LYMPH NODES / DISTANT METS
PHYLLOIDES MANAGEMENT
CORE BIOPSIES

BENIGN , Excision with clear margins

MALIGNANT, Mastectomy
HAMARTOMA
Incidental from mammogram/ rarely
clinical resembling fibroadenoma
SOFT , WOMEN..>35

Mammography diagnostic,
Trucut confirmatory
ENUCLEATION
FIBROADENOSIS

FIBROCYSTIC DISCEASE

FIBRO CYSTIC CHANGES


25% OF NORMAL WOMEN OVER 35
HAVE NON PALPABLE CYSTS IN
THEIR BREAST
IN INVOLUTION BREAST STROMA IS
REPLACED BY FIBROUS TISSUE
IN F. C. C. , THERE IS AN
EXAGARATION OF THIS PROCESS
CLINICAL DIAGNOSIS
BEGINS IN 30’S
HISTORY ~ LUMP & PAIN ( TYPICAL)
INSPECTON X
PALPATION
MAYBE TENDER
SURFACE ; SMOOTH / IRREGULAR
BORDERS ; NOT CLEAR/ IRREGULAR
MAYBE MULTIPLE, INCLUDING OPPOSITE
BREAST
AXILLA ; FREE
SYTEMIC ; NOTHING
CLINICALLY DIFFICULT TO RULE OUT EARLY
MALIGNANCY

MAMMOGRAM

CANCER / F.C.C.

F.C.C. : SOLID / CYSTIC


F.C.C. SOLID

12 CONCORDANT CORE BIOPSIES


F.C.C. SOLID BIOPSY
MALIGNANT

ATYPICAL CELLS

PROLIFERATIVE LESION

NON PROLIFERATIVE LESION


LESIONS WITH CELLULAR ATYPIA AND
PROLIFERATIVE LESIONS

EXCISE WITH WIDE MARGINS

IF NO MALIGNACY CLOSE FOLLOW UP


OF THE BREAST
NON PROLIFERATIVE LESIONS

SIMPLE FOLLOW UP
MAMMOGRAM F.C.C. CYST

ULTRASOUND

SIMPLE CYST
COMPLEX CYST
CYST WITH PAPPILLARY
PROJECTIONS
SIMPLE CYST

THIN WALLED, CLEAR FLUID,


POSTERIOR ACCOUSTIC SHADOWING
LEAVE ALONE IF ASYMPTOMATIC
ASPIRATE IF SYMPTOMATIC
NO INCREASED CHANCE OF MALIGNANCY
COMPLEX CYST
IRREGULAR WALL

SEPTETE CAVITY

THICK FLUID WITH REFLECTIONS

NO POSTERIOR SHADOWING
COMPLEX CYST
ASPIRATE
CLEAR FLUID
NO RESIDUAL LUMP

MANAGE AS SIMPLE CYST


COMLEX CYST
ASPIRATE BLOODY

RESIDUAL LUMP
ULTRA SOUND GUIDED F. N. A. C. OR
TRUCUT BIOPSY OF RESIDUAL
LUMP
BIOPSY
MALIGNANCY

CELLUAR ATYPIA

PROLIFERATIVE LESION

NON PROLIFERATIVE LESION


CELLULAR ATYPIA AND PROLIFERATIVE
LESIONS WIDELY EXCISED AND
CLOSELY FOLLOWED UP

NON PROLI FERATIVE LESIONS SIMPLY


FOLLOWED UP
CYSTS WITH PAPPILLARY
PROJECTION
DANGEROUS

F.N.A.C . TO LOOK FOR MALIGNANCY

IF NO EVIDENCE OF MALIGNANCY , IT IS STILL


DANGEROUS. SO EXCISE WIDELY AND SEARCH
HISTOLOGICALLY FOR MALIGNANCY. IF STILL THERE IS
NO MALIGNANCY KEEP THAT BREAST UNDER CLOSE
SURVEILLANCE
MASTITES
MASTITES SYMPTOMS

LUMP
PAIN
SKIN CHANGE
+/_ FEVER
CLASSIFICATION MASTITES

LACTATIONAL MESTITES
&
NON LACTATIONAL MASTITES
LACTATIONAL MASTITES

RED
WARM
TEMDER
VAGUE LUMP
TENDER AXILLARY ADENITES
SYSTEMIC SIGNS OF INFLAMMATION
?MASTITES ??ABSCESS

OEDEME / FLUCTUATION

IF IN DOUBT ULTRASOUND
TREATMENT OF LACTATIONAL
MASTITES
ENSURE FLOW OF MILK
ANTIBIOTICS
SUPPORTIVE MESURES

COAMOXYCLAV , ERYTHROMYCIN
CHLORAMPHENICOL,CIPROFLOXACIN,TETRACYCLINE
TREATMENT OF LACTATIONAL
ABSCESS
EVACUATION OR PUS
U.S. GUIDED ASPIRATION
SURGICAL DRAINAGE
ANTIBIOTICS & SUPPORTIVE MESURES
+/_ CABERGOLIN
NON LACTATIONAL MASTITES

PERI AREOLAR PERIPHERAL


NON LACTATING, PERIAREOLAR MASTITES
YOUNG
CONGENITAL RETRACTION OF NIPPLE

Treat the mastitis, and manage the retracted


nipple
NON LACTATING MASTITES
PERIAREOLAR POSITION
YOUNG
PERIDUCTAL MASTITES
SMOKERS
PATHOLOGY
TREATMENT
DANGER IS COMEDO CARCINOMA
IN SITU
PERIAREOLAR MASTITIS, OLDER PATIENTS

Secondary to ductal dilatation

Winking nipple retraction

Beware of cancer
T. D. E.
NON LACTATNG MASTITES
PERIPHERAL POSITION

AGE

ABOVE 40 BELOW 40
AB0VE 40

USUALLY INFECTION & ABSESS

MAMMOGRAM, IF NOT ON SURVEILANCE


ASSOCIATINS ; DIABETES, AUTO IMMUNE
DISCEASES
BELOW 40
USUALLY BACTERIAL INFECTION

IF ANY DOUBT, MAMMOGRAM

GRANULOMATOUS MASTITES (CORE


BIOPSY)
GRANULOMA

MAYBE DUE TO
BACTERIA, FUNGI OR AUTOIMMUNE
DISCEASE
GRANULOMATOUS MASTITES

50% RESOLVE WITH TIME

STEROIES, METHOTREXATE

SURGERY TROUBLESOME
MULTIPLE INTRADUCTAL
PAPILLOMATOSIS
ASYMPTOMATIC LUMP

O/E NIL DIADNOSTIC

MAMMOGRAM & CORE BIOPSY

TREATMENT IS EXCISION

BIOSY : WATCH FOR ATYPICAL DYSPLASIA


OTHER PAPILLOMA’S

SOLITARY DUCTAL PAPILLOMA

JUVENILE PAPILLOMATOSIS
JUVENILE PAPILOMATOSIS
ASYMPTOMATIC LUMP IN TEENS

O/E ; SIMILAR TO FIBROADENOMA

CORE BIOPSY

TREATMENT EXCISION WITH CLEAR MARGINS

INCREASED CHANCE OF CA. ESPECIALLY WITH FAMILY HISTORY


FROM FAT CELLS
LIPOMA

PSUEDOLIPOMA

MAMMOGRAM, FNAC/ CORE BIOPSY

U.S.

EXCISION BIOPSY
FROM FAT CELLS
FAT NECROSIS

H/O , TRAUMA &


O/E, DISCOLORATION

MAMMOGRAM , INCONCLUSIVE
CORE BIOPSY , DEFINITIVE

RESOLVES ON ITS OWN IN 3 MONTHS


FROM NERVE CELL
NEURO FIBROMA

GRANULAR CELL TUMOR


FROM SCHWAN CELLS, HARD,IRREGULAR &
FIXED LIKE MALIGNANCY
TREATMENT ; WIDE EXCISION WITH CLEAR
MARGINS
FROM FIBROUS TISSUE
AGGRESSIVE FIBROMATOSIS
&
DESMOID TUMOR
MIMICS MALIGNACY , CLINICALLY,&
MAMMOGRAPHICALLY
FNAC / CORE NOT DEFINITE
INCISION BIOPSY NEEDED
TREATMENT , EXCISION WITH WIDE CLEARANCE
FROM MYOFIBROBLASTIC CELLS

PSEUDO ANGIOMATOUS STROMAL


HYPERPLASIA ( PASH)
DIABETIC MASTOPATHY
SCLEROSING LYMPHOCYTIC LOBULITES

HARD MASSES SUSPICIOUS OF MALIGNANCY


ASSOCIATED WITH OTHER END ORGAN
AFFECTIONS
CORE BIOPSY
MOSTLY EXCISED
MASTALGIA
Pain in the breast without obvious pathology

A definite clinical entity


A common clinical entity
MASTALGIA
2.5%, of mastalgias ultimately lead to a
diagnosis of cancer
MASTALGIA
RULEOUT CANCER AND OTHER BENIGN
PATHOLOGIES
REFFERED PAIN TO THE BREAST

CHEST WALL
LUNG
HEART
ABDOMEN
MASTALGIA

EXESS OESTROGEN
EXESS PROLACTIN
INSUFFICIENT PROGESTERON
ALTERATIONS IN FATTY ACID
MASTALGIA

HISTORY AND PHYSICAL EXAMINATION


ALL PATIENTS OVER 35 SHOULD GET A
MAMMOGRAM
MANAGEMENT

O. C.P./ H.R.T. ,RELATED

Tamper with dose and formulations


MANAGEMENT

REASSUARANCE
80% SACTISFIED
MANAGEMENT

LIFESTYLE MODIFICATION

DIET MODIFICATION
phytoestrogens
MANAGEMENT

DICLOFENAC OINTMENT T.I.D. FOR 12 WEEKS


MANAGEMENT

TAMOXIFEN
DANAZOL
BROMOCRIPTINE
4 HYDROXY TAMOXIFEN OINTMENT
MANAGEMENT
SURGERY AS A LAST RESORT. MASTECTOMY