BREAST Begashaw M (MD)
Dec 13, 2015
Introduction
Modified sweat gland - produces milkBreast ca - most common cause of deathBenign conditions discomfort confusion
with neoplastic disease
Anatomy
overly -2nd – 6th rib - from lateral border of sternum to anterior axillary line, between clavicle & to the 7th & 8th ribs below
Ligaments of cooper Areola contains involuntary muscles nipple covered by thick skin lactiferous ducts Lymphatics -axillary lymph nodes on the ipsilateral
side
Breast lumps
DDx
• Cancer
• Fibrocystic change
• Fibroadenoma
• Fat necrosis
• Duct ectasia
• lipoma
•TB
Breast cyst
Raredue to a nonintegrated involution of stroma
& epitheliumoften multiple & may be bilateralDiagnosis –aspiration/ultrasoundTreatment – Aspiraton
Fibroadenoma
Most common in women age < 30 C/F
Nodulessmooth, rubbery, discrete, well-circumscribed, non-tender, mobile
Ixs
-biopsy
-ultrasound
-FNA Treatment
_Generally conservative: serial observation
_Consider excision if size 2-3 cm & rapidly growing
Phyllodes Tumor
_Are benign tumors
_Usually occur in women over 40 years
_large, massive tumor with unevenly lobulated surface and occasionally with ulceration of overlying skin
_Treatment – Enucleation
_ Simple mastectomy
Ductectasia/ periductal mastitis
is dilatation of breast ducts associated with periductal inflammation
Pathogenesis
_ Dilatation of lactiferous ducts filled with a stagnant brown or green secretiondischarge
_irritant reaction in surrounding tissue leading to periductal mastitis
Clinical presentation
-Nipple discharge
-subareolar mass
-Abscess
-Mammary duct fistula/nipple retraction Treatment
-Excision of all major ducts
Acute mastitis
is acute inflammation of the breast Bacterial mastitis is the commonest variety of mastitis and nearly
always commences acutely associated with lactation
Causestaphylococcus aureus Clinical presentation
- Pain
- Swelling- Redness- Tenderness/hotness- abscess
Treatment
Antibiotics – cloxacillin Breast restbreast-feeding on the opposite
side only Support breast Local Heat/Analgesics
Breast abscess
If acute infection of breast doesn’t resolve with in 48 hours/tense induration Abscess
Fluctuation is a late signWhen doubt exists incision & drainageTreatment – incision & drainage
Breast Carcinoma
is the commonest cause of death in middle-aged women in western countries
In our set up, increasing incidence is being observed
Risk Factors
_ Gender -99% Female
_ Age80% >40 years old
_ Prior hx of breast ca
_1st degree relative
_ Nulliparity, First pregnancy >30 years old, Menarche < 12 yrs old, Menopause >55 yrs old
_Decreased risk with lactation,Early menopause, Early childbirth
_Radiation exposure
_Obesity,Diet,Geography-western
Pathology
Arise from the epithelium of the duct system May be entirely in situ or may be invasiveGrades -Well differentiated
-Moderately
-Poorly differentiatedDuctal carcinoma -Most common Lobular carcinoma -10 %
Spread
Local spread: increases in size & invades,involve skin,penetrate pectoral muscles & chest wall
Lymphatic spread
_Axillary lymph node
_Supraclavicular nodes
_Contra lateral lymph nodes Hematogenous Bone(lumbar,Femur, thoracic
vertebra, rib/skull) osteolytic) liver, lungs & brain
Clinical presentation
occurs commonly upper outer quadrant/UOQ
Local Findings
_Hard, irregular lump
_nipple retraction
_Skin involvement with peau d’ orange
_Frank ulceration & fixation to the chest wall
27
Signs and Symptoms
Most common: lump or thickening in breast. Often painless
Change in color or appearance of areola
Redness or pitting of skin over the breast, like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Signs of metastasis
_Lymph node enlargement
_Bone pain
_cough Chest x-ray, Serum alkaline phosphates &
liver ultrasound
Prognosis
- Tumor size & LN status
- Invasive & metastatic potential
- Histological grade
- Estrogen receptor status- Patient age